203297 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMITNO.
I") O n
10100 Torre Ave. Unit 12
G J
wners aces: - one;
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/09/90
Contnctor.N.me: Lk. No:
738-4444
BUFC
[LDING-ELECTRICALMUMBINGMHANICAL
CATEGORY
CONTROLN
Architect/Engineer, Llc. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO`,'.
Address:
9 E9 D KI
PERMITISSUANCE 1
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that em licensed under provistonsofChapter 9 (coneorso.
IngwlthSection7000)oflXvl.lon3 oftheBusinessandProfessionsCode,and my
license I. In full foand dfeci.
rce
APPLIANCES -RESIDENTIAL
JOB OFECRB'TID
;` w l
�J V V
PANELS
License Cmm Lia#
Date Contnctor "UP
TO 200 AMPS
RCB
IDI -1000 AMPS
ARCHITECTS DECLARATION
I understand my pbsushall be used as public remMs
OVER 1000 AMPS
SQ. FT. FLOOR AREA
S/SQ. FI.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby afRrmthat I am exempt from the Contractor's License Lw for the
1115 -
74.92
SPECIAL CIRCUIT/M15C "
TEMP METER OR POLE INSI.
following reason.(Sectlon 70715, Business and Professions Code: Any city or
crunywhichnqubeaapermittoconsi c4a1ter,improve,deeaIbh,oropalr
any structure prior to its Issuance, also requires /he applicant for such permit to
file a signed statement that he to licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commencing with Section 7000)of Divi.
sion 3 of the Business and Professions Code) orthat he It exempt therefromand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation olfaction 7031.5 by any
applicant fora permit subjects the appllcaot toss civil penalty e(nnt morethan
OUTLEISSWITCH6SEXTURFS
$83,536.00
five hundreddollars nerofthepr7.
as owner of the property, or my employees with wages a their door
NEW RESIDENTIAL ELFETR SQFT.
STORIES
TYPE CONSTRUCTION
compenI, In
reh notIntendedorofferedfor
sae (Sec.
.1.(Se .70Kation, Businesswill do workendthes Code:
Busman and Professions Code; The License Lw
V—N
docs not apply to an owner of properly who Wild. or Improve thereon, and
apply or improves
odcessuehwarknIntendedorwgh Msow. yen, provided
OCC. GROUP
RES UNITS
in forage. If, however, ildinIhat
r
Improvementsarenaintendedearofedoraan,the cmerelheWlidinave
Improvement issproving
TOTAL:
R-3
of g that he did entbuild rimer improve
t11LJLurdenafpmving that he did wt build orimprave (w purpose o(nleJ.
for purpose of
U 4 as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7061, Business and Professors Code:
The Contractor. License Lw does net apply to an owner of property who
Wilds or Improve thereon, and who contracts for such p�ojecta with a
co,1BE+nor(O licensed pursuant to the Contranor's License Law.
L j I am exempt under See B & P C for this rea,on
QTY. ,. ..,, PLUMBING PERMIT FEE
FLOOD ZONE
APN
pgRMIT ISSUANCE
N , 12
ALTER -DRAIN & VENT - WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTS[ DE FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
REC®'T N
Owner —_Dine
WORKMAN COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to wit -lean, or a
rercUlrate ofWorken' Compensation Insurance or a certified copy thereof (Sec.
MOD, Lab C.)
Pollry#
FI%TURFS PER TRAP
SCI IDOL TAX Y_ N—
RECEIPT
RECEIPTN
GAS EA. I'E.1-I SYSINCA OUTLETS
PARKFEE Y N
RECEB NN
. GAS FA. SYSTEM-OVER4(EA7
Com any
BUILDING DIVISION FE ES
Knified copy b hereby furnished.
its ied copy in fled with the city inspection division.
GREASE/INDUSTRL WASTE IN'ITE EPTOR
PLANCHECK FEE
-'
CREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thissectlon need not be completed Who permit la forum hundred dollars
Date Remi t#
SEWER -SANITARY -STORM EA 20BFI
HEATER W/VENT/E,ECTR
ENERGY FEE Y_ N_
PAID
'
(S100)orless.)WATER
I certify that In the performance ofthework forwhlch this permit is Issued,
I shall not employ any person In any manner so as to become subject to the
Workers Compensation Laws of California. Date
WATER SYSTEM/TREATING
Applicant
NOTICE TO APPLICANT:ILafter mating this CertBicete of Exemption, you
should become subject to the Workers' Crmperaxtlon provi,ons of the Labor
NEW RESIDENTIAL PCMB. SQ}7.
Date Remi t#
TOTAL:
NG
6 7,50
Code, you resat forthwith comptywth such provisions orthls permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.88
Ihembyafffrm thatthere is aconstruction lerdlogagency forthe perform-
ance of the work for which this permit is issued (Sec 3097, Civ. C.)
Landers Name
Lerdee.Addre,a
I.Aifyth.tihawe.dtheappBcetonendteatethatthcabovelnfomatlon
Is correct.I agree to comply with all city and county ordinances and state laws
TOTAL
ELECTRIC FEE
39.88
PLUMBING FEE
-49
QTY. , MECHANICAL. PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
relating to building construction, and hereby authorlae representatives of this
citytoenterupontheabove-mentioned property for inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against Wbllltler, , Odgmenta, notes and expenseswhlch may In anywayaaxue
-
Date Recei t#
P
ALTER OR ADD TO MECH.
AIR HANDLING UNIT CTO 10,000 CFM)
SUBTOTAL:
1117
.8.1 t acid y Inco en aI,;iaae ming of this permit.
/ �= R���D
AIR HANDLING UNIT (OVER 10,000 CENT,
CONSTRUCI70N TAX
Signature of Applicant/Contractorto
DCFIAUS'C HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT CID 100,00D BTI)
Date Recef t#
Will the a ppllcant or future building occupant store or ha cells havrdous
material as defined by the Cupertino Municipal Code, Chapter 9.1 7, and the
Health and Safety CodeSection75532(1)?
Yes u No
_
HEATING UNIT COVER 10%000 BTU)
TOTAL:
6 3.
VENTILATION FAN (SINGLE RESID)
j$ AN7GTi,j)ATg
Will the applicant or future building occupant use equipment or devices
which emit hawrdous air contaminants as defined by the Bay Area Air
Quality Management District?
Yes MNo
h.vem.dthehava ousmaterialsrequlmwntsunderChapter6.95o(
t.
j 1. t99U
BORER -COMP QHP OR 1DQIXD BTII)
BOILER-COMP(OVER 100,000 BTU)
the California Health & Safety Code, Sections 25505, 75533 and 75534. 1
understand that lithe building does not currently have a tenant, that it is my
responsibility to notify the occupant of the requirements which must be met
City of CIIBertinn
ai
NEW RESIDENTIAL MECH. SQXT.
prior to issuance of a Certificate of Occupa nn,.
11..
ISSUED BY.
Owner or authorised agent Data
-
TOTAL:
OFFICE COPY V