20361•
T T
cc N
LU
a
no
LL ~
Ow
y0.
H N
2
U -
It
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES= t E RAL_ PnINT aFN nul v
Building Proed Identification _
Building Address: -
10100 Torre.Ave.' Unit 161 (D1.1)
wnersName: -
----•--•
PERMIT NO.
20361
one:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
APP_ CATION A
5/10/90
contraderaName: Lk. Na
1
r
BUILDLNC-ELEcnucA4PLUMBING-MECHAMCAL
CATEGORY
CONTROL#
Architect/Engineer, , Lic. Na
. Qn- . • •' rt + itt?..s
.• ,ELECTRIC PERFIIT'+ ,. FEEi •
BUIL OING'•PERMIT•INFO" 1
• ! •'-• ....,
Address: - -
,,-�:
'
PERMITISSUANCE
- LICENSED CONTRACTOR'S DECLARATION
I hereby eHirm thallam llemseduMerprovLNona O(Chapter 9 (comment
Ingwilh5ection7000)of DI Bm3ofthe Budnessand ProfeaelOnaCode,-it my
license la in full force and died.
' License Clan . Lic #
Date Contndor '
APPLIANCESRESIDENTIAL
PANELS
e JOB DESCRB'T7 N
S• RCB
ARCHITECT'S DECLARATION
Iunderstandmyplansshallbeusedaspublicrecords.
201-1000 AMPS -
OVERIOOOAMPS
SQ. FT. FLOOR AREA
$/`.Q.FT.
Licensed Professional
SIGNS ELECTRICAI:
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt fromthe Contradob Limnw IAw ferthe
following recon. (Section 7031.5, Business and Professions Cede: Any city or
countywhichmquicesapermitmmrutmc alter,impmve,demolish,orrepair
anyslruMm PeortoiGlaaance,aLwrequlreatheapphmntfwsuchpert tto
file a signed statement that he is licensed pursuant to the providoa of the
Contractor's License law (Chapter 9 (commencing with Section 7000) of Divi.
sion3 ofthe Business and ProfessfoaCode) or that he is exempt therefrom and
the bails for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjectstheapplicanttoa civil penalty of notmorethan
five hundred dollars($500),
❑L, as owner of the property, or my employees with wages a their tole
compensation, 70 Businesswill do weak, ansedmixd the odurehe Comradesntended License L w
Code: The or
dale (Sec. apply to Business and of eves Wrente Law
does not apply to rk owner of property who builds or improvesthereon,that ami and
whodoessnts are khimae dedorough Naow ale.14oepr, the building or
improvements sold withiite nded etirofoomplroffered tion IE however,theTOTAL:
Improvement issokl within oneyearofcompldbrytheowner-builderwN have
t" rd en of proving that he did not build or improve for purpose of sale.).
u Lae owner of the properly, (m.7044, exclusively mnlracting with licensed
contractors to matmd the project (Sm. 7044, Business and Professions Code:
The Contractors License Law does nor apply to an owner of property who
bu
Wilds or improves thereco
on, and who contracts fee such p4ojects with a
hound pursuant m the Contractor's License Law.
ctrl
i_J I am exempt under Sec B & P C for this reason
669
74.92
SPECIALCIRCU[T/MISC
Tpg(P, METER OR POLE INST.
ppWgg DEVICES
gytrythENC POOL ELECTRIC
VALUATION
$ 50 ,121..00
OUTLETSSWITCHESFIX'ITIRES
NEW RESIDENTIAL EI.ECTR SQ.F2
STORIES
'
Il'PE CONSTRUCTION
V—N
OCC GAOUIe
R-3
FLOOD ZANE
RES.UMTS
I
APN
QTY,`, tP[,[JjyjgING PERMIT .+ its; 'i
Cv.; FEE"::
pp�pp ISSUANCE 12
ALM-DRAIN &VENT- WATER (EA)
BACK FIAWPROTI:CT. DEVICE
•14'ttt '••;�EEE'SL7MMARY. 4
_
OwnerDate
DRAINS FLOOR, ROOF, AREA, COND. -
FA1vRES PER TRAP
GAS EA. SYSTEM.1 INC.4 OUTLETS
SAMTARY Y N
RECEIFI'X
- WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have • ¢Mfirate of consent to self-Imre,or a
certificate of Workers' Compensation Insurance ova mrtlfied ropy thereof (Sec.
3800, Lab C.),
N
SCd3OOLTAX Y N
RECEIPT #
PARK FEE Y 'N
RS= a
Conry
Company
d.
rl fled copy is hereby tcity
ert Ned copy Is filed withh the the city Inspection division. •
CAS EA. SYSTEM-0VER4(EA)
GREASE/NDUSTRL WASTE INTERCEPTOR
BUILDING DIVISIONFEES
PLANCHECK FEE
GREASE TRAP
.. CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'.(Thlssedien need not be completed H the permit isforone hundred dollars
(81I ormity th
ID-M-hatlnthe pedemnnreaf the work for which mimemdtie oche
I shall not employ ay person In any manner eo a to become aubfect to the
Workeri a
COmpeatWn laws of CaBfomla. Date
Applicant
NOTICE TO APPLICANT: If, after moving this Certificate of Exemption, you
should become subject to the Workers'Compeaation provisions of the Labor
deemeeddoevoketdforthwith comply with such provisions,permitarihis permit shall be
PAID
Date Recei t#
SEWER-SANITARY-STORMFA.200FT.
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N _
PAID
Date Recei t#
WATER SYSTEM/TREATING
NEW RESIDENTIAL PLMB. —�d'T•
- TOTAL:
BUILDING
419.00
_
'TOTAL:
CONSTRUCTION LENDING AGENCY
I herebya(firmthat there Is a coatmdmn lending agency forthe perform,
ince of the work forwhich this permit is issued (Sec. 3097, Cle. C.I
andera Name
Lendcra Address
IcertifythatI haveread this applicationand statethatthe aboveuuuo nxuon
SEISMIC FEE
ELECTRIC FEE
28.73
t....
QTY:" . MECHAN1CALePfiRMIT :,4�FEE}'"
PLUMBING FEE
MECHANICAL FEE28-73
he correct. I agree to comply with all city and county Ordinances and state laws
relating to building corutmdion, and hereby authorize representatives of this
city to enter upon the above-mentioned property for Inspection pu rposes.
(We) agree to ave, indemnify an it keep harmless the City of Cupertino
against liabWties,judgments, mets and expenses which may In any way arose
agalatBaId CBy ln�paa,quenc (c fgra Ing o(thle permit
/�1J S
Q
PERMTrtSSUANCE12
ALTERORADDTOMECH. '
AIR HANDLING UNIT (To 10,000 CFM)
FEES PAID:'
'
-2872
Date Recei t#
SUBTOTAL:
O
uRI-IANDUNG Lmlrr rovER lo,000cFM)
CONSTRUCTION TAX
Slgnatuxof Applicant/Contmdor lite
HAZARDOUS MA ALS DISCLOSURE
Will the applicant orfohme budding occupant atom or handle hazardous
material a defined by the Cupertino Municipal Code, Chapter 9.1 2, and the
Health and Safety Cale Section 25532(a)7
F1 YeaM No
'
EXHAUST HO TO(W/DUCT)
CONSTRUCTIONTAX PA ID:
I
HEATING UNIT (70 100,000 BTU)
D ate Recei t#
HEATING UNIT T (OVER 100,000 BT
TOTAL:
�'
Will the applicant or future building Occupant use equipment or devices
which emit hazardous air contaminants as defined by the Bay Area Air
lity Management District?
Yea FF�� N
ahavereadthehuargeuOmtedalsrequimf
VENTILATION FAN (SINGLE RESID)
ISS6lA CE,DATE
S'.''T J1ILA
!a
BOILER -COMP (3HPOR 100,000 BTU)
BOILER-COMP (OVER 10),000 BTU)
nounder Chapter6.95of
the California Health & Safety Code, Sections 2550.5, 25533 and 34. I
255
understand that lithe building dcea not currently have a tenant, that it Is my
resporeibility to notify the occupant of the requirements which most be met
prior to Issuance of a Certificate ofoccupancy.
j id'1990
i V
- CRY Of1.1J[j P,I{IIID '
NEWRFSIDENTIALMECH. SQ.FT.
•
ISSUEDBY:
Owner or authorized agent Date
'TOTAL:
OFFICE COPY