20324APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification _
Building Address:
10100 Torre Ave. Unit 124 (D1.1)
PERMIT NO. 0 3 2 4
nen ams: one;
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT* •
BUILDING-ELECnUCAT PLIIMBINGMFCHANICAL
APPLICA HON SU RISE I I AL
5/09 90
Contractors Name: Lic. No:
738-4444
CATEGORY
CONTROL#
AmAlted/Engineer. Lk. No:
QTY ELECTRIC PERMlf� ` FEE
:BUILDING PERMIT INFO.
Address:
PERMIT755UANGE12
LICENSED CONTRACTOR'S DECLARATION
I hereby
hSectiimnthatl amsior3 dhe ButdrovWonof Chapter9(mmmmc
Ingwith SedWn force of Dlvipon3 ofthe BupmresandlsrofeWonaCude, and my
LimidIi e lain full !arae and cited.
Data Cbm Lie #
Date Contnaor
ARCHITECTS DECLARATION
I understand my plana shall be used as public records.
Licenced Professional
OWNER -BUILDER DECLARATION
I hereby afOrmthat l am exempt from the Contractors Lieeve Law ferthe
following reason. ISection 7031.5, Business and Professions Code: Any city or
cmntywhkhrequbesapermittocontr Malteglmprove,demolbh,orrepalr
any structure pdorto lb lsexan<e, alto requlreatheappBesnt foraueh permit to
Me a signed slaterrent that he In licensed pursuant to the pro !ons of the
Contndor'sLicense Law (Chapter 9(mmmencing with Stolon 7000) of Divi.
slon3 of the Business and Professions Code) orthat he in exempt therefrom and
the basis for the alleged exemption. Any violation of Section 70715 by any
applicant for a Permit subjects the applicant to a civil penalty a sea nnre than
five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as thele sole
compensation, will do the work and the structure is not Intended or offered for
sale (Sec 7044, Business and Profession Code: The Contractors Liceme Law
don not apply to an owner of property who builds or improves thereon and
does such work MmseLforthrough hlsown employees, provided that such
Improvements are not Intended oroffered for sale. If, however, he building or
Improvement bsold within one year o(cempldlon the Owner-builderw111 have
the Ituden of proving that he did not baud or improve for purpose of sale.).
I J with licensed
L as owner of the property, am exclusively Business Profession Code:
ess and
Project (Sec. apply
The Commodes
The Coor impo'n Esther law den not apply tct en owner a property who
to an
Wilda or improves hereon and who contracts ice such pto)erb with a
the Contraaw'a License Law.
off Ia m e licensed under Sm
L� I am exempt under Sec 0 k P C for thio reason
APPLIANC75RESTDENTIAL
JOBDESCRH'HON
�� ^ �
'ICY)
CB
PANELS
201-1000 AMT'S
OVER I ODD AMPS
SQ. FT. FLOOR AREA
669
-
-
- $/SQ. Fr.
74.92
SIGNSELECTRICAL
SPFGULCIRCIRT/MLSC
TEMP MFTEROR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OU7LETSSWn'CFIFSnXTURES
VALUATION
r0o 121
NEW RESIDENTIAL ELECTR SQ.FT,
STORIES
TYPE CONSTRUCTION
V.N
TOTAL:
QTY. �,' PLUMBING PERMIT FEE
OCG.GROIIP
R-3
RES. UNITS
1
FLOOD ZONE
APN ,
PERMIT ISSUANCE
ALTER DRAIN k VENT, WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
'
DRAINS. FLOOR ROOF, AREA, CONTI.
SANITARY Y_ N
RECEIPT #
Owner Date
WORKMAN COMPENSATION DECLARATION
pI hereby afform that I have a cedllWts of consent to self -insure, ora
certiflate,afWor#emce
rs'Cepereatlon Inadonce ora rtified copy thereoffsec.
3800, Lab C.I
Policy M
FIXTURES. PER TRAP
SCHOOL TAX Y_ N_ -
RFLFR N'
S
GAFA.SYSTEAf1 INCA OUTLETS
PARKIN Y N
RECEIPT M
GAS EA. SYSTEM-0VER 9 (EA)
Com an
BUILDING DIVISION FEES
IRed copy is hereby lumbhed.
Certified copy h filed Mth the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlscectlon need not be completed Hlhe permit In (oron hundred dollen
W o))orlees.)
I neatly that In the performanceof the work forwhich this permit is Issued,
I shall not employ any person In any manner so an to become subject to the
Worked Compensation Laws of California. Date
AppNOTICEt
NOTICE co AI'PLICANTa, after making hb Certificate o(Exem the Lyou
should become subject to the Work en' CompewUon Provhlom rm, s Labor
Codgyou inked. with mmply with such provinba or thio pedNt shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
IherebyaMrm thatlherebaconsideion lending agency for the perform
anteoftheworkforwhichthbped tbtimed($ec.3097,CIv.C3
Lender's Name
Landcr'a Address
1 cercifyhm I haveread thbappileationand ppethat theabovelnforrrWlan
b correc[.Iagreeto comply with all dtyand countyordlnancmand pate laws
relating to building construction, and hereby authorlu representatives of this
city toenter upon the abovementiomdproperty for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against lbbaltien,judgments, costs and expenses which may in any way accrue
agalnt Wd in cons uence t got ing oflhhpermit
`
Signature of Applicant/Contractor Date
HAZARDOUS MA ALS DISCLOSURE
Will the applicant or future building occupant store or handle haeardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code Section 25532(x)?
p
Yen
ilhed ppllcant Ora mm building occupant use equipment or devices
which eMt havardous air contaminnts as defined by the Bay Area Air
Quality Management Dlsted7
Yen ❑❑ No
Ihave readthebus ousrruterialsroqulrernenlsunderChapter6.95of
the California Health k SafetyCode,Sectioa 25505,25533 and 25534.[
understand that lfthebulMing dean not comettly have a tenant, that It is my
responsibility to notify the occupant of the requirements which moat be met
prior to Issuance of a Certificate of Occu pa ocy.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
'
PAID
Date Remi t#
GREASETRAP
SEWER.SANrrARY.STORMEA.200n.
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N
PAID
Date Revel t#
WAT'Ot SYSI77s1/TREAnIYG
NEW RESIDENTIAL PLMB. SQFT.
TOTAL:
BUILDING E
SEISMIC FEE
TOTAL:
ELECTRICFEE
9R 71
x rkr7 n:"I.,;a
QI'Y{' ... MECHANICALPERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
28.73
-
ALTFRORADDTOMECH.
Dale ReCCIPf#
AIR HANDLING UNIT CTO 10,000 CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER IO,000CFM)
-
CONSTRUCTION TAX
EXHAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HEATING UNIT( TO 100,000 BTILB
Date Recei t#
EA
HTING UNIT (OVER 100,000 BTU)
TOTAL:
J VQ
VENTILATION PAN( SINGLE REBID)
ISSUANCE DATE
P//�E 77
I`RR�
p}
city of Gen? rtinn
ISSUED B ,
BOILER -COMP DEH'OR 100,000 BTUI
BOILER-COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MEIN. SQ.FT.
Owner or aulhodred agent Date
- TOTAL:
OFFICE COPY v