20331APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project identification -
Building Address:
PFRMATNO."
20331
10100 Torre Ave. Unit 131 E1
wners ams: one.
Town.Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
cwtaanr. Name: Lie. No:
738-4444
BIILDINO-ELECTRICALPLUMBING-MECHAMCAL
CATEGORY
CONTROL
Architect/Engineer. Lk. Na
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lamlicensed under provlaloneo(Chapter9(mmmen
Ingwith Sealon7000)of DiW9=3oflhe Buknessand Pmfession,Code,and
license lsln mU(amand cies.
AI'PIIANCESRE5IDENTIAL
JOB DESCR1Pn0l((y
PANELS
Llano Clam Llca
L(B "
Date Contactor
UP TO 200 AMS
201-IDOOAMPS
ARCHITECTS DECLARATION
I understand my plata ah.0 be used As public record..
OVER I ODO AMPS -
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Lhenacd Professional
791
74.92
SI'FIIAL CEiC[IT/MIST
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Taw for the
following reason. (Section 70115, Business and Professions Code: Any city or
rountywblch requbea a permit W mmtmct, titer, bnpmve, demalbh, orrepkr
-
TEMP. METER OR POLE INST.
anystruatureprbrtoitsWuarceaborequlreatheappliant forsuch permit to
file a signed statement the he is licensed pursuant to the provbrov of the
Contractor's License Law (Chapter 9 (mmmencing with Seaton 7000) of Divi-
sion 3 of the Business And Professions Code) or that he b exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
appliant fora permit subjects the applicant to a civil penalty of not more than
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETESWITCHFSFDOURES
VALUATION
$59s 262.00 '
M.
oT1'Asrownered of the pro
Luh I, as owner of the property, or my employers with wages ser there
NEW RESIDENTIAL ELECTR SQP7.
STORIES
TYPECONSIRIICTION
do the wakandthesemaureis et offered fo
c mflec.7
KB knel
Ask (Ecc 7064, Business and Prooperty Code: The Contractor. theme, Law
he Contended L...L w
does not apply torn owner orthrou h who nempoyees,povidedrmR and
who Maesuch work himseaathrough Msownemployees,providedthat such
�/—r]
OCC.GROUP
RES UMI9
improvement Are And iniended neyear lfcompletimthehowever thderwilingm
got
Improvement beoM within thee
Por
TOTAL:
R-3
'
he did mat im for purpose of sahave
tl(, jL as ones ing of the property, exclurimproveforpur with
u I, ere owner tr the property, am exclusively Business
mntntton ct mrvwct the project (Sec. Andcontrading with licensed
Busmen and Code:
Q7y, PLUMBING PERMIT. '.FEE
FLOOD ZONE
APN
PERMIT ISSUANCE
12
TheWil Contractor's Limner Taw does not apply tct an owner I property who
not apply of property
Wilda t Improved thereon, and who contracts for such ploieN with a
a�6t�+ctor exempt underuantrothe Contractor's License Law.
LJ I am exempt under Sec B & P C for this reason
ALTER -DRAIN k VENT- WATER (EA)
FEE SUMMARY
BACKFLOW PROTECT. DEVICE
OUTS I DE FEES
DRAINS FLOOR, ROOF, AREA, COND.
SANITARY Y_ N_
BBC=a
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have • mrtlaces, of consent to self -Insure, ora
3800, teofWorken'Comperwtian lruunnceora cekllhd mpythemof l5ec.
3800, Tab C.)
FIXTURES PER TRAP
SCHOOLTAX Y_ N_
RECEI T N
GAS EA. SYSTEM -1 INCA OUTLETS
PARKFEE - Y N
RECEIPT R
C. M
Co�any
GAS F.A.SYSTEM-OVER4(EA)
BUILDING DIVISION FEES
IBM copy b hereby furelehed.
edified copy Is filed with the city inspection dlvlkon.
CREASE/INDUSCRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF E!K MPTION FROM WORKERS'
PAID
COMPENSATION INSURANCESEWER-SANITARY-STORM
GMM section need out be completed If the permit Is forme, hundred dollars
Date Rf i t#
EA. 4001'1'.
WAIER� ER WIVENT/ate
ENERGY FEE Y N
PAID
s100)aless3
the performance of the work whichW
I ser less.at N perperformancea t which this permit is oad,
I shall not employ any person In any manner so as to become subject to the
Workers' Compensation Laws of California. Date
WATER SYSTEM/TREATING
Applicant
NOTICE TO APPLICANT: V, cher making Ude Certificate of Exemption, you
should subject to the Workers' Compewi provisions the Labor
Date Recei t#
NEW RESIDENTIAL PLMB.SQFr.
TOTAL:
BUILDING
oum us
Coda you must fathwllh comply with such provisions orchis pertmt shall be
io permit
deemed revoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hembyafflrmthat there is amratmctlon lending agency for the perform-
anceof the work for which this permit b Issued (Sec. 3097, Clv. C.)
Isnder's Name
Lender.Addmss
certifythatl have readthbappliatlon end katthattheabove Infomation
Iscorrect. I agree mcomply with all city and county ordinances and kale laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE
31.78
- .._
QTY. " ,_, MECHANICAL PERMIT,., - I'E6MECHANICAL
FEE
PERMIT ISSUANCE12
FEES PAID:
relating to building construction, And hereby authorize representatives ofthis
city to enter upon the above-mentioned property for inspection purpose..
(We) agree to save, indemrdty an d keep harmless the City of Cupertlro
against liabilities, Judgments, mica and expenses which may N any way amus
-
ALTERORADDTOMECH.
Date ReCei t#
AIR HANDLING UNIT UO 10,000 CFM)
SUBTOTAL-
.0
against said CI In roneequence f < a a this Parent,
AIR HANDWNG UNIT (OVER tO,ODOCFM)
CONSTRUCTION TAX
Signature of AppUant/Contractor /Dafe
EXHAUST I TOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HALkRDOUS MA LS DISCLOSURE
Will the applicant or fumm building mcupant store or hand Is hazardous
material as defined by the Cupertino Municipal Cale, Chapter 9.12 and the
Health and Safety Cade Section 25532(a)I
Yes Na
HEATING UNIT 070 100,000 BTU)
Date Rmei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
ilig
VEN77LATION FAN (SINGLE RESID)
ISSMG&DATE
��Iti:pj '
�1
Rllilhe appliant or sure buildingompant use equipment or devices
or
whkhemlthazard... air contaminant, as defined by the Bay Area Air
Quality Management District?
❑Yn j� No
ii our materials requireenunder Chapter 6.95 of
Ihave read the harur`mt
BOILER -COMP C1HP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTI!)
the Glifomia Health k Safety Code, Sections 25505, 25533 and 25534, I
understand that lithe building does not currently have a tenant, that It Is my
'
NEW RESIDENTIAL MECH. SQ.Fr
roparuib0lty to na l/y the occupant of the mqulremvnla which me at be metCf
o Cupertino
prior to Issuance of a Certificate
te of Occupancy.
` � /
ISSUEDSY: �t`
Owner or authorized agent' Date
TOTAL:
OFFICE COPY