20410APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pro'ed Identification
Dullding Addres,:
10100 Torre Ave. Unit 210 F1.2
PERMIT NO.
20410
me:
q;OiiP-Qd=IwS Pro e7�leS
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
BUILDING-ELECnECALMUMBING-MECHANICAL
5/10/90
Coonselm's Name: Lic. No:
738-4444
CATEGORY
CONTROL
Archlted/Fngimen Lk. Na:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add.
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby ectionmthm lamlkm3 oftheerpostand of Chapter9(commmc-
If...I Section force andeffect. ,frits BusinemandProlessloneCpde, and my
Ilmnx la In (uI force and effect.
License Gla®
Date Conlrador
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
OWNER -BUILDER DECLARATION
Iherebyafflrmthatl amexempt fromthe Cont radon's License Lawforthe
following reason.(Section 7ml5, Bwlnemand Professions Code: My city or
cauntywhich requireaa pemdttocomtmM alter, Improve, dennibh,ur repair
anystrudure pdorto Its issuance, also requlreatheapplicant forsuch permit to
file a signed statement that he b homsed pursuant to the provbimm of the
Contractor's Licene, law (Chapter 9 (commencing with Section 70(0) of Dist.
slon3 of the Busimssand Professloru Code) orthat he is exempt therefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fora permit subjects the applicamto a civil perulty of not room than
ifhundred dollars ($M.
❑I, as owner of the property, or my employees with wages as their sole
compensaeon, will do the work, and thestructure is not intended or offered for
role (Sec. 7004, Busmen and Professiow Code: The Contractor, License Law
does not apply to an owner of property who builds or Improves thereon, and
doessuch work himselorthrough Ms own employees, provided that such
Improvements are not Intended oroffered foreale. If,however,thebuildingor
Improvement Issoldwithlnomyearofcompidlon,theowner-bullderwill have
the Nen of proving that he did net build or Improve for purpose ofsale3.
4 as owner of the property, am exclusively contracting with licensed
comcadors to coustrud the project (Sec. 7044, Business and Pro@sslom Code:
The Contractor's Llmnse Law does not apply to an owner of property who
bu
Wilds or Improves thereon, and who contracts for such ptojeds with •
cgR((ador(s) licensed pursuant to the Contractors License Law.
LII am exempt under Sec B & P C for this reason
APPLIANCESRESIDENTUL
]OB DESCRIPTION
RCB
PANELS
UPTO2Q0AM2q
2D1-10DOAMPS
OVERIODOAMPS
SQ. FT. FLOOR AREA
985
S/SQ, FT.
74.92
SIGNS ELECTRICAL
SPECIALCRCUIT/MLSC
TEMP. MEYER OR POLE INST.
POWER DEVICES
SWIMMING IDOL ELECTRIC
_
OUTLETSSWIT'CHE-SFIXTURES
VALUATION
$73,796.00
NEW RESIDENTIAL ELEC7R SQ.FT.
STORIES
TYPECONSIRUCTION
V—N
TOTAL:
QTY, PLUMBING PERMIT FEE
l7CC.CR0111'
R-3
RES. UNITS
FLOODZDNE
APN
PERMIT ISSUANCE 12
ALIS-DRAIN & VENT- WATER (FN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE.
DRAINS. FLOOR ROOF, AREA, COND.
SANITARY Y_ N
RECEIPT X
Owner Dale
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate7iX.IlJRES
of consent to self -Insure, or •
mAlficateofWorken'Cnmperetlmlremnmoramnifiedmpythereof(Sec.
MOD, Lab C.)
>
SCHOOLTAX Y_ N_ '
RECEIPT M
GAS 13A. SYSTEM -1 INC.4OUTLETS
PARK FEE Y N
RECGAS
EA. SYSTEM -OVER 4(EA)
Co.Cany
DING of
BUILDING DI VISION FRES
�C�afffied mpybhereby fumished.
RCedNe i copy is filed with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Uhlssectlon need not be completed if the permit Is fosse hundred dollars
(S1ro)or lea,.)
I unify that In the pedormanes of the work for which this permit is issued,
I shall not employ any peme n In any manner so as to become subject to the
Lawsof Glifomla, Date
Applicant CompensationNEW
NOTICETO APPLICANT: I, after making this Certificate of Exemption, you
should become subject to the Workers Compensation provisions of the Labor
Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I herebyaffirm that there is a construction lending agency for the pedormv
.nm of the work for which this permit is Issued (Sec. 3097, Civ. C3
Lenders Name
landers Address.
I cerdlythst I have readthe applicatlonand etatethattheabove informatim
beerred.Iagree to comply with all city and county ordinances and state laws
reining to building construction, and hereby authorise representatives of this
city to enter upon the aWve-memionnd property for Inspection purposes.
(We) agree to save Indemnify an d keep harmless the City of Cupertino
agairut liabilities, Ikdgments, mate and expenses which may In anyway accrue
,gainer uld C Pdn c a a he an g of this perrnl/t),/
i / �s—� Permit
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
PAID
Date RCCeI t#
GREASE TRAP
SEWER-SANITARY-S[oRM FA 2WF1.
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N
PAID
Date Recei t#
WATER SYSTEM/TREATINGWorken'Compeosrtion
RESIDENTIAL PLMB. SQFT.
TOTAL:
B G
522. 50
SEISMIC FEE
5.1
TOTAL:
ELECTRIC FEE
116
PLUMBING FEE
MECHANICAL FEE
X63
QTY. MECHANICAL PERMIT FEE
PERMIT ISSUANCE 12
FEES PAID:
36.63
ALTERORADDTOMECH.
Date Recei t#
P
AIR HANDLING UNIT (to 10,030 CFM)
SUBTOTAL:
AIR DANDLING UNIT (OVER I O,ODO CFM)
CONSTRUCTION TAX
r
Signature of Appiiw/m�/C�oniradorate
HA ZAR DOUS MATERIALS DISCLOSURE
Willtheapplicantorfuturebuildingo pant store or hand to hazardous
material as defied by the Cupertino Municipal Code, Chapter 9.1 2, and the
Ilealthand Safety Code, Sedloon 25532W7
Will the applicant or❑future building occupant use equipment or devices
which emit haeardous air =to minants as dented by the Bay Area Air
Quality Ma ugement District?
(�1 Yee I-1 No
esread thehaza us medallrequirements under Chapter 6.95 of
the California Health&Safety Code, Sections 25505, 25533 and 25534.1
understand that lithe building does not currently have a tenant, that it is my
responsibility to notify the oaupant of the requirements which must be met
prior to issuance of a Certificate of Ocou panty
D IAUST HOOD ON/ DUCT)
-
CONSTRUCTION TAX PAID:
HEATING UNIT (10 100,000 BTU)
Date RCCeI t#
HEATING UNIT (OVER 100,000 BW
TOTAL:
37
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
�f'„ xi D I.y+lJV
/1
p. City of °UOAIfino
ISSUrDBY: 9 4
BOILER -COMP Of Ice OR 100,000 BTU)
BOILER-COMP(OVFR 100,000 BTU)
NEW RESIDENTIAL MEIN. SQ.PT
Owner or authorized agent Data
TOTAL:
OFFICE COPY