20322APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
tloildln Protect Identification
Building Add a..
PERMIT NO.
I% 0
10322
100 Torre Ave. Unit 122 1.1
G
nems one:
A
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
5/09/90
Cmtraomes Name: Lie. No:
—
BUILDING-ELECnUCAL.PLUMBINGMFGHAMCAL
CATEGORY
CONTROL M
Architect/Engineer. Lk:. No:
QTY/:' ELECTRICPERMTT, .,FEE
BUILDING PERMIT -INFO"
-
Adtlrese:
El lil El
['EtMITI55UANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that son licensed under provisions of Chapter9(mmmenc
inenseiSection force anDlvWon3 ofthe Bumuesand Pro(eestoneCodc, and my
license le In full (ores and affect.
APPUANCE&RESIDENTLIL
JOB DESCIU11 pin
V' r/1�
�R� 1_/ P
PANES
Lt... Clan LILY
Date Contactor
201-1000 AMPS
ARCHITECTS DECLARATION
I understand my place shall be used as public records.
OVER1000AMPS
SQ. Fr. FLOOR AREA
E/SQ. Fr.
SIGNSELFGTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contramoes Lfcensa Law forthe
following reemn.(Section 7011S, Buelness and Professions Code: Any city or
countywhich requlrcsa permittomretrucl, alter, improve, demoLLsh,orrepair
anystm mpr rtoia ance,aborequimtheappllantforsuchpermltto
Ole a signed statement that he Is limm d! pursuant to 1M provisions of the
Contractor's License Law (Chapter 9(mmmendng with Section 700) of Dist.
mon3 ofthe Business and Professle. Code) rthat he is exemptlherefrom and
783
`
.
74.92
SPECIAL CIiCIIT/M15C
TEMP. ME[TROR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7091.5 by any
m fora permitaubje the applicant tea civil penalty ofnorcthan
appBa. a m
rte nnnareddellare(ssom.ty,
NI, as owner of the properor my employers with wages act their sole
OUTLh'ISSWITCHESFIXI'URES
$58,662.00
NEW RESIDENTIAL ELECTR _SQ,FT.
5MR{
TYPE CONSTRUCTION
compensation, will do the work and the structure la not intended or offered for
sale (Sec 7064, Business and Profess es Code: The Contratlot's Limine Law
V—jaj
don ms,
not apply to an owner of property who builds or improves t harand
who doessuch work himself or through his own employees, provided that such
OCC.GROUI'
RFS TARS
Improvements arc not Intended oroffered for sale. If, however, the building or
Improvement isaold within oneyearofcomplmion, the owner -builder will have
tttjlvden of proving that he did not build or improve for purpose of sale.).
LJ L as owner of the property, am exclusively mntmetlng with licensed
contractors to moslmot the project (Sec. 7044, Business and Prolamines Cade:
The Commuter's License law does not apply to an owner of Property who
builds or Improves thereon, and who contracts for such pWjmn, with a g
Rlfedeia)BremM Pursuant to the ContnRada License Law.
L� I am exempt under Ser. B 4 P C for this reason
TOTAL:
- PLUMBING PERMIT FEE
R-3
)
l
QTY,
I'FAMI.I.ISSIIANCE
12
ALTER -DRAIN 4 VENT - WATER (EA)
FLOOD ZONE
APN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR, ROOF, AREA, COND.
SANITARY Y_ N
RECEIPT X
Owner Dale
WORKMAN COMPENSATION DECLARATION
E31FIXTURES
1 hereby affbm that I have a cecom
nf0ale of nsent self -Insure, or
acnlBote ofWorkeri Compensation Insurance ne. certified copy thereof(Sm.
3800,1.6CJ
Policy p
PER TRAP
SCHOOLTAX Y_ N_
RECEIPT Y
CAS PA. SYSTEM -1 INCA OUTLETS
PARK FFR Y N
RECEIPT M
GAS EA. 9YSTEM-OVER4(EA)
Coaty
BU ILDING DI VI SION FE
certBled mpybhercby famished.
ified copy la f lod with the city Inspection division.
CREASE/INDuSfRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(TMssecifon need not M completed tithe permit b (orone hundred dollen
(ft 00)orlen3 -
I llnotify cep o the pemonin an thework so as to blas penult cblued,
I snake not employ any person In any manner m m to become subject to the
Workcn'Compensalion Laws of California. Date
SEWER -SANITARY -STORM EA 200frr.
Date 'Recei tin
WATER HEATER W/VENT/ELEGTR
E14ERGY FEE Y N_
PAID
WATER SYSTEM/TREATING
ApplicaNOTICE aftermakingtelaotionkro is Exemption,you
NOTICETO esubje t to
Codedhumus subjectto the Workers C..hp.nbm provisionsofthe Labor
Date Re i til
NEW RESIDENTIAL PLMB. SQXT.
TOTAL:
Code, you mum forthwith comply with men pmvlabes orthls'permlt shall be
deemed revoked.
NG.
SEISMIC FEE
411
CONSTRUCTION LENDING AGENCY
IhembyafBun thatthereba mostmmion lending agency for the perform-
ansa of the work for which thio pemolt la blued (Sec. 3097, Civ. C.)31
LendeLender's nae as
I certifythat T havered this application and stafethm theabovelnformatlon
bmnect.IAgree to comply with all city and county erdlnanmaod male laws
TOTAL:
ELEC'T'RIC FEE
58
PLUMBING FEE
31.58
Q,t Wtc MidIANICALtPERMIT "-',i: E.
aX '
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
31.58
relating to building construction, and hereby authorize representatives of thb
city to enter upon the above-uenliened property for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cu penia
aga lost Babilitfes,judgments, costs and expenses which may In any way accrue
Date RerniptH
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
s
aga hat said Cl m eweweer a . t of this permit
— /
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
Signature of Appilant Contractor Dat
IXHAUST HOOD
CONSTRUCTION TAX PAID:
HAZARDOUS MATE SDISCLOSURE
HEATING UNIT CFO IOQODO BTU)
Will the applicant or future building occupantmore or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
I'Iexlth and Safety Cade Section 2S532(a)7
❑ Yee [n No
Date Re ei tic
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
mna
VENTILATION FAN(SINGLE RFSID)
ISSUANCE DATE
W91 the applicant orfutumbuikdingompantuse equipment ordevim
which emit hazardous air contaminants as defined by the Bay Area Air
alley Management District?
Yee nn No
AJDn n T^
/
BOILER -COMP DHP OR 100,000 BTU)
BOILER -COMP 100,f1(p BTU)
have read the Fazac tus materials requirements under Chapter 6.95 of
the California Health 4 Safety Code, Sections, 255D5, 25533 and 25534. 1
understand that ffthebuildingdm not currently have a meant, that it is my
�7
I •..� 1 O "w9y
NEW RESIDFr-MAL MECH. SQFI'.
responsibility to notify the occupant of the requirements which moat he met
prior to issuance of a Certificate of Occupa ncy.
CITY nlt I;IIHP(}I Dl)
ISSUEDBY,
Owner or authorized agent Data
TOTAL:
OFFICE COPY