20371APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY civ
Building Project Identification -
Building Add res`: -
PERMITNO.
10100 Torre Ave. Unit 171 (M2..1)
20371
hersName: one:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
Cantradar.N.me: Pe. No:
738-4444
BUILDING-ELECnUCALPLUMBINC-MECHANICAL
CATEGORY
CONTROL.
ArcFitect/Engineer. Lir. No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Address:
v
PEFMTISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
Iherebyaffbm that am licensed under provWansof Chapter9(mmmenc.
Ingwith Sedion7000)ofD3vislm3afthe Buslnenand PmfessimsCode,andmy
limens le in NU to. and effect.
APPLIANCESRESIDENTUL
JOB DESCRIPTION
ES Ip
S • V
PANELS
LicenseClan Licit
R l.0
Date Contractor
IM TO 2W AMPS
211 -IOW AMPS
ARCHITECT'S DECLARATION
I understand my plans sh3R be used as public records.
OVERIODOAMPS
EQ. Fr. FLOOR AREA
S/9Q.FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby of lreathat I am exempt f oro the Contradoe. LicenseLaw forthe
SPECIAL CIRCUIT/MISC
995
74.92
TEMP. METER OR TOLE INST.
following moson.(Section 70315, Business and Prefenluns Code: My city or
county which requires a permit roconstruct, alter, leaprove, demALsh, or repair
,
any structure prior to its issuance, also rxVims the applicant for such permit to
lite a signed statement that he is licensed Pursuant to the pmvbiom of the
POWER DEVICES
SWIMMING IDOL ELECTRIC
Contractor's License law (Chapter 9 (commencing with Section 7000) of Divi.
cion 3 of the Business and ProfessImus Code) orthe he k exempt therefrom and
VALUATION
the bask for the alleged exemption. Any violation of Section 7031.5 by any
appHeant for a permit subjects the applicant to a civil penalty of not ore than
OU7LEISSW[.ICFipB,FIKfURpS
pp74> 545.00
Y
dolls -Moo).
live hon.%.
I, er o! the property, or my employees with wage u their sole
NEW RESIDENnALELECTR SQ.FT.
STORIES
TYPE CONSTRUCTION
compensation, will do the work and the structure is not Intended or offered for
sale (Sec 7044, Business and Protrusions Code: The Conlradors License Law
V—N
does not apply to an owner of preperty who build. or Improves thereon,and
doasuch work himself orlheaugh Memployees, provided that such
improvert ments anot intended oroffered foruw
le. If, however, thebuilding or
imprevereent keold within oneyearoftompletion, the owner-builderw111 have
'
TOTAL
OCCGROUP
.sown
R-3
R6. UNITS
t1ig.kuNen of prevmg that he did not build or impreve fee purpose of axle.).
LJ L as owner of the property, am exclusively contracting with licensed
contractors to consumer the prefect (Sec. 7064, Business and Professions Code:
QTY; PLUM13INGPERNUT FEE
FLOOD ZONE
AI'N
PERMIT ISSUANCE
12
The Contractor's Licame Law does cad apply to an ..or of Property who
Wilds or Improves Thereon, and who contra for such pt,oJcers with a
tg0t(�darts) licensed pursuant to the Contractors License Law.
L,J I am exempt under Sec B k P C for this mason
ALTER -DRAIN &VENT • WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECE1Pr #
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I M1ereby affirm that I have a certlfirate of consent to seifdnsum, or a
3800, ab Lof C.) Workers Compensationlnsurana oraartl(kd copythereo(t5ec.
abRECEIPT
Policy
P
SPER .I.�P
SCHOOL TAX Y_ N_
RECEIPT #
EA. INC60UTLETS
GAS SYSTEM-1PARK
FEE Y N
##
M
Com an �
GAS F.A.SYSTEM-OVER 6 (EA)
BUILDING DIVISION FEES
Bled copy hereby famished.
edified copy k filed with the city Inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF IXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCESEW
Obisseerlon need not be completed Uthe permit k (coon hundred dollars
Date Receipt#
FR-BANITARY-5[ORM EA 2WF1'
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y_ N_
($100)°`]`°°.)
I certify that In the performance of the work for which this permit Is issued,
WATLR SYSTEM/TREAnNG
I shall not employ any person In any manner so as to become subject to the
Worked Compenutbn Lawsof C.Ifcmk. Data
PAID
NEW RESIDENTIAL PLMB._SQFr.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
Date Recel t#
TOTAL:
B
Code, you mut forthwith comply with such provklons or this permit shall be
revoked.CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I hereby affirmthtthami,. construction lending agency forthe perform
ance oflhe work forwhkhthk permit k kmed t5ee.3097,CIv.C.)
Iendrr.N.me
Lenders Address
I artlfy thatl have read thkappliatlonand statethatthe above Information
Iscorrect. l agreeto complywith all cityand county ordinances and state laws
TOTAL:ELECTRIC
FEE
PLUMBING FEE
QTY: MECHANICALPERMIT. , PEE.
MECHANICAL FEE
E7.deemed
PERMITISSUANCE 12
FEES PAID:
relating to building consuudlon, end hereby authomke representativesof this
city to enter upon the above-mentlored property for Wpectloa purports.
(We) agree to save, IndemN(y an d keep harmless the City of Cupertino
against liabilities, Judgments, "sand expenses which easy In anyway accrue
ALTERORADDTOMECH.
Date Regie) !#
P
act HANDLING UNIT ICO lO,1100C4M)
SUBTOTAL:
agoi aid I�n�j➢/uem:e t an gofthispemmit
r /l�a.a�
- AIR HANDLING UNIT (OVER IBODBCFM)
CONSTRUCTION TAX
.6a/
Signatureo(AppBant/Contractor a
EXHAUSTHOOD(W/DUC'D
CONSTRUCTION TAX PAID:
HAZARDOUS MAT LS DISCLOSURE
HEATING UNIT CTO IDgODO BTU)
Date Recei (#
Will the applicant or future Wilding occupant store or handle haaardous
material as defined by the Cupertino Municipal Code, Chapter 9.1Z and the
Health and Safety Cade Section 25537W7
F� Yes r] No
�NIII the appliescat orfuwm building occupant use equipment or device
HEATING UNIT (OVER 100,OID BTU) -
TOTAL:
.2a
VENTILATION PAN(SINGLE RESID)
ISSUANCEDATE.
which emit hanrdous at, contaminants a. defined by the Bay Area At,
RAI p}1•
BOILER -COMP OPT' OR 100,D00 BTU)
Quality Management District? -
Yea No
7�d'137�'
BOILER -COMP (OVER 100,000 BTU)
have read the h aza73aus materials requimments under Chapter 6.95 of
the California Health k Safety Code, Sed ions 75505, 75533 and 75534. I
understand that lfthebuilding don not currently have. tenant, that it k my
NEW RESIDENTIAL MECH. SQFr.
responsibility to notify the oaupart of the re i.irmu nls which moat be mot
prior to lana race of a Certificate of Oacupa racy.
C&I of r,uppF6Ff1
DBY-4• %k �I1VGGI CT o'V
Owner or authorized agent Date)SS
TOTAL:
OFFICE COPY