20336` APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Protect Identification PH7(MIT NO.
Budding Add
�°20336
10100 Torre Ave. Unit 136 jN1.1)
nets assn: one.
-APPLICAHON
SUBMII IAL
Town Center Properties
CITY OF CUPERTINO-BUILDINGDIVISION
APPLICATION I PERMIT
S/10/90
Contactors Name: Lm. Na:
738-4444
BUILDING-ELECTRICAleFLUMBINGMECHAMCAL
CATEGORY
CONTROLAl
ArehltM/Engiraer. - Lle No:
QTY ELECTRIC PERMIT " FEE
BUILDING PERMIT INFO
Add.
EZ
PERMITISSUANCE
19
LICENSED CONTRACFOR'S DECLARATION
—
I hereby affirm that l am licensed under provisions of Chapter9(mmmenv
In$Mth Section70(D)of Divieion3oftheBaimssadPmfnMd Code,andm
APPLIANCES -RESIDENTIAL
- JOBQESC�Na//`
licenseIs In fullforce and effect.-
PANELS
l/ -\J
S
n
License ClaLM.Y
RCB
Dale Contrador
— UP TO 2D)AM126
201-1000 AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used As pub0c recoNa
IOVFRIOOOAMPS
SQ. FT. FLOOR AREA
$/9Q. FT.
SIGNSELECTRICAL
Licensed Professional
909
74.92
SPECIAL CIRCUIT/M]SC
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractor's License law fm the
TEMP METER OR POLE INS(.
following ... (SecHon 7031 S, Business and Professions Code: Any city or
muntywhich requ resa perrrdt to mmtmd, alter, improve, de=16h,orrepalr
'
anydm=mpdortoib issuance,alsorequlreelheappRmntforsuchper tto
fib a signed statement that he Is licensed punoant to the pmelsWN of the
Contractor's License Law (Chapter 9(mmmencing with Section 7000) of Dwl-
Alan 3 of the Business and PmfessioaCade) or that he isexempt fherefromarul
POWER DEVICES
'
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7011.5 by any
Applicant for a permit subjects the applicant to a civil penalty cf net more than$68,102.00
OUTLETSSWITCHFSFIXTURFS
NEW RESIDENTIAL EL1GTR
five hundred dollan(SrW).
�I, as owner of the property, or my employees with wages a their salecSQFT.
STORIES
TYPE CONSTRUCTION
mmpensaflon,widdathe work ancithe structure Isnot Intended or offered for
sale (Sec. 7094, Business and PmfemlON Code: The Contractors License Law
V_N
does not apply to an owner of property who builds or improves thereon, and
whodoessuchwork himseRorthrough hbownempioyeea, provldedthatsuch
OCC. GROUP
RES UNITS
Improvements are not intended oroffered(orale. If,howevepthebulldingor
Impmvemnntissddwithlnomyearufcompldloa.theowner-bulWerwlllhave
TOTAL:
,.
11-3
tryspuben of proving that he did not build or Improve for purpose ofsalaJ.
L3 L as owner of the property, am exclusively mntmctlng with licensed
contractors to coratrot the project (See 7096 m , Business and ProfessiaCode:
QTY, , PLUMBING PERMIT FEE
FLOODZONE
APN
PERMITISSUANCE 12
The Contactors License law don not apply to an owner of property who
Wilds or Improves thereon, and who contracts far such pi jade with a
ryB(pdor(e)Rcemed pursuant to the Contrad&. License Law.
Lj I am exempt under Sea B 6 P C for this reawn
ALTER -DRAIN h VFM-WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR, ROOF, AREA, GOND.
SANITARY V N_
RECEIPT If
Owner Data
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate of consent to self -insure, ors'
cedflrcate o(Worker%Compematlon Imuran ore edified copy thenvf IS".
3800, Lab C.)
Policy
PIX77JRES PER TRM
SCHOOL TAX Y N
RFGIOPT M
GAS EA.SYSTEM-I INC40UTLETS
PARK FEE Y N
RECEIPT Y
yY
Coany
GAS EA. SYSTEM-OVER4(EA)
-
BUILDING DIVISION FEES
copy Ishereby (ur.
Ified rontshed
emtlfled copy Is filed -Mth the city lmpcdlon dlvbion.
GREASEANDUSMI, WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF IOEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need not be completed lithe permit isfor one hundred dollars
SEWER -SANITARY -STORM EA. 200RT.
Date ReCel t#
WATER HEATER w/vF1-].r/FyEt.c.R
ENERGYFEE Y N
PAID
(Bt00)ar len.)
I certify that in the performance of the work for which this permit is ted,
hea
I .hall not employ any person In any manner so as to become subj.d to the
Workeri CompenaHon laws of California. Date
WATER SYSTEM/TREATING
Applicant -
NOTICE TO APPLICANT: If, after nuking this Certificate of Exemption, you
should became subject to the Workers' Compensation provisions of the Labor
NEWRESIDENTIAL PLMB. SQ.FT.
Date Recel ted
TOTAL:
B UILDING FEE
son r)nl
Code, you most forthwith comply with such provisions or this permit shall be
deemed revoked.
SEISMIC FEE
4.8
CONSTRUCTION LENDING AGENCY
Iherebyaffinn that there Is a construction lendingagency for the perform,
ance of the work for which this permit Is Issued (Sec. 3097, Civ. CJ
Leader'. Name
Lenders Addrev
1 certifythat I havereadthis appllcationand datethattheabovelnformation
Is correct. I agree to comply with all clfyand county ordinances and state laws
TOTAL:
ELECTRIC FEE
34.7
PLUMBING FEE
34.7
QTc`. t�. °MECHANICALTERMIT, FrE,:
MECHANICAL FEE
34.73
PERMIT ISSUANCE 12
FEES. PAID.
relating to W ilding construction, And hereby authorize representatives of thio
city to enter upon the abovcmentloned property for inspection purposes.
(We) agree to ave, indemnify an d keep harmless the City of Cupertino
egaWtllabilltke, pdgment., codeand expenses which may In anywayaccrue
ALTER OR ADDTO MECH.
Date ReCefPtli
-
AIR HANDLING UNIT(to 10,ODO CFM)
SUBTOTAL:
0
agahmtaid CJJyyJJn ronsequenc9.of lye gr Iing o(tib permit.
�Z 11190
Sigrutureof Applicant/Contractor aI MW
AIR HANDLING UNIT (OVER 10,(IOOCFM)
CONSTRUCTION TAX
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA IALS DISCLOSURE
Will the applicant orfuture budding occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.17, and the
Health and Safety Code Section 25531(9)?
❑ yes . M No
W11 the applicant orfmme building occupant use equipment or devices
HEATING UNIT (To 100,000 BTU)
Date Recel til
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
. D
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
which emit hazardous ab contaMmnb as defined by the Bay Area Air
Q+buy Management District?
j��L 1
BOILER-COMP(3HPOR 1DO,000 BTU)
Yn
1 Ip
aa2M
BOILER-COMP(OVER 110,000 BTU)
MNo
have read the has oua materials requlrerccnb underChapter6.95 of
the California Health A SafetyCode,Secitom 25505, 25513 and 15539. 1
understand that lithe building does not currently have a tenant, that it is my,
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which must be and
prior to issuanre of a Certificate of Occupancy.
'
City of Cunerfinn ,
ISSUED BY: s 0
Owner" authorized agent Date
TOTAL:
OFFICE COPY