20344\ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project identification
Building Addrtu: -
PERMITNO.
10100 Torre Ave. Unit 144 (Cl)
20344
TareName: one:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
ATE
5/10/90
CrntradorsName: ue.N.
738-4444
BUILDINQELECTRICAL-PLLJMBING-MECHANTCAL
CATEGORY
CONTROL#
Archltea/Englraer. Lie. Na
,Q7R ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Address:
PERh11TISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I herebya(tlam@rnadavWr9c
Ingwfon7ODD)nDlvftheBuMnrndPmfmsimsCade,and my
licenseIs In full formand effect.
APPLIANCFSRFSDENML
JOB DES`C,Ax El'I_TO1i�N
D -
RCB
PANQ
Lt..o Chas elf
Dale Contractor
UP TO 200ANIPS
201-IOOOAMPS
ARCHITECPS DECLARATION
I understand my plam.hailbe used as public records.
OVER I000 AMPS
SQ. FT, FLOOR AREA
$M. FT.
SiGNSELEOTRICAL
Licensed Professional
1 s 181
74.92
SPECIAL CIRCIRT/MLSC
OWNER -BUILDER DECLARATION
I hereby of 1. that [ am exempt from the Cmuradore License Law for the
'
gFAtp METER OR POLE INST.
following reason. (Section 7031.5, Business and ProtmWnt Code: Any city or
county which requires a permit to congrun, alter, Improve, demolish, or repair
-
any structure prior to its Issuance, also require. the applicant for such permit to
file a signed statement that he Is Bcenaed pursuant to the provisions of the
Contractorb Licence Law (Chapter 9(rommancing with Section 7000) of Divi-
Won 3 ofthe Business and Profesaloru Code) orthat he Is exempt therefrom and
the WaIs for the.leged exemption. Any violation of Sedlon 70315 by any
applicant fora permit subjedathe applicant to a civil penalty of nest rtdre than
OFll, ..hundred dollars .fth.00).
❑ I, as owner of the property, or employees with wages as thele sok
[OWER DEVICES
,
SWIMMING POOL ELECTRIC
OUTLETSSWITCHFSFIXTURES
VALUATION
$88,481.00
NEW RESIDENTIAL ELECTR SQFT.
STORIES
TYPECONSTRUCTION
ha
compensation, willclothe Code: h Contended oroffered for
Bu sinessand Profmiom Code: The Llamalaw
ale(Sec.70Kot
V—N
pply or Impr ,da
dos oessu apply torn owner ofpmpmtywho nem oyees,provided
who uchw orough hlsors employees, pr ovidedreoRand
such
OCC. GROUP
RES. UNITS
not Intended thebuhil
ed
improvements am issold lntendneyear(ered(olationale. If, owner -q ilderwdi have
Improvement sli
PwW wlththedid
TOTAL:
R-3
of notbroildori prove fner-bulose of ale.).
Ll� Lasoner ofteproerty,abxclorimprovefactingou oaeofcense
1_I 4 er owner of the property, Se exclusively Bush.anding with aCodd
contndon to coretsuct the project (See 7WA, BueNm and Profeasbro Cade:
QTY, PLUMBING PERMIT' FEE''
FLOOD ZONE
APN
(PERMIT ISSUANCE
12
The Contractees License Law does not apply to an owner of property who
Wild. or Improves thereon, and who contracts for such jnplac t with a
mygador(U licensed pursuant to the Contractors Llanse Law. -
Ll I am exempt under Sec. B & P C for this ..on
ALTER -DRAIN & VENT - WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT' DEVICE
DRAINS FLOOR ROOF, AREA, CONED.
SANITARY Y_ N_
RECEIPT N
Owner Data
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have • certificate of ..or to self -insure, or
nrtifiate of Workers' Compensation lremeance er a certified copy thereof (See.
3800, Lab C.)
FIXTURES PER TRAP
SCHOOL TAX Y N
RFCmrp N
CAS EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y N
RECEIPT N
Policy Y
Com any
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DI VISION Fr. FS
ified copy Is hereby furnished.
an copy Is filed with the city Inspection division.
S
GRFAE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GRFASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thlssedlon need nes be complded tithe permit later.. hundred dollars
SEWER-SAMTARY-STORM EA. 700Ff.
Date Reseal tH
WATER HEATER W/VENT/ELDCTR
ENERGY FEE Y_ N_
(SI ID)a1m)
I cedl(ythal N the pedomana of the work (orwhich this permit le IssuM,
WATER SYSTEM/TREATING
I shall not employ any person to any manner m as to become subject to the
Workers'Compensatlen[aw.of6ltfomla. Date
PAID,
ApplicaNOTICE[
NOTICE co APPLICANT:ttohe altar making pse atism pro is Fxemp he Labo
Cowl.becomesubtleto the Workers'Compemation Labor
NEW RESIDENTIAL PLMB. SQFT.
Date Recei tit
TOTAL:
BUILDING5
0. 00
CodgYom orthioraofthe
voked.with comply with such provIslona orthIs permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
6
I herebyaffirm that there Is a construction
lon lending agency for the perform,ELECTRIC
arca of the work for which thin Permit Is Issued (Sec. 309'/, Civ. CJ
Landers Name
Landee. Address
I mnifylhat I have madthisapphatOnand galethal theaboveln(ormatlon
Is comma. l agree to comply with all city and munty ordinances and gate laws
TOTAL:
FEE
41 53
PLUMBING FEE
41.53
r.
QTY. is'MECHANICAL PER FEE
PERMIT ISSUANCE 12
MECHANICAL FEE
FEES PAID:
relating to building 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 harmieas the City of Cupsdino
against liabilities, judgrrnma,cog. and expenses which may In any way aedue
ALTMORADDTOMECH.
Date Re:eip t#
AIR HANDLING UNIT CFO 10,000 CFM)
SUBTOTAL:
7ZO,k
a g a best aald%CI �'�n co ^ f t9Ed this pecon I.
liJ ilKi
AIR HANDLING UNIT (OVER 10,0o0CFM)
CONSTRUCTION TAX
Ka� ay/6�0
Signature of Applicant/Commetor a
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
-
HAZARDOUSMATERICALSDISCLOSURE
HEATING UNIT (M 100,000 BTU)
Date Reeeiptll
Will the applicant or future building odvpart at.. or ba od le hazardous
cos ectal as defined by the Cu Pertlw Municipal Code, Chapter 9.17, and the
Health and Safety Code— Section 25532(a)i
❑ Yes _I No
Will the applicant or wm building occupant use equipment ordeelcea
HEATING UNIT (OVER 100" RITZ
TOTAL:
Z
VENTILATION FAN (SINGLE RESID)
IT"CE-DATE
which emit ham elves air contaminants as defined by the Bay Area Air
Quality Management D❑itrld7
No
4havee read the hazard mar materials requirements under Chapter 6.95 of
Is�ra116.0
BOILER-COMP(3HP OR 100,000 BTU)
BOILER-COMP(OVER 103,000 BTU)
the CilRornh Health & Safety Cade, Sedlmo 25505,25S33 and 75534. 1
understa nd that if the building does em currently have a tenant, that it Is my
responsibility to notify the occupant of the requirements which must be met
N#�s /t `
of Cuoier{In$
NEWRFSIDFNTIALMECH. 'SQ.FT
price to Issuance of a Certificate of Occupancy.
,laity
ISSUED BY: aI, f N�k ye—c- D`
Owner or aulhorined agent Date
,TOTAL.
OFFICE COPY