20412APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Budding Address:
PERMITNO.
n0 A 1
10100 Torre Ave. Unit 212 I1.2
G Lt I
Lrw�r. IN Vitoria:
A
roperties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/ PERMIT
5/10/90
Contractors Name: Uc. No
738-4444
BUILDINGELECTRICAL-ILUMBINGMECFIAMCAL
CATEGORY
CONTROLN
Architect/Engineer. Lie. No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Address:
SLUG ul�l 11
® ® El M
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby
ecitme mthat l amlkmsedhafh provisions re Chapter
salons9(commme-
Ingwith eis1. fell 700().fDlvfect. !the Bumruxand Pro(eselmsCade, and my
Lkx x b in lull force a—dLkc. tt,
License Cbx
APPLIANCESRESIDENML
JOB DESCRIPTION
RCB
•� D �
PANELS
UPTO 2D0 AMPS
Date Contractor
Contr
N1-1000 AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
OVERIOWAMPS
SQ,FT_FLOORAREA
E/SQ.Fr.
ELECTRICAL
Licensed PmfexlmulSIGNS
OWNER•BUILDER DECLARATION
1 hereby affirm that I am exempt fromthe Contractor's License Law fee the
1,020
74.92
$PECIALCRCIJIT/#LSC
7FAiP METER OR POLE [NST.
following reason. (Section 7031.5, Business and Professions Cade: Any city or
cmntywhlch requlre,a permit to mmtmes, alter, Improve, dennlbh,orrepalr
anystmdureprbrmitabwance,alamquimslheapplimntfer.uchpermitto
file a signed statement that he is Ilcensed pursuant to the pmW Ina of the
Contractors License Law (Chepter9(mmmencing with Section 7000) of Divi-
slop 3 of /he Business and Professlmes Code) orthat he b exempt therefrom and
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
cant los civil penalty of not ore than
applicant fore permit Subjects theapplm
OUTLETSSWITCHESFIXIVRES
$716,418.00
NEWRESIDENTIALELECTR SQ.FT.
five F11, ahundred ownerdollars thepR.
role
F1 1, as owner of the property, or my employees with wages r offered
compensation, will dsthe work and the structure bnot oroffend
STORIES
TYPECONSTRUC'HON'
V-pj
sale (Sec. Business and Code: The C w
Cembintended ctoe License law
apply f property improvers
whoddoes otapply torn owner ofp rough who nemporlmproovided con,and
who doesauch work himself or through his own employees, provided that such
-
OCC.CROUP
RFS. UNITS
Improvement annotwithinded or neyear fcomered orsale. If, however, deerhe buildinghave
Improvement Is sold within orsyearo(completlorythe owner-builderwlll have
TOTAL:
g-3
I
t rdan of proving that he did not build or Improve for purpose of sale.).
MI, as on, of the property, am exclusively contracling with licensed
mnbactanm onretunt the project (Sec. 70K Business and Professions Code:
CITY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PFRMITLSSUANCE
12
The Contractor's License law dm not apply to m owner of property who
builds or Improv. then me, and who contracts to such pTJects with •
C11){Tactor(s) licensed pursuant to the Committers License Law.
LJ I am exempt under Sec. 0 k P C for this reasonOUTSUDEFEES
-
ALTER -DRAIN & VENT • WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT#
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I hereby .(firm that I have a certificate of consent to self -Insure, or a
certificate of Workers' Compensation insurance or a certified copy thereof (Sacs
3800, Lab C0
Polity
FD(TURES PER TRAP
SCHOOLTAX Y N_
RECEIPT N
GAS EA. SYSTEM -1 INCA OUTLETS
PARKFLE Y_ N_
RECEIPT NGAS
N
Com any
EA. SYSTGf-0VER 4 (EA)
BUILDING DI VISION FEES
Red copy bhereby furnished.
enified copy t filed with the city inspection division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASETRAP
CERTIFICATE OF IXEM PFION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Tale section need not be completed If the permit b for one hundred dollars
SEWER -SANITARY -STORM EA. 200FT.
Date Re i t#
{Y/vEN•T/E?.ec.rR
ENERGY FEE Y N
PAID
(SIOU)erles.)Wp.I.¢cl-1FA,I.ve
I mAify that N the performance of the work forwhlch this permit is timed,
I shall not employ any person In any manner au as to become subject to the
Worker: Compensation Laws of Gllfamb. Date
WATER SYSTEM/TRGnNC
Applicant
NOTICE APPLICANT: I, after nuking lab Certificate of Exemption, you
Date Rete) t#
NEW RESIDENTIAL PLMB.SQ.FT.
TOTAL:
co
becomesubjectt.the Workers' Compensation p Labor
Code, orthisuofthe
Code, you must forthwith comply with each proal less or this permit shall be
deemed revoked.BUILDING
B
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
lending agency for the perlorm
I hercbyaork for w thereIs in permit
Lend erthe work for which this permk b timed (Sec. 3097, Civ. CJ
Lenders Name
[enders Address
I certilythat I have read thbapplcatlonand statethatthe above information
ismrmR. lagree to comp)ywllh all cityand county ordinances and mate laws
TOTAL:
ELECTRIC FEE
37 50
PLUMBING FEE
37.50
QTY. MECHANICAL PERMIT FEE
MECHANICALFEE
PERMIT ISSUANCE
FEES PAID:
37.50
relating to bullding contraction, and hereby a.therize representatives of this
city toenter uPon the above-mentioned property for inspect.. purposes.
(We) agree to save, Indemnify an d keep aamdes the City of Cu pert I.
against lbbilitke,judgments,".and..per. which may in any way accrue
against ..I In an t gra Imgotthispermit
5..
Slgrutem of Appleant/Contractor t
ALTER OR ADD TO MECH.
Date Receipt#
AIR HANDLING UNIT CTO 10,000 CFM)
SUBTOTAL:
54.97
u R HANOLINC I2Nrr rovFR lB,000cFM)
CONSTRUCTION TAX
EYHAUST HOOD(W/DICT)
CONSTRUCTION TAX PAID:
HEATING UNIT (TO 100,000 BTU)
HAZARDOUS MA IALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 91Z and the
ITealth and Safety Code Section 2551200E
❑ Y. No
jute ReCej t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
Will the applicant o tum building occupant use equipment or devices
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District?
Yes No
haveread the haze .u, materials requirements under Chapter6.95 of
n
BOfLFR-COMP OHPOR 100,00B BTU)
BOILER -COMP (OVER 100,000 BILI)
the California Health k Safety Code, Sections 25505,25533 and 75534. T
understand that lithe building does not currently have a tenant, that it is my
rlt 1 iy90
NEW RESIDFNTIAL MECH. SQ.FT
ruiparsibllity to notify the occupant of the requireme newhich must be met
prior to issuance of a Certificate ofO=psncy.
�Y
City Of runplttno
ISSUED9Y:
Owner or authorized agent Win
TOTAL:
OFFICE COPY