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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Proect Identification
""°dlogAd°res`Ph
PERMITNO.
20343
a Unit 1 3 (N1 .3
summa .roesTorre
A
Town Center Properties
CITY OF CUPERTINOUBUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractor'.Name: Lt.. N.
38-4444
BUILDIN&ELECTRICAL-FLUMBING-MECHANICAL
CATEGORY CONTROL#
Architect/Engleaer. Lk. No:
QTY: ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Addreac, D
Pf]2hETISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affion70Mrt )(vislson en3ofthe usines and Pr Cssions9(mmmmc
Ingwes1.fi! 2000) ofDlvifect. ftheBueime.and ProleWanaCade,and my
license le In (uLL force and effect
AI'PI.IANCESRESIDENML
JOB DESCRIPTION
PANELS
Limn.[ Claes LloY
Date Contractor
UP TO 200 AMPS
RCB
20-IOX)AMPS
ARCHITECT'S DECLARATION
I understand my plans shall be used as public remrda
OVERIODOAMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
. SIGNS ELECTRICAL
Licensed Professional
909
74.92
SPECLLLCEICUIT/MISC
OWNER -BUILDER DECLARATION
I herebyaf(irm that I am exempt frwnthe Contractor's License Law for the
TEMP MEIFR ORPOLE INST.
following moon. (Seatlon 7031.5, Business and Pmfesslons Code: Any city or
countywhich mqu Ire. a permit to mmutmd, aIle q impmve, demolIsh, or repair
anystructure ferlortolts Issuance, also requirestheappliant(orsuch permit to
file a signed statement that he is Licensed pursuant to the providom of the
POWER DEVICES
-
SWIMMING POOL ELECTRIC
Contractor's License Law (Chapter9(mmmencing with Section 7000) of Divi.
sion 3 oflhe Business and Pecd.ssime, Code)orthat he Is exempt therefrom and
VALUATION .
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fees permu subjectsthe applicant to a civil pemky of not morethan
five hundred dollars($500).
❑I, as owner of the properly, or my employees with wages as their sob
OUTLETSSWITCHFSHXTURFS
$68,102.00
NEW RESIDENTIAL ELECTT( �,Ff.
STORIES
TYPE CONSTRUCTION
mmpensatton, will dothe work and the structure isnot Intended or offered for
ale (Sec. 7044, B..m s...d Profemlom Cade: The Cmd,actoes License Law
V -N
does not apply to an owner of property who builds or improve, thereon, and
who daessuch work hiroalf or through his own employees, provided that such
OCC.GROUP
RES. UNITS
improvement are not intended or offered for sale. If, however, the building or
Improvementbsoldwithinoneyearofcompledon,thetuwner-builderwlllhave
t rden of proving that he did not build or improve for purpose ofb.).
La
L as owner of the property, am exclusively contracting with licensed
sct mruwct the project (Sec 704y Business and Pofessimu Code:12
TOTAL:
.,
QTY; PLUMBING PERMIT," FEE'
R-3
/
1
FLOOD ZONE
APN
'
PERMIT ISSUANCE
The Cmd
The ontrsctor'• License Lw does not apply to an owner of property who
builds or Improves thereon, and who contra for such pkt)*m with •
o.d.d.r(a) licensed pursuant to the Contractors License Law.
I am'exempt under Sec B A P C for this reason
ALTER -DRAIN k VENT- WATER OW
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS FLOOR, ROOF, AREA, GOND.
SANITARY Y_ N_
RECEIPT Y
Owner Date
WORKMAN COMPENSATION DECLARATION
[:]I hereby affirm that I have . esrtlflate of consent to self -Insure, or
mrtiflateofWorkeWCompe.s Honlnsuanmmamnifiedmpythem f(Sec.
3800, Lab C.)
Policy Y
FIXTURES- PER TRAP
SCHOOL TAX Y_ N_
RECEIPT
GAS EA. SYSTEM -1 INCAOIITLETS
PARK FILE Y_ N_
RECEIPT
Co�any
GAS P.A.SYSTEM-OVER 4 (EA)
BUILDING DIVISION FEES
[aCNed copy Is herebydwith t le cityed.
ertified copy b (tied with the city inspection division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thusee ion need nes becompleted If the permit b fortune hundred dollars
Date Reset [»
SEWER -SANITARY -STORM EA 2f10FT
WATER HEATER W/VENT/EJECTA
ENERGYFEE Y N
(f100)orfeas.)
I ceor lm.at in the performance ofthe work (orwhlch this permit le issued,
WATPR SYSTEM/TREATING
1 shall not employ any person In any manner so as to become subject to the
Workere'CompeneaHon Lawsof Califomla. Date
PAID
Applicant
NOTICE TO APPLICANT: R, after making this Certificate of Exemption, you
Mould become subject to the Worlurs'Compemation provisions of the Labor
NEW RESIDENTIAL [.LMB. SQFT.
Date Recei t»
TOTAL:
BUILDING '
O
Code, you =at forthwith comply with such provisions orthis permit Mall be
deemed revoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirenthat theme is a commuctim Lending agency for the performTOTAL;
an" of the work for which this permit Is Issued (Sec. 3097, Civ, CJ
Iandere Name-
Lender'.Addresa
I mdifythat I Mvemad thbappliatlonand statethattheabove Information34
borne[.( agree to complywith all cityand muntyordinances and state laws
ELECTRIC FEE
34.73
QTY. 'MECHANICAL PERMIT', - '' PEE
PLUMBING FEE
14-71
MECHANICAL FEE
73
PERMITISSUANCE
FEES PAID:
relating to building rand uctlon, and hereby authorizerepresentativesof this
city to enter upon the above.mentioned property fou Inspection purposes.
(We)agree to ave, Indemnify an d keep harmless the City of Cu pert Ino
agaimt liabilities, judg mmi uds, coats aexpenses which may In any way acwe
ALTERORADDTOMECH.
Date RxeiptA
AIR HANDLING UNIT
SUBTOTAL:
ag.Wtsai CtIn or ence t Lin Ing ot thin permit
j
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
Dg
Signa urc of AppBantanor a
IXHAl15'f HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO 100,00O BTI)
Date Recel t0
Will the applicant or future building occupant store or handle hamrdme
material as defined by the Cu pertleo Municipal Code, Chapter 9.1 7, and the
Health and Safety Code Section 75532(1)7
❑ Yes No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
O .9
VENTILATION FAN (SINGLE RESID)
I WANCE DATE
Will the applies est or lure building occupant use equipment or devices
which emit haaardous air ontaMmnts as defined by the Bay Area Air
Quality Management District?
Yea readthehazaiojj��II No
ttmsunderChaper6.95of
4havcusmaterials regWen
Q(�
BOILER -COMP OHP OR 100,000 BTU)
BOILER-COMPFR000
(OVI00,BTU)
the Calif.ia Health h 9.(&yCd, Sections 25505, 25533 and 75534. 1
understand that lithe building daea notomotly have a tenant, that it 6.,y
responsibility to notify the occupant of the requirements which moat be met
/�
of Cuaertlno_
NEW RESIDENTIAL MECH. SQTT
prim to issuance of a Certificate of Occults my.
,City
ISSUED RY:
Owner or authorised agent Date
TOTAL:
OFFICE COPY