20350APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMITNO.
n O G O
10100 Torre Ave. U
G J
DereName: one:
CITY OF CUPERTINO6BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
Contractor• ante. Lk. Ne,
718-4444
BUR.DINGE.BCnUCALPLUMBINGMECHAMCAL
CATFCARY
CONTROL#
Architect/Eng/neer Lie No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
�nj
® LhL ® tAa
PERMITIS5IlANCE 12
LICENSED CONTRACTOR'S DECLARATION
Iherebyaffiran that l am licensed under provWonaaf Chapter 9(commenc
Inansel SecHan700mat Dlvifect. ftheBusine.andl'rofeulonsCade,and
Ilmnsefe In fug force and d(ect.
APPLIANCESRESIDENTIAL
JOB DESCRIPTION
VV r
�R `wr1
PANELS
Llmnse Clan LION
Date ContractorUP
TO 2DOAMPS
201-1000 PS
ARCHITECTS DECLARATION
I understand my plans shag be used as public records.
OVERIODOAMPS"
SQ. FT. FLOOR AREA
$M. FT.
SIGNS ELECTRICAL
Licensed Profe.ionel
805
74.92
SPECIAL CIRCUIT/MISE
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractor's License Law for the
"
TEMP METER OR POLE INST.
following reaaun.(SecHon7011S, Buaineseand Professions Code:Mydlym
rounlywhich requiresa permit to construct, alter, improve, demolish, orrepalr
anysimeture priorto its iscomee,alsorequlresthe applicant forsuch permit to
file a signed statement that he S licensed pursuant to the provisions of the
Contrador'sLicense Law (Chapter9(commencing with Section 7000) of Divi-
sion3 of the Businessand ProfessbruCode) orthat he is esempltherefromand
POWER DEVICES
.
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applkant to a civil penalty of not m urethan
OUTLETSSWITCHES-FIXI'URES
$60,311.00
It�I,undred dollars (5500).
as owner of the property, or my employees with wages as their sole
NEW RESIDENTIAL ELECTR SQFI.
STORIES
TYPE CONSTRUCTION
compensation, will do the work and the structure is not intended or offered for
elle (Sec. 70K Business and Profession; Code: The Contractors Lim. Law
,
V—N
doea not apply to so owner of property who builds or Improves thereon, and
who dormuch work himself orlhrough his own employees, provided that such
ImpmeementearomeIntended oro0ered for sale, If, howeventhebuildingor
Improvement issold Mthinoneyearo(complet Ntheowner-budderwlll have
t4e.tpurclen of proving that he did not build urbnprove forpurposeofsele.).
Lj 4 as ..or the property, am exclusively B Business
to construct
ess and Pre with licensedcon
project (Sec. Busine and Code:
TOTAL:
QTY, ' PLUMBING PERMIT FEE
OCC. GROUT'
R-3
RFS UNITS
,
FLOOD TONE
AIN
t
PERMIT NUANCE
Licanthe
The Ctton
The Contractor's impoe Limn a Law does rat apply tc an owner of property who
apply o of propmoterty
builds or improves thereon, and who contracts forice such p(o)em with a
the Contractors License Lew,
"fflctor(se erupt corer Sm
Ll I am exempt ;ruler gee e k P C for this reawn
ALTER -DRAW kVENT-WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, ARRA, COND.
SANITARY Y_ N_
RECEIPT N
Owner Date
WORKMAN COMPENSATION DECLARATION
-Inre, or a
C31 hereby affirm that I have a certificate of consent to segm
mrti0aof Workers'Cumper;aHonlr;uranmmaoertified mpythereof pec.
38W, Lbb CJ
Polley
IRES-PER TRAP
V(7l1
SCHOOL TAX Y N
RECEIPT a
S E
GAS. WCAOUTLETS
PARK FEE Y N
RECEIPT N
p
Co
GAS F.A. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
ff,c fed mpybherebyfumishel.
estNdcopybfiledththcii.ctiooMdivision.
CREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASETRAP
CERTIFICATE Of EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(TMseecUon need not be completed Bibs permit isforom hundred dollars
SEWER -SANITARY -STORM EA. 100Ff.
Date Recel IN
WATER HEATER W/VENT/ELF-CTR
ENERGYFEE Y_ N_
05100).1...)
I mrHfy that In the pedom;nm of the work for which this permit Is Issued,
WATER SYS[[M/TREATING
1 shall one employ any person In any manner so as to become subject to the
Workers Ccmpeosatlun Laws of Gllfomla. Date
PAID—
Applicant
Nouldb OAP.bjdtothe aftermakingthissdi.. procate of Ezemglo Labor
should become subject to the Workers' Compematlon provislom o(the Labor
NEW RESIDENTIAL PLMB, SQ.FT.
Date Rece1 t#
TOTAL:
BUILDING FEE
464.00
Cade, you must forthwith comply with such provisions orthis permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
4.27
I hereby affirm that there is a mmtrudlon lending agency for the perform-
ance of the work for which this permit Is Issued (Sec. 3097, Civ. C.)
Lmder.Name
Lender's Adders
I ornifythatl have read this appliotlnnand statethal theabove Information
limmact.]agm to camplywlth allcityend county ordinance and orate laws
TOTAL:
ELECTRIC FEE
32.13
PLUMBING FEE
32.13
QTY. '- MECHANICAL PERMIT : ', ,FEE ,'
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
relating to building mextruction, and hereby authorize representatives of this
city to enter upon the above-mentloned property for inspection purposes.
Me) agree to save, indemnify an d keep harmlea the City of Cupertino
against liabilities, )udgments,cost,mil cape... which may in any way a..
ALTER OR ADD TO MECH.
Date Recei t#
AIR HANDLING UNIT CFO 10,000 CFM)
SUBTOTAL:
.r
agaimu.ii`d ty In�ppnTuen of he atog of thi.permit Q
/jC/ 5��9
AIR I-wNDUNc uMr (OVER lB,aaa CFM)
CONSTRUCTION TAX
Wt.
Signature of AppgnntAR PE,IALSDISCLOSURE
IXFRAlJST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
DOaaor
NAlARDOUSM
Will the applicant d b m(uNrertino building Code, hhand9. hazardous
He.1t hl as defined edthe Cupertino Mumctpal Code,Ehapter 9.1 7, and the
Hncahh and Sdey Code Section 75532(a)7
1: Yea No
Ill the tore building omupmt equipment or
FIFATINCUMT(TO 100,f#100TU)
Date RCCCI IN
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
IS -01 14
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
haaarcantor
it
which emit hazardous ab contaminants as defined by the Bay Area Air
Quality hLnagement D';Mct7
Yea No
have read the haat Due matedals requirement under Chapter 6.95 of
the California liealth k Safety Code, Sections 25505,75533 and 25534.1
understand that if the building does not currently have a tenant, that It is my
p
PsP'idSY
( t'
BOILER -COMP ptiP OR 100,000 BTU)
BOILER-COMP(OVER 100,000 BM
NEW RESIDFNDALMECFi. SQ.FT.
responsibility to notify the occupant of the requirements which =at be mel
prior to issuance of a Certificate of Occupancy.
"II' of CBEpll.{
ISSUEDBY CRY inn
Owner or authorized agent Date
TOTAL:
OFFICE COPY