20317APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pm'eat Identification
Bu 000TAdd
ss:
10orre Ave. Unit 117 (Hl.l) -
PERMIT NO.
2031.7
sva me:
A
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/09/90
C.etract.e.N.me: Lie. N.
738-4444
BUILDING-ELECTRICAL.PLUMBINC-MECHANICAL
CATTCORY
CONTROLIf
ArcMlect/Englecee Llc. N.
OTT ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
21 M
PFRh9TISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
Ihereby ioflrmth).f son DIWkm3.fth. ur nemdonaofCAapter9(mmmmc
ingweh In foh force efflon3oftha ButlnessandPro(eealonaCade,and my
license Is in foss and
APPLIANCESRESIDENITAL
JOB DESC ON
� YS.e
PANELS
Licener Cbm Lk.Y
s e. a
Cha/
Date Contractor
UP TO 200AMPS
201-1000 AMPS
ARCHITECT'S DECLARATION
I understand my plana shall be used es public records.
OVERI000AMPS
SQ. FT. FLOOR AREA
S/SQ. Fr.'
SIGNS ELECTRICAL
Licensed Professional _
OWNER -BUILDER DECLARATION
I hereby e(Rnothat l em...mpt from theC m r.d.e.Llcenss Law for the
following remon.(SMim TONS, Buerm and Prufemkru Code: My city or
m ntywhkhrequtmapermlttommtmd,alwer pmve.demoll N.,Rpair
;.'805
74.92
'
SPFCIALCIRCUIT/MISC
TQdp METER OR POLE INST.
anystmmmprkrtait,l ance,aMrequimstheappUmntforsuchpert tta
file a signed statement that M is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9(commenMg with Section 7000) of Divi.
Mon 3 of the Budness and Profession Code).,that he b exempt therefrom and
the basis for the alleged exemption. My violation of Section 7031.5 by any
applicant fora permit subjects the applicant to a civil penalty of not mom than
five E]1, ashundred
I, a. owner of the property, or my employees
wnerofdollars the pr. with wages n there eek
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWITCHES-FIXTURES
VALUATION
$60,311.00
NEW RESIDENTIAL ELECTR_SQFr.
STORIES
TYPECONSTRUCTION
compensation, will do in
work andthe is net Intended oroffered for
Business
sale (Sec. 7041, Business and Profession Code: The Contractors License law
ions Code:
V—jQ
does not apply to an owner of property who build, or Improves thereoq and
Rwn
whodoessuchwork hiorthrough hlsoemployees, provided that such
OCC.GROUP
R75. UNITSm
Improvements are not Intended oruffemd forsale. If, however, thebuiHing or
Improvementbsold wlthlnoneyearofcompleskan,the owner-bullderwlil have
tliLturdenofprovingthe hedid embulldorbnprovefeepurposeof sale.).
U
Las owner of the property, am exclusively contracting with licensed conPERMIT
to nstruct (Sec. appy BusNemand
TOTAL:
..
QTy. PLUMBING PERMIT FEE
R-3
-
FLOOD ZONE
APN
ISSUANCE 12
The Commenrs
ces
The Contractor's Limner law don not apply to an owner of property who
of property who
bu1Ws o improves therms, and who contracts
actox. for such p(o)em with a
cq_j, en exempt under ant Sec. the Contradora Clem, Law.
L I am exempt under Sec. 0 & P C for thio reason
ALTER -DRAW & VENT- WATER (RA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
rvrq
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N�
BBC= N
Owner Date
WORKMAN COMPENSATION DECLARATION
QI hereby affirm certificate that I have a rt
ificate of consent to self -Insure, or
certificate of Workers' Compensation Insurance or a certified copy thereof (Sec.
CJ
#
Policy Y
I1XTS PER TRAP
N
SCHOOL TAX Y__
RECEIPTNY
GAS EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y N
RECEIPT
o11ry
Company
GAS Fit. SYSIITIAVER d (RA)
BUILDING DIVISION FOES
Q rtlfledcopy khereby dwithtfurnished.
�ertlRed espy b filed with the dty Ivpectian division.
city
CREASE/INDUSTRLWASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WOR KERS'
PAID
SEWER -SANITARY -SCORN EA 200Ff
COMPENSATION INSURANCE
(Thlssection need not be completed lithe permit re forone hundred dollars
Date Recei tiF
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
(f1I ortilem.)
I cent that In he h this is blued,
performance ny heworkmanner
WATER SYSTEM/TREATINGWorken'Compewtlon
eemdt
employ anyarsonI M, as to
I shall not employ any person In any manner n n to become subject to the
laws of California. Date
PAID
Applicant
NOTICETO APPLICANT: If, after nuking this Certificate.f Exemption, you
shmld became subject W the Worken'Compenadon provision of the Labor
Date Recei tM
NEWRESIDENTIALPLMS, SQFr.
TOTAL:
1311ILDING FEE
464
Code, you moat forthwith comply with such provision orthb permit shall be
deemed revoked.
SEISMIC FEE
-nn
4-27
CONSTRUCTION LENDING AGENCY
Hurebyegrm that there is a construction lending agency forthe perform
ance of the work for which this permit b Issued (Sec. 3D97, Civ, CJ
Lenders Name
Lenders Add rem
I cenlfythatl have read thisapplkati e.ed aamthatthe above In(ornutlan
iscemet.I agmte, complywlth all cilyand county ordinances and Mate laws
.TOTAL:
ELECTRIC FEE
32.13
PLUMBING FEE
32 .13
.:. —
QTY: ', MECHANICAL PEAMIT � " FEE
MECHANICAL FEE
112-11
PRRMEEL%UANCE 12
FEES PAID:
relating to building construction, and hereby authorize repreaentativesof this
city to enter upon the aWvementfomd property for Wpection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cu pen Inca
against liabilities, judgment, costs and expenses which may in any way accrue
ALTER OR ADD 7D MECH.
Dale Recef Ile
P
'AIR HANDLING UNIT(TO 10,000 CFM)
SUBTO'T'AL:
agaWtsaid CC �'sa�neco h an gofthispemit.
l_��S� D
SignammofApplicant/Contractor Dattee�—
AIR HANDLING UNIT (OVER 10,=CFM)
CONSTRUCTION TAX
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA LS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Date Recei of
Will the applicant or future building occupant store or handle hazmdou,
material as defined by the Cupertino Municipal Cade, Chapter 9.12, and the
Health and Safety Code Section 25532(a)7
❑ Yea No
Will the applicant ce tum Wilding occupant use equipment or devices
HEATING UNIT (OVER ]Og000 BTU)
TOTAL:
VFNDLATTON FAN (SINGLE RMD)
ISSUANCE DATE
which emit hazardous air contentious rata as defined by the Bay Area Air
Quality Management District?
❑❑ No
PAID
a
BOILER -COMP OFIP OR 100,00D BTU)
BOILER -COMP (OVER 100,000 BTU)
4haveYn
readthehaxrs oosmaterialsrequirementsunderChapterG95of
the California Health & Safety Code, Sections 25505, 25533 and 2S534. I
understand that if the building does not currently have a tenant, that It t my
S J I.y�V
NEW RESIDENTIAL MECH. SQ.PT.
responsibility to notify the occupant of the requirements which most be met
prior to Issuance of a Certificate of Occupancy.
Yf ,�
MY Of rimer Inn
ISSUED EIY:
Owner or authorized agent Date
TOTAL:
OFFICE COPY