20378APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
10100 Torre Ave. Unit 178 (D1.2)
PER.WTNO.
20378
weer,Name: one:
—TOIsm!'anter Prnpertiaa
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
BUILDING-MECTMCAL-PLUMBINC-MECHANICAL
A
$�10�90
Contractors Name: Lk. Na
7IR—LL44
CATEGORY
CONTROL N
Archllect/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
. BUILDING PERMIT INFO
Adtlreu
O a
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm that L amiv Bans oftheerpr.vand Pr fChapter sionsC(mmmenc
.(the Buelnevand Profdal.neCode,and m
If...I. In fon force of and effect.
Lienee lslnfu0forceanddfect.
License Claes Cort
Dale Conlndar
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
Licensed Proressloml
OWNER -BUILDER DECLARATION
IherebyafOrmthat l amexempt from the Contractors License Law for the
following reaeon.(Section 70315, Iked.resand Pmfeaskma Code: Mydtyor
county which requires a permit loo.robact alter, improve, demolish, orepair
anystructure priori. it. bsuance,sb.mcf tre.the applicant forsuch permit to
file a signed statement that M is licensed pursuant to the provisbN of the
Contractors License Law (Chapter 9(commenting with Section 7000) of Divi-
sion3 ofthe Business and ProfevfmuGode) or that he b exempt therefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fora permit subject, the applicant to a civil penalty of not more than
flFe 1, as ed owner dollars ($500).
I, as owner will of property, or my employee with weed as there w4
som(Sec.7 K willdorsaworkand the structurebnot Wended o iofferedfor
Code: rsaContractors Llceme Law
sae (Sec aptly to a nev and Professionof property
apply loan owner ofthroug hiswho
does who does nemporimproovidedes con,and
whododsuch work hlmeeRorthr.ugh Menwnemployed, provided that such
Improvements ate not Intended proffered for sae. If, however, the build Ing or
Improvement be.ld within one year ofcompldlon, the owner-buBderwlll have
the burden of proving that he did not build or improve for pu rpose of sale.).
F] L as owner of the property, am exclusively contracting with licensed
contractors to comm uct the project (Sec 70K Business and Profeseloro
The Contractors License Lew dm not apply to an owner of property who
or imprevsi lhercon, and who contracts for such projects with a
%p(pactorte)R¢nsed punuanttothe Contractors License Law.
LJ I am exempt under Sec B k P C for this reason
APPLIANCFSRESIDENITAL
JOB DESCRIPTION
RUB
D 1
PANF7S
UP10200ANIPSr
MI -I" AMPS
OVER 1000 AMPS
SQ. Fr. FLOOR AREA
669
$/SQ. Fr.
74.92
SIGNSELECTRICAL
SPECIAL CIRCUIT/MISC
TEMP METERORPOLE INST.
]OWER DEVICES
SWIMMING POOL ELECCRIC
OUTLETSSWITCHESFIXTURES
VALUATION
$50,121.00
NEW RESIDENTIAL ELECTR SQFr.
STORIES
TYPECONSTRUCTION
V—N
TOTAL:
QTY. PLUMBING PERMIT FEE
OCC.GROUP
R-3
.RES. UNITS
FLOODZDNE
APN
PERMIT ISSUANCECode: 12
-
ALTERDRAIN kVENT- WATER (WWilde
FEE SUMMARY
BACK FLOW PROTECT.
DRAINS FLOOR ROOF, AREA, COND,
SANITARY V N_
RECEIPT p
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have • Irturane of consent d self -Insure, (S a
3800,abo(Workers'Compewllonlruurance.racertified mpytheeof (Sec.
3800, LebCJ
Pollry p
Fp(TUR1& PER TRAP
SCHOOL TAX Y _ N
RFDEII'1' N
GAS EA. SYSTEM4 INCAOUTLEIS
PARK FEE Y N
RECEPf N
GAS EA. SYSTEM-OVER4 (FA)
COPYBUILDING
DIVISION FEES
fled copy is hereby te ty
ertUed copy b (Lied withh the city
e city Isupectlon division.
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSbf
(This section need sa nor completed I(tsa permitrmit b (Drone hundred dollen
0300)ne lots.)
I certify that In the peffomanceof Ne work forwhich this permit Is Weed,
I shall not employ any person In any manner w as to become subject to the
W.rken'Compenxatlon Lawa of Calffomia. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become sub)ecl to the Workers' Comperaatlon provisions of the Labor
Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
Iherebyaflm,thetthere lesmnstmdion lendfngsg.nry lorthe perform
ance of the work for which this permit is Issued (Sec, 3097, Civ. C.)
Lender's N.
Leed.e.Addres.
I ddltylhatl have readthbapplfcallonand statethatthe above inm
foulion
Is cored. 7 agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorlu representatives of this
city to enter u Pon the above-mentioned property for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
agaivt habllitles, Ndgmente'corteaa//..d expenses which nuy In anyway accrue
agaWtsald !nm carne. ? a Ing d this permit.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
PAID
Date Recei t#
GRFASETRAP
SEWER -SANITARY -STORM E17WF7
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y_ N_
PAID
Date Recei t#
WATER SYSTEM/TREATING
NEW RFSIDENTIALPLMIL SQ.Fr.
TOTAL:
U D G FEE
419.00
SEISMIC FEE
5-7
TOTAL:
ELECTRIC FEE
28,73
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
PERMITISSUANCE 19
MECHANICAL FEE
28 73
FEES PAID:
ALTFRORADDTOMECH.
Date Receipt#
AIR HANDLING UNIT (TO 1p,W0 CFM7
SUBTOTAL
NR HANDWNC UNIT (OVER ID,OWCFM)
CONSTRUCTION TAX
or R e
Signatureo(ApplHAZA
HAZARDOUS MAT SDISCLoSURE
Will ia thedefineamor future building occupant Coere.rhaer hazandmis
materia as defned bye SCupertino Municipal Cafe, Chapter 9.11, and the
Health eand saretycoaeSeNo 1s53zan
❑ Yes No
Wilemd, appilcard harandusa tut Wilding occupant use the BayequipmentArea devima
whkhemilharensced arerict? rale as defined by the Bay Arca Air
ilty Maiugem.nt D'uMd7
Yd ❑No
•nave read the hazardous materials rcqulremenls under Chapter 6.95 of
the Califomla HaalthASafetyCode,Se i..25505,75533end25534. 7
understand that if the building does not currently have a tenant, that It is my
responsibility to notify the occupant of the requirement, which must be rout
prior to Issuance of a Certificate of Occupancy.
LYFi AUST HOOD(W/DUC'D
CONSTRUCTION TAX PAID:
HEATING UNIT 00 100,000 BTO
Date Recei t#
HEATING UNIT (OVER 1W,IXDer(n
TOTAL:
.%
VENTILATION FAN 6INCLE RESID)
ISSUANCE DATE
R_d'iLL�!/
RAI
p ,4
Clfy of CUBpIfino
ISSUEDBY: kATO V til GL
BOILER -COMP OFB' OR 100,000 BTU)
BOILER-COMP(OVIR 1fA,000 BTU)
NEW RESIDENTIAL MECH. SQ.IT
Owner or authorised! agent Date
TOTAL:
OFFICE COPY