20380APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
building Project Identification
Building Address:
PERMITNO.
O O
10100 Torre Ave. Unit 180 A1.2
UM.M. ante: one.
A
Town Center Properties
CIN OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
S/10/90
Centraator'sNa'ne: Lic.N.:
738-4444
BUILDINGELBCTRICAI PLUMBING -MECHANICAL
CATEGORY
CONTROL#
'
Archheo/Engineer. - LIC No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
a
PERMETISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby affbm that l am hemsed under provisions of Chapter 9(commene
ingwhh SedWm7000)of Divhioe3 oftheausinessand PrefessionsCode, and
APPLIANCESRESIDENIAL
- JOB DFSCRII'ITON
Beene I. in fail force and effect.
PANELS
XV
Llama Claes LIC#
Date Contractor
201-1000AMPS
ARCHITECTS DECLARATION
I understand my phmashall be used as public records.
OVERIMAMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNSELECTRICAL
Licensed Professional
'
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
lherehyaflren that lam exempt from the Contractor's Liarue Law forthe
following ... (Sedion70013, Businewand fee
Presione Code: Any city or
county which requires, a permit tomrutruct, alter, Improve, demolish, orrepair
1 115
s
-
74.92
TEMP. METER ORIaOLE INST.
anystmcture prlorto its Lssuance,aborequlreathe applicant forsuch permit to
file a signed statement that he is licensed pursuant to the provisions of the
POWER DEVICES
,. ,
SWIMMING POOL ELECTRIC
Contractors License Law (Chapler9(mmmentlng with Section 7000) of Owl.
was 3 of the Bushessand PnafenioMCode) orthat heh m
exepttherefromaM
VALUATION '
the bash for the alleged exemption. Any violation of Section 7031.5 by any
bleatathe applicant 1. a civil penalty of mat more than
appliaot for a permit sucivils
OUTLETS-SWITCHES-FI%TURFS83
536.00
five hundred
owner of he pr .
I, as owner of the property, or employees with wages thele sole
NEW RESIDENTIAL ELECTR SQJrE.
STORIES
TYPE CONSTRUCTION
he
compensation, Mon,wOldotheworkanitiord ucturchnot .meander or License
sok (SeC 704y BuslMss and ProfessloM Code: The Contractors LIceMe Law
eLaw
V_[x]
'
does not apply to an owner of property who 'solids or improves thereon, and
who doessuchwork himselforthrough hhownemplWers, provided thatuch
OCC.CROUI'
RFS. UNITS
Improvenrnhare not intended oraffered forsale. Hhoweverthebulldingor
Improvement hsold withinoneyearofcompldion,theowner-bu0derwBl have
TOTAL:
R-3
t rden of proving that he did not build or Improve for purpose of sale.).
11 L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Businew and Poureadm a Cade:
QTY. PLUMBING PERMIT FEE
FLOOD TONE
APN
PERMIT ISSUANCE 12
The Contractor's License Law don not apply to an owner of property who
builds or Improve thereon, and who contracts for such p cojees with a
rgp(Jador(s) licensed pursuant to the Contractor's License Law.
LJI am exempt under Se, B h P C for this reason
-
ALTERDRAIN &VENT- WATER ffN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR A, ROOF, ARECOND.
SANITARY Y N_
RECETPf #
OwnerDate
WORKMAN COMPENSATION DECLARATION
[:]I hereby affirm that I have a certificate of consent to nit -Inure, or
3800,Laeo(Workers'ComperaatlonlMurana araartllkd ropythemof(Sec.
3800, Lab CJ
Policy
FIXTURES PER TRAP
SCHOOLTAX Y_ N_
RECEIPT If
GAS EA. SYSTEM -1 INCA OUTLETS
PARKFEE Y N
RECEIPT #
M
C
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
IBed copy is hereby furnished.di ied copy h filed with the city inspection division.
GRIASUINDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE.
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thissedioo need net be completed tithe permit h foroM hundred do0ars
SEWER -SANITARY -STORM EA 200FI'
Date fiscal [N
WATER HEATER W/VENT•/ELECTR
ENERGYFEE Y_ N_
PAID
($100)orleea.)
I artily that In the pedormanceaf the work for which this permit Is hued,
I shall not employ any person In any manner u as to become subject to the
Workemi Compensetlon I.ws of Califomh.. Date
WATER SYSTEM/TREAnIJG
Applicant
NOTICETO APPLICANT: If, after making this Certificate of Exemption, you
should became subject to the Worksm Compensation provisions of the Labor
Date Reoel t#
NEWRESIDENTIALPLMB. SQkT.
TOTAL:
pU � INC
567.50
Code, you swat forthwith comply with such provision orthh permit shall be
damed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.88
I herebyaffirm that there ha construct.. lending agency for the perform-
and of the work for which this Permit h hued (Sec. 3097, CIv.C.)
Lenders Name
Lender.Addrew
Icertt"at] have mad thhappllcationari statedut theabove Information
hrorred. I agree to conplywith all cityand county ordinances and state laws
TOTAL:
ELECTRIC FEE
39.88
PLUMBING FEE
TY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
PEES PAID:
relating to to liding construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for inspection Purposes.
(We) agree to save, fedemudfy an d keep ham -dew the City of Cupertino
against liabilities, Pdgments, mets and expenses which may in any way aarun
ALTEf4ORADDTOMECH.
Date ReCet tM
AIR HANDLING UNIT (TO 10,0(0 CFM)
SUBTOTAL:
.3 0
against said int Rwquen of he doling of this permit
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
Slgnatureof Applimt/Contactor 115te
F7(I IAl15T HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUSM IALSDISCIOSURE
Will the applicant ortoture building occupant atom or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code mrz--S..��ection 25532(a)7
❑ Yes u No
HEATING UNIT (TO 100,000 BTU)
Date Recei tff
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
to
VENTILATION FAN (SINGLE RESID)
ISSdP --L ATE -
Will the a ppltaest or future building occupant use equipment ev devices
which rout hazardous air contaminants as defined by the Bay Area Air
Quality Management Distrkt7
YesNo
have read theh.9 usmMteriah requirementsunder Chapter6.95of
!C'd"iI
BOILER -COMP UHPOR 100,000 BTU
BOILER.COMIP(OVER 100,00 BTU)
the Czlifomh Health h Safety Code, Sedi..25505, 25533 and 25534. 1
understand that lithe building docs nM currently have a tenant, that it is my
i
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requircnents which moat be met
4�
City of Dinp..IF
prior to Issuance of a Certificate of Occupancy.
trtit
�y
ISSUED B Y 4a y `- r4Ly6zi �
Owner or authorlud agent Date
-
TOTAL:
OFFICE COPY