20323APPLICANT TO FILL IN INFORMATION WITHK RED LINES —USE BALL POINT PEN ONLY
Building Prefer, Identification
Building Address
PERMITNO.
20323
10100 Torre Ave. Unit 123 (111.1)
sonars ante: one:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/09/90
Cormactor.Name: Lac. No,
738-4444
BUILDING ELECTRICAL PLUMBING MFGHAMCAL
CATEGORY
CONTROL N
Architect/Engines Lk. No:
`,QTY ELECTRIC PERMIT ." FEB
` BUILDING,PERMIT INFO
Address
PERMITISSUANCE 12'
LICENSED CONTRACTOR'S DECLARATION
Ihy'hat I arn lic
tlamllcmprovisions 9 (commume,
thScti.n7DODof an3.fth.BusixandProfesgonsCode, and my
11...is lfuB form anleffect.
APPLIANCES RFSIDENTIAL
S JOB DES.CiVRI�TV'/HO J
0
PANELS
LlenxCla
Date CContontractor
UP TO 2DO AMPS
RCB
201-1000 AMPS
• ARCHITECT'S DECLARATION
I understand my ph. shall W used as public rcmrds.
OVERIODOAMPS
SQ. FI. FLOOR AREA
S/SQ. Ft.
9GNSELECTRICAL
Limned Prafe®lanal
669
74.92
SPECIALCEiCNT/M15C
OWNER -BUILDER DECLARATION
I herebyafflrenthal I am exempt fromthe Contractor's License Law for the
TEMP. METER ORPOLE INST.
following reason. (Section 7031.5, Business and Professions Code: Any city or
county which require, a permit to mnttroci, alter, Improve, demoish, or repair
any structure prim to its issuance, also requires the applicant for such permit to
file a signed statement that he is licensed pursuant to the proWlom of the
Contractor's License law(Chapter 9(commencing with Section 7000) of Divi-
slon3 ofthe Business and Prolexlone Code) orthat he is exempt therefrom and
90000E DEVICES
SWE13h31NG POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7011.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
OUTLRTSSWITCHESFIXTURES
- $50,121.00
five F11, asmwnerof thepr.
❑Las ownero!theproperty,ormy with wages their sole
NEW RESIDENTIAL ELECTR SQ,FT.
STORIES
TYPECONSIRUCTION
hesemployee
r
compensation, 70C!, Busiwill es and P. and mestrociurc is rCl intended or tens offeredforV_N
sale( Sec apply mif law
Cade•. The (improves
to m owner
doe, not apply to rk owner or property who builds or Improve, thereon, and
property hereon
who does such work himseBorthreugh his own employees, provided that such
OCG CROUP
RFS. UNITS
Improvements are not Intended oroffened forsale. If, however,thebuildingm
Improvement issold within oneyearofcmnpleUon, the awner-bullderwlll have
TOTAL:
R-3
t)a�Srden of proving that he aid not build or improve fee purpose of sale.).
u L as owner of the property, am exclusively contracting with licensed
contractor, to cemtroct the project (Sec. 70K Business and Profexloru Cade:
QTY. - PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE 1.2
The Contractor's License law don nut apply to an owner of property who
bullds or Improves thereon, and who contracts fee ouch pkajech with a
contractor(s) licensed pursuant to the Contractor's License Law.
I am exempt under Sec. B k P C for this reason
ALTER -DRAIN A VENT -WATER (EN
FEE SUMMARY
BACK PLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RFC= X
Owner Date
WORgHAN COMPENSATION DECLARATION
E31 hereby affirm that I have a cemtlBmte of consent to sell -insure, or a
certificate of Workemi Compersatlon Insurance ora unified copythereof fSec.
3800, lab CJ
Policy X
FV('lURFS' PER TRAP
SCHOOL TAX Y N
RECEIPT X
GAS FA.SYSTEM-1 INCA OUTLETS
PARK FEE Y_ N_
RRCRBR X
—
lis. SYSTEM -OVER 4 (EA)
Cam any
BUILDING DIVISION FEES
VCAS
ertified copyis hereby fumished.
nified copy is filed with the city Inspection division.
CREASE/TNDUSIRL WASTE RJTFRCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXMPf10N FROM WORKERS'
PAID
COMPENSATION INSURANCE
CChis section need not be completed If the permit isfor one hundred dollars
SEWER -SANITARY -STORM EA. 200Ff.
Date RCCeI (#
wATEx.1.�y1,/VENT,/ELECTR
ENERGY FEE Y_ N_
(5100>mlex.>
I certify that In the perfomuneso/the work car which, this permit Is Issued.
WATER SYSTEM/TRGTING
I .hell not employ any person In any runner x as m become subject tome
Workers' Campareation [..of California. Date
PAID -
Applicant T:
NOTICE TO APPLICANIL after making this Certificate of Exemption, you
should become subject to the Workers' Compensation provislmu of the Labor
NEW RESIDENTIAL PLMB. SOFT.
Date Recei t#
TOTAL:
BUILDING
Code, you moat forthwith comply with such provisions or this permit ohall be
deemed revoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe perform-
ance ohneissued work for which this permit is ued (Sec. 3097, Civ. C.)
[ender: Name--
Lender. Add...
Icedifythatlhavercadthisapplimtbnandaatethattheaboveinforn int28.73
ismrmct. I agreetocomplywith all cityand ceuntyordinancesand state laws
TOTAL
ELECTRIC FEE
2A. 71
PLUMBING FEE
98 73
QTY: ', MECHANICAL,PERMIT FEEMECHANICAL
FEE
PERMITISSUANCE 12
FEES PAID:
relating tobulldleg construction, and hereby authorize representatives of this
citytoenterupontheabov rrmtWmd property for inspection purposes.
Me) agree tomve,indemnify
,.A.andkeep ha.hleh the City of Cupertino
agalrotllabllltlea, judgments, cestsend a:passes which may In anyway aroma
-
ALMORADDTOMECH.
Date Recei t#
AIR HANDLING UNIT 10,000 CPM)
SUBTOTAL:
against uid C.t m�n�(a!3�enmo�ant ofthlspertnit
ZOO00 S/�/qd
AIR HANDLING UNIT (OVER IO,000 CIM)
CONSTRUCTION TAX
Sigvtumof Applicant/Contractor Dae
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATE SDISCLOSURE
Will the applicant or/uture buddiegonvpant store orhandle hassrdous
material as defied by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safely Code Section 25532(a)?
Yes M No
R ill the applicant or future WildingomPontux equipment or device,
HEATING UNIT (10 100,000 BT1J)
Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VFNI7LATION FAN (SINGLE RESID)
ISSUANCE DATE
which emit hazardous air cenbminents as defined by the Bay Area Air
Quality Management District?
Yesj No
PAI®,
BOILER -COMP DHP OR 100,000 BTU)
BOILER-COMP(OVER 100,000 BTU)
ihavereadtheh.9.usmaterlalsrequimmnl,underChapterG95of
the California Health k Safety Code, Sections 255d5,25533 and 25534. 1
and enstand that if the building does not currently have a tenant, that it is my
'
NEW RESIDENTIAL MECH. SQ.F1
responsibility to notify the occupant of the requirements which moat be met
prior to issuance of a Certificate of Occupancy.
CiV of Pn`nerti nn
ISSUED BY. .` 0 h J
Owneror aulheriud agent Date
TOTAL:
OFFICE COPY