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20401APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-71JSE QALL POINT PEN ONLY Building Project Identification Building Addren: 10100 Torre Ave. Unit 201 (141.3) _ PERMH NO. 204,01 l ... APPLICA nON SUNMI I IAL Properties CITY OFCUPERTIN0. ILDINGDIVISION APPLICATION / PERMIT 5/'10/90 G°"o-a°mraName: Lie. No: 738-4444 BUILDING-ELECTRICALPLUJMBINGMECHANICAL CATEGORY CONTROLS Archlten/Engineer. Llc. Na: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address ® © ® E. PFRhUTISSUANCE '12 LICENSED CONTRACTOR'S DECLARATION ON [ hereby of Ch ecEOn mtiut lam Bcrosedunder pessand of Cssmos9(mmmme the BuRnesand Pro(eWona Code, and my It"..ugO,ItI. I. full force and liana b in full force and dfect. Llcenx ClassLic R APPLIANCES -RESIDENTIAL JOB DESCAII'TTO C p Nr� S T HCB - ' PANGS Date Contractor 201 -IOW AMPS ARCHITECT'S DECLARATION I understand my plans shall be used as publlemeords. OVERIMAMPS SQ. FT. FLOOR AREA $/SQ. FT. SIGNSELECTRICAL Licensed Professional OWNER -BUILDER DECLARATIONSI'GCIALCE2CUIT/MIST I hereby affirm that I am exempt from the Contractor's License Law for the 8055 74.92 TEMP.MEITRORPOLEINST. following reason(Seetion 7031.5, Business and Professions Code: Any city or county which requires a permit to mrutrud, alter, Improve, demolish, or repair any structure prior to its Issuance, also requires the applicant for such permit to file a signed statement that he ts Ransed pursuant to the provisions of the Conlranr/•License Law (Chapter 9(commencing with Section 7000) of Divi- Ron 3 of the Business and Prefeniom Code) orthm he is exempttherefromand the basis for the alleged exemption. Any violation of Section 70115 by any applicant for a permit • itjectathe applicant to a civil penalty of not more than POWER DEVICES SWIMMING I%)OL ELECTRIC OUITLETSSWITCHESFIXTURES VALUATION $60,311.00 NEW RESIDENTIAL ELECTR SQJ'r' five hundred dollars WOO). 171, as owner of the property, or my employees wit h wages as their sole STORIES TYPE CONSTRUCTION compensation, will do the work and the structure Isnot Intended or offered for V—N sale (Sec 7044, Busbies., and Profmslan Code: The Contractors License law don not apply to an owner of property who Wilda or Improve•thereon, and who donsuch work himself or through Ms own employees, provided that such OCC. CROUP RFS. UNITS Improvements arc not Intended or offered for sale. If, however, the building ame TOTAL: R-3 Improventtssold within°neyearo(compidlomtheowner-builderwill have ' t Nen of proving that he did not bund or lmprovefor purpose of sale.). Lj L as owner of the property, am exclusively contacting with umnand contractors to construct the project(Sec. 7Ot4, Business and Prefenioru Code: QTY. PLUMBING PERMIT FEE FLOOOZONE APN pp(M(T ISSUANCE 12 The Contractors License law don not apply to an owner of Property who or Improve thereon, and who contracts for such p(ojecis with a contractor(O licensed pursuant to the Contractor's License Law. U I •m exempt under Sec B & P C for this reason ALTER -DRAW &VENT- WATER (PA, FEE SUMMARY BACK FLOW PROTECT. DEVICE ' DRAINS FLOOR ROOF, AREA, COND. SANITARY Y N RECEIPT 0 Owner Data WORKMAN COMPENSATION DECLARATION 31 hereby afflmn that I have a artlOcate of consent to self -insure, or a certificate artlflab of Worken'C°mpenatlon Wunna ora certified copylhererf(Sec. policy3800, Lab C.) Y pp(T()(ES PER TRAP SCHOOL TAX Y_ N— RECEnrr# GAS EA. SYSTEM -1 INCA OUTLETS � PARK FEE Y_ N RFGEUr N Company Comp GAS. EA. SYSTEM -OVER 4 (EA) - BUILDING DI VISION FEGS u` nedcopyts hereby fumished. ertined copy Is filed with the city inspector, division. CREASE/WDUSML WASTE INTERCEPTOR PLANCHECK FEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID COMPENSATION INSURANCE (This section need not be completed if the permit ts forom hundred dollars Date Recei t# SEWER -SANITARY -STORM EA pnFI• WATER HEATER W/VENT/E.ECTR ENERGYFEE Y_ N— (SIW)°rles.) I artify that In the performance of the work forwhich this permit Is Issued, WATIZIt SYSTM,/TREATING I shall not employ my person In any manner n as to become subject to the W.n1xom'Compensallonlaw•of California. Date . PAID Appliant NOTICETO APPLICANT: IL after making thts Certiflate of Exemption, you should becomesubject wthe Wrrkers'Compar atinn provWon°fthe Labor NEWRESIDENTIALPLMB. SQFT. Date Rewi t# TOTAL: BUILDINIS 464. 0 Code, you must forthwith comply with such provisions orthis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 4 Ihereby afflmnlhat there is a construction lending agency for the perform arm of the work for which this permit Is Issued (Sec. 3097, Civ.C.) lander'c Name Lenders Add.. I certifythatl havereadthisappliation ami Rate that theabuvelnfmmation Iscorred. I agree to comply with all city and county ordinances and Rate laws TOTAL: ELECTRIC FEE 32,1 PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE PERMIT ISSUANCE 19 FEES PAID: 32 1 relating to building construction, and hereby suthome, representatives of this city to enter upon the above-mentioned property for Inspection purposes, (We) agree to save, Ind emrdfy an d keep harmless the City of Cu pertlno age [net liabilities, jrdgments,mets and expenses which may In any way awoe ALTERORADDTOMECH. Dale Receipt# AIR HANDLING UNIT TIO 10,030 CFM) SUBTOTAL: subb agairut/uld�C Wln co ens t gr ting of this parrnt. �� aT�ar 0 AIR HANDLING UNIT (OVER 10,000CFM) CONSTRUCTION TAX Sigreture of Applicant/Contractor EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE I MATING UNIT (TO 100,000 DIM Will the applicant or future building occupant store or handle haaardous Date RecOi t# material as deReed by the Cupertino Mu"itlpal Code, Chapter 9.12, and the Hea ith and Safety CodeSection25532(a)? Yrs [] No Will the applicant or future building ocmpanluee equipment or devices HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN (SINGLE RFSID) ISSUANCE DATE which emit haezrdous air contaminartsea defined bythe Bay Area Air Quality Mamgem cnt District? 4Yn❑❑ No have read thehaea ms materfakrequimmentsunder Chapter6.95 of the Califomla Health&Safety Code, Seniors 25505,25533 and 25534. 1 understand that if the building don not currently havo a tenant, that It I. my kA./a�- 1� . AY 1 51990 NAY ' BOILER -COMP (31E' OR 100,000BTU) BOILER -COMP (OVER 100,000 BTU) NEW RESIDENTIAL MECH. SQ.FT responsibility to notify the ocmpant of the requirementswhich must be met ' prior to Issuance of a Certificate of Occupancy. City of Cunartina ISSUEDBY: 44'-- I IAV GGIo�YU Owner or authorized agent Data TOTAL: OFFICE COPY