20327APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Proed Identification
Building Address:
PERMIT NO.
20327
10100 Torre Ave. Unit
neva aces: one.
Town Center
CITY OF CUPERTINCLBUILDING DIVISION
APPLICATION / PERMIT
5/09/90
C..bactoe.Name: LIc.No:
738-4444
BUILDINGELECTR)CAI PLUMBINGMECHAMCAL
CATEGORY CONTROL#
Architect/Engineer. Lta No:
. QTY I ELECTRIC PERMITFEE
BUILDING PERMIT INFO
Add.
13d IR R1
ER
I'ERhRTI55UANCE
LICENSED CONTRAROr DECLARATION
I hereby affirm that ce t]alicensed under provisions o(Chapter9 (mmmmc
f<he Bugnsssandlarofugon&Code, and my
limens Is In fail force and effect.
limnse ISect1on force and
APPLIANCES -RESIDENTIAL
JOB DFSCRIIxr10N
F\ ,. r
I -J W
PANELS
D,d,Chen LIc#
Dale Contrector
RCB
'
201-IDOOAMPS
ARCHITECT'S DECLARATION
I understand my pians shall be used as public record..
OVER 1000 AMPS
SQ. Fr. FLOOR AREA
$/SQ. Fr.
SIGNSELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby dorm that I am exempt from the Contractor'. License Law for the
1040
74.92
SPECIAL CIRCUIT/M1SC
TEMP. MEfEROR POLE INST.
following ... (Section 7031,5, Business and Professions Code: Any city or
counlywhkh requires a penrdtromnstruct, alter, Improve, demolish, ormpair
anystm=mpriortolbbmanee,abomquimtheapphuntforsuchperMtto
file a signed statement that he is licensed pursuant to the provisions of the
Conlnctoes License Law (Chapter 9 (commencing with Section 7000) of Divi-
gon 3 of the Business and Pre(ess(ons Code) arthat he b exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
for a permit subjects the applicant to a civil penalty of not name, than
)OWER DEVICES
"
SWIMMING IDOL ELECTRIC
OUTLETS -SWITCHES -FIXTURES
VALUATION
fit�undred dollars (15(
1, as owner of the property, or my employees with wages as their sole
NEW RESIDENTIAL ELECTR SQFT.
STORIES
TYPECONSIRUCTION
mmpenwtion, will do the work. and the structure Is cot Intended or offered for
sale (Ser. 7014, Business oil Professlons Code: The Contractor. License Iaw
does not apply to an owner of property who builds or improves thereon, and
who does suchwork himaelforthrough his own employee., provided that such
Y_jv
- OCC. GROUP
R6. UNITS
improvement are not Intended oroffered for sale. If, however, thebullding or
Improvement bwldmthinoneyearofcampletb theownerbuBderwill have
TOTAL:
R-3
'
ttalZurden of proving that he did not build or Improve for purpose ofsale.).
j_j L as owner of the property, am exclusively contracting with licensed
contractors to construd the project (Sec 7014, Business and limfessiova Code:
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE
TM Contmetore License Law does not apply to an owner of property who
Wilds or improves thereon, and who contracts for such p(o)em with a
cgREl.ctc(a) licensed pursuant to the Contractor'. License Law.
LJ I am exempt under Sec B k P C for this reawn
ALTER -DRAIN AVENT- WATER (FA)
FEE SUMMARY
BAIX FLOW PROTECT. DEVICE
DRAINS FLOOR, ROOF, AREA, COND.
DRAINS-
SANITARY Y N
#
Owner Date
WORKMAN COMPENSATION DECLARATION -
❑I hereby atfan that I have • cerdficate of consent to self -Insure, ora
ce0011,0olWorkere Compensation Insurance arammifled copy thereo((Sec.
Polis Lab C3
Policy
F.IX.TU�S PER .[.LAI,
SCIilX1L TAX Y N
RFCE�I'
GAS PA. SYSTEM -1 INCAOUTLETS
PARKFTE Y_ N
RECET T p
#
Company
GAS. EA. ESYSTEM-OA) VER 4 (E
BUILDING DIVISION FEES
L� Ified copy is hereby famished.
edified copy b filed with the city Inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
GhlssecHmn need not be completed 0the permit b forone hundred dollars
SEWER -SANITARY -STORM EA. WIFE
Date Recei t#
WATER HEATER W/VENT/ELOCTR
ENERGY FEE Y_ N_
(S100)orl..)
I mmifythat In the performanceof the work fnrwhich this permit Is issued,
WATER SYSTEM/TREATING
I shall not employ any person In any manner so as to become wbject to the
Workcn' Campensatton law. of C.1 forma. Dae
PAID
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you
should become wbjed to the Workers' Compensation provisions of the Labor
NEW RESIDENTIAL PIMEL SQ.FT.
Date Recei Hl
TOTAL:
BUILDING
Coda you must forthwith comply with such provblons orthb permit &hall be
deemed cooked.
CONSTRUCTION LENDING AGENCY
-
SEISMIC FEE
5.46
I hereby affirmlhat them is a construction lendingagenry forthe perform
anceof the work forwhlch thb permit It blued (Sec. 3097, Clv. C.)
lander. Name
Lenders Addross -
IcemifythatlhavereadthbappButbnandetatethAtheabovein(carnation
bcormd. I agree to complywBh all city and county ordinances and gate laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE119-00
-
QTY,: !? ':;,IjMECHANICAL PERMIT n't? .FEE
MECHANICAL FEE
PIRMITISSUANCE 12
FEES PAID:
relating tobullding construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for inspection purposes.
(We) agree to save, indemnify an d keep harmless the City of Cu pert iso
against liabilities, ).dgments, cogs and axpc..s which may In any way accrue
ALTERORAODTOMECH.
Date Recei tN
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL'
againslaaid inconsequence it gra agafthiapermit
AIR HANDLING UNIT (OVER IO,ODO CFM)
CONSTRUCTION TAX'
Signanattreof Applicant/Contractor to
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO 100,000 ETU)
Date Recei t#
Will theapplicant orfuturebulldingoccupant stomor handle haaardous
diderbt a. defided by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Cade Section 25532(a)7
nn YetNo
TVllltheapplicantor tore Wllding occupant use equipment or devices
HEATING UNIT (OVER 100,000 BTI)
TOTAL:
, e�
VENTILATION FAN(SINGLE RESIDE
ISSUANCE DATE
Mich emit hazardous air contaminants as defined by the Bay Area Air
a llty Management Distrlal
Yes F1 No
have read the hazardous materials requirements under Chapter6.95 of
the California i lealth A Safety Code, SM Ions 25509,2S.S33 and 75530. I
understand that tithe building does not arrently have a tenant that It is my
PAID
PAID
' L
BOILER-COMP(3HROR 100,0[10 BTU)
BOILFA-COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MECO. SQ.Fr.
mporul601tyto rally the occupant of the requirements which must be met
prior to issuance of a Certificate of Occtipanry.
.y
City Ofp CUpP1`I np
)SSUEDBIJ (/
Owner or authorized agent Date
TOTAL:
u
OFFICE COPY