20319APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pmect Identification
BnBding Addres:
Unit 119 L1.1
PERMIT NO. "
20319'
nen ams: one.
Town Center Properties
CITY OF CUPERTINOLBUILDING DIVISION
APPLICATION / PERMIT
BUfLDINGELECTRICALPLUMBINGMECHAMCAL
5/09/90
Coetsctor's Name: Lk. No:
738-4444
CATEGORY
CONTROL 0 -
Archltect/Engineer.
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Atltlret:
O E E
PERh9TISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I heh SxcBo 700(fitl hrsi=3 ofuuderp osand of Cssions 9(mmndm
If..Is I. fon force of Divfect. Rhe Buelnetand ProfndonsCade, and my
license la In full (eros and effect. -
License Claw Lk.B
Datc Contractor
ARCHITECPS DECLARATION
I understand my plan shall be used as public records.
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt fromthe Contractor's Limine Law for the
following recon. (Section 7031.5, Business and Professions Code: Any city or
countywhlch requiresa permit mmrutruct, alter, Improve, demollsh,orrepalr
anystmu mpMrtoltsbmance,Womqusstheappllantfmsuchpermitte
Ne a signed statement that he b Bttnsed pursuant to the provblom of the
Contractor's Ucerue Law (Chapter 9(commencing with Section 7000) of Divi-
dBurins 3 ofthe Buris and Predations Code) or that he la exempt therefromand
the basis for the alleged exemption. Any violation of Section 70115 by any
applicant fora permit mbjectsthe applicant to a civil penalty of no rrorc than
fiv61, as undre
ownerdollar
hepr, employes with wags as thele sole
I, ac owner of the property, or the
compensation, 70K Buldothecomicendthes Code: be at Intended oroffered for
License, Law
sic does net. apply Busmen and Pro(essios Code: The or improves
apply torn imsero tpropertyhrough who Wilds erlmprovsthereoryand
who does
whodossuN she hot maelfco ded..mgh his Own emIf,how ,the d that Im11dsuch
improvementsarenMlntendneyearoeredpletto fee .If, ower-buileerwillgm
improvement baoldwithin enayearo(complmlorythe awner-Wllderwillhave
clS.�urden of proving that he did not build or Improve for purpose of sale.).
Lj L as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec. 70K Business and Profeados Code:
The Contractor's Limns Law does net apply to an owner of property who
Wilds or Improves thereon, and who contracts for such p;ojem with a
cgpl(actona) licensed pursuanttotothe Contnee's License Law.
off, am exempt under SB k P C for this reason
APIs1.IANCESRFSIDENML
JOB DESCRIPTION
,
PANELS
201.1000 AMPS
OVERIODOAMPS
SQ. FT. FLOOR AREA
1040
,
S/SQ.FT.
74.92
SIGNS ELECTRICAL
SPECIALCIRCUIT/MLSC
TEMP METER ORPOLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OlIILE.ISSN7•LCI I6SFIX7•URES$77,917.00
VALUATION
NEW RESIDENTIAL ELECTR SQFT.
STORIES
TYPE CONSTRUCTION
V_jv
TOTAL
,. ,. ..
QTY.' .' :`PLUA'IBING'PERINIT FEE
OCC.GROUP
R-3.
RFS. UNITS
-
I
FLOOD ZONE
APN
PERMIT ISSUANCE 12
-•
ALTER -DRAIN A VENT WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR RODE, AREA, COND.
SANITARY Y N_
RECEIPT 0
Owner Date
WORKMANCOMPENSATION DECLARATION
❑ affirm
I hereby arm that 1 have a mAl(late of consent to selE ns rs, or
mrtifimteofWorkerYCompes tim ImusnmmamAifWmpytherm!(Sec.
3800,Lab C.)
Policy 8
FIXTURES. PER TRAP
SCHOOL TAX Y N
RECEIPT 8
GAS EA. SYSTEM.1 INCA OUTLETS
PARK FEE Y_ N_
RECEIPT 8
Cum ny
GAEA. SYSfEMAVERd(EA)
BUILDING DIVISION FEES
ertNed copy is mi
hereby furnished.
Certified copy b (Ilea with the city
ty Inspection division.S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon need not be completed If the permit b for one hundred dollars
(4100)orfm)
I mor performance In the per(oance olthe wink (orwhlch this permit is hosted,
I shall not employ any person In any manner n as to be.. subject to theWATER
W.,lars'Compenstion Laws of California. Date
Applicant 1a
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, YOU
should become subject to the Workers' Comperuation provisos of the Labor
Code, you =a[ forthwith comply with such provision orthls permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
Iherebyaffirmthat there bamstmction lendingagency forthe perform
anceo(the work forwhichthis permit is Issued (Sec. 3097,Civ,C.)
lender's Name --
Lenders Addreu
I certify that l have read thisapplication ami state that the above Information
Iscorrect. l agree to complywlth all cityand countyordinances and mate laws
relating to building costructlon, and hereby authorize representatives of this
my to enter upon the abovo-mentionedproperty for inspection purposes.
(We). agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, Judgments, ends and expense, which may In any way accrue
agaistsid CClltyln ronseue a the�aMing ofthb permit.
/��� tl
Siglnaaw.ofof AppBmnt/Contraeer\ / Ute
HAZARDOUS ISIIwWEERIALS DISCLOSURE
Willtheappllcantorfuture building ompant store or handle hazardous
material as dented by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Cede Section 25532(1)'!
❑ Yes No
Will the a ppheant ar ture building ompant use equipment or devices
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management DisWe7
Yes ❑ No
have read the hazardous materials mqulrernnb underChapier 6.95 of
the CaliforniaHealth k Safety Code, Sections 25505; 25533 and 25536. I
understand that if the building does not currently have a tenant, that it is my
responsibility to notify the ottupant of the requirements which at be met
prior to issuance of a Certificate of Occupancy.
CREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
PAID
Date Recel t#
GREASE TRAP
I
SEWER -SANITARY -STORM EA 200FT
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
Date Recei t#
SYSTEM/TREATING
NEW RESIDENTIAL PLMB. SQFI.
TOTAL:
BUILDING .E
5 AQ. 50
SEISMIC FEE
SAL,
ELECTRIC FEE
38.00
PLUMBING FEE
38.00
QT;".�,="s MECHANICAL PERMITf�' FEE
PERMITISSUANCE 12
MECHANICAL FEE
FEES PAID:
ALTERORADDTOMKIL
Date Recef [#
AIR HANDLING UNIT(TO 10,000 CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 1Q000CFM)
CONSTRUCTION TAX
IXIiAUST HOOD (w/DUCT)
-
CONSTRUCTION TAX PAID:
HEATING UNIT (TO 100,ODO BTU)
Date Recel t#
HEATING UMT (OVER 100,000 BM
TOTAL:
VENTILATION FAN (SINGLE REBID)
ISSUANCE DATE
:7 it YT
/_A P
5 `'
1 J
.. `
/I ,.
Ci y of CBnettlnn '.',�..
ISSUED BY: 5�s— s
BOILER -COMP OFC' OR 100,M BTU)
BOILER -COMP (OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
Owner or authorized agent Date'
TOTAL:
OFFICE COPY