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20349OZ z H y ccj WO a_ 0 OF 'LL Ow IL H U) Z U— APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Naiad Identification Building Address: Tnrrn PERMIT NO. 20349 wners ante. - "om. Town Center Properties CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT 5/10/90 Cord.do/.N.mx: LIc.Na: BUILDING-ELECTRICALFLUMBINGMECHANICAL CATEGORY CONTROL% ' Architect/Engineer. Lic. Na Q1Y ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: I �'} 91 © © 3 PERMITISSUANCE LIC ENSEDCONTRACTOR'Ssed IMhSedioreby r )ofat tv Bcm3ofthe ugp sand Pro ChawBCoe,andme- underDECns of Chapter tngwitlimaschifull700m)rfdeffeon3o(theBudnessand Pro(exlmaCode, and my license Is In (uB force and d(ect. APPLIANCESREEDENML JOB DFSGRB'I70N PANELS Llan.e Class LIOX, RCB Date Contractor UP TO 2DO AMPS — 201-IODD AMPS ARCHITECTS DECLARATION I understand my plans shag be used as public records OVERIOODAMPS SQ. FT. FLOOR AREA $/SQ. FT. - SIGNSELECTRICAL Licensed Professional 909 74.92 S7+EC7ALCiRCUIT/MIST OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law fm the following reason. (Section 7031.5, Business and Professions Code: Any city or muntywhlch requbesa permit toconstrud, alter, Improve, demolish, armor TpAgp METEROR POLE [NSI. anystructure priurtolts bauance,als requiresthe applicant fm such permitto file a signed statement that he la licensed pursuant to the provisions of the Conlndoes License Law (Cha per 9(commencing with Section 7000) of Divi- don 3ofthe Bness udand Pmf.WmCWc) orthat he b exemm pttherefroand POWER DEVICES SWIMMING POOL ELECTRIC' VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit-subjedathe applicant too civil peealty ofnd more than p $68,102.00 " OITMMSI SWITCHFSFIXTURES NEW RESIDENTIAL ELECTR SQYr. fiv61,asunded owner of hepr. dole I, as owner of Me property, or my employees with wages as offered mmpeneallon, Businthe work ess sale (Sec and Profen thestr ode: Th not intended or m. L for now and Pro(mlma Code: The dols Wane Law STORIES TYPE CONSTRUCTION V—N ' to a dceanot apply loan owner ofpropertywho builds or mrymd apply or imp whodam.vch work hlmmBcirthrwgh his own employen, provided that such OCC.GROUP RES. UNITS Improvements are not lntendedoraffered forsam. If, how ever,th.wildingor Improvementlsdold withlnoneyearofcompletlon, theowner-builderwill have tFd.purdenof proving that he dm am build orlmprove fm purpoao(sale.). LJ L as at of the property, am exclusively contracting with licensed contndon to mmlroct the project (Sec. 70K Business and Professions Code: TOTAL QTY.'" "" PLUMBING PERMIT FEE R-3 PERMIT ISSUANCE 12 .p(ppp7pNE pPN The Contractor's Llcenss Lw does not apply to an owner of property who bullds or Improves thereon, and who contracts for such plojects with a cl5ador(s) licamed pursuant to the Contractor's License Law. _J I am exempt under Sec. B P C for this rea k wn PRIER -DRAIN A VEM-WATER (EN FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. SANITARY Y_ N_ RECEPT X Owner Data WORKMAN COMPENSATION DECLARATION 711m I hereby affirthat I have a cer igate of consent to self -Insure, ora certificate a(WorkeW Compematlonlruurance or a certified mpythemof(Sec. 3800, lab C3 Policy FIXTURES PER TRAP SCHOOL TAX Y N RECEBrT % GAS F.A.YSTEM-I INCA OUTLETS PARK FEE Y N RECEErf X X - CRPyffled GAS F.A. SYSTEM.OVER 4 (EA BUILDINGDIVISION FEES Bled copy is hereby furthe ropy is filed with the city inspection division.CRIASE/INDUS7RL WASTE INTERCEPTOR PLANCHECKFEE CREASE'IRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID SENF.R-SANITARY STORM EA ZIXIFT COMPENSATION INSURANCE (Thlsaedlan need not be completed lithe permit la fasciae hundred dollars Date Recei t# WATER HEATER W/VENT/m cr.I.R ENERGYFEE Y_ N_ ($100)orless.) I cenifythat m the performanceof the work forwhich this permit is blued, WATER SYSTEM/TREATING I sMti not employ any person In any manner so as to become subject to the Workera' Compensation laws of CaNfomla. Date PAID licant NOTICE APPLICANT:[(, after ranking this Certificate of Exemption, you should become subject to the Workers'Compematlon provisions of the Labor Date Recel t11 NEW RESIDENTIAL PLMB. SOFT. - TOTAL: Code, you at forthwith comply with such provislom mthla permit shall be BUILDING dMmed revoked. SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirmthat there is a construction lending agency fettle pedant arm of the work forwhlch this permit Is Issued (Seo 3097, Civ. C.) Landers Name - Lender's Address I artifythatl have read thlaapplicati nand statethatthe above Information iemred.Iagreetocomply with all city and county ordinances and date law. TOTAL: ELECTRIC FEE PLUMBING FEE 34 73 - Q"rY.{;- "'MECHANICAL•PERMIT.,t', :. 'FEE PERMITISSUANCE MECHANICAL FEB FEES PAID: 34.73 relating to building construction, and hereby authorize repreantatives of this city to enter upon the abovementloned property, for Inspection purposes. (We) agree to save, Indemnify an d keep harmless the City of Cupertino against lhbWties,judgments, codsand expenses which mayln anywayamue ALTER OR ADD TO MECH. Date ReteiptM AIR HANDLING UNIT CTO 10,000 CFM) SUBTOTAL: agalnstssid Cl ran soft atm this permit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX SlgnaNre of AppBantARDOUS Dat IXIiAl15T HOOD(W/DI1CT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIA . ISCLOSURE HEATWC[JMT(TO 100,WDOTIp Date RecCl tN the or future ruin Muavpantode, hhandle 9.M1aaardom Will the aefined by material as defimd odthe Cupertino Munictpal Code, Chapter 9.12 andthe Health and SafetyCode Sedien 2553Ha)7 ❑ Yee ,Q_ No ' HEATING [IMT (OVER 100,000 BTI!) TOTAL: VENTILATION PAN (SINGLE RESID) ISSUANCE DATE Willmr the ding occupantusebyequipment or ms spplicanus haeard air contain &Air which emir hazardous is contaminants a defined by the Bay Area Air Quality Mawgement District? Yea ❑ No PAID", /.=�'E9� BOILER -COMP DT-0'DR 1011,000 BTU) BOILER-COMP(OVFR IOD,OW BTU) Moe read the M1azarclous materials requlrcmenb analerCM1apter6.95 of the California Health k Safety Code, Sections 75505, 25533 and 75534.] understand that if the building does not currently have a tenant, that It is my 1011 a. :J I�9U NEW RESIDENTIAL MF.CH. SQ.FT. rsporaibility, to notify the occupant of the requirements which must he mat prior to lasuana of a Certificate of Oaupancy. Xs rs ,y city of t%IIDBFt1110 ISSUED BY: Owner or authorized agent Data TOTAL: OFFICE COPY