20354APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
tlulldln Project Identification
Building Address:
PERMIT NO.
10100 Torre Ave. Unit 154 (D1.4)
20354
caner.Name: - one:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
API LICA I ION SUBMI 1-1 AL
5/10/90
Contradnr's Name: - Lic. No:
738-4444
BUILDING-E.ECTRICAI PLUMBINGIMECHAMCAL
CATEGORY
CONTROL N
Archited/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add..
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
(hereby effi.td tl.hcensed4n orpr Wwsof Chapterg(mmmm
ingwith Section 7(00)of Dlvlslon3ofthe Buslnessand ProfessionsC°de,and my
Ilmnse Is in !u0 farm and d(ect.
APPLIANCESRESIDDRIAL
N
JOB DESCRB'71pL
�• �.+ N� �•
�] !�
-
PANELS
Lkense Clam LIcN
Date Contractor
RCB
mi-IODOAM
ARCHITECTS DECLARATION
,lunderstand my planssha0 be used as PublicremrdL
OVER1000AMPS
SQ. FT. FLOOR AREA
$/SQ.FT.
SIGNSELECIRICAL
Licensed Professional
SPECIALCIRCUIT/M19C
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractors License Law for the
669
74.92
TEMP. METER OR POLE INST.
fo0owingremon.(Sedim7031.S,Businewand Pmfmss ns Code:Anydtyor
countywhkhrequiresape tWmmtr cgalter,impn ,demolfsh,orrepar
anystmcture prlortolts Lsmarms,also requireatheapplicanl for such pemNtto
file a signed statement that he is limned pursuant to the provisions of the
Conlrador's License Law (Chapter 9(commencing with Section 7000) of Divi-
on3oftheBusnmndProf.b Code)orihehebemmpttherefmmand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 70115 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five M.
hundred
I, as owner
asowne ofthears pro
property, or my employer. with wages there sole
OUTLETSSWITCHES-FIXTURES
$50,121.00
NEW RESIDENTIAL ELFL:IR SQFr,
STORIES
TYPE CONSTRUCTION
Idol r
compensation, Ton, Basin.. work,andthe Code:
ainem.MPm@ml°ro Thee is c.absetuead Intended or offeredLaw
Commdofs Llmnse Law
cafe (and
V—N
apply to who Wild, and
does not such ork owner.(propedywho nempoy employees,
whodoessuchworkhimeendedorough hlsowne. provided that
dthatsuch
OCC. GROUP
RES UNITS
If, however,
improvementiswIdMntendedorooeyed(oreiomth,h er,the
TOTAL:
R-3
ner-pthebulldingor
Improvement lsseld within oris yearolcompldbn, Iheowner-buiderw0l love
tlitprrden of proving that he did not build or improve for purpose of sale.).
1,-J 1, as owner of the property, am exclusively contracting with Ilmneed
mec ntracton to construct the project (S70K Business and Professions Codec
QTY, i. ':`:i«,PLUMBING. PERMIT .' .FEE.
FLOOD TONE
APN
PERMIT ISSUANCE
12
The Contractor's Llmnse Lw does one apply to an owner of property who
builds or Improves thereon, and who contracts for such p,ojem with a
cqp([+dur(s) licensed pursuant to the Conlradoes License Law.
LJ I am exempt under Sec B k P C for this reason
ALTER -DRAIN N: VENT -WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS -FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEBT N
Avner Do.
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate of consent to sell-Inwre, or a
certificate ofW°rkerY Compensation Insurance or a motif ed copy thereof (Sac.
3800, Lab C.)
Polity N
FIXTURES PER .TRAP
SCHOOL TAX Y_ N_
RFiCEBs'TN
GAS EA. SYSTFbf-1 RJCA OUTLETS
PARKFFE Y_ N_
RECEIPT NCAS
FA. SYSITM-0VERd (EA)
CW
Com ray
BUILDING DIVISION FEES
Ned copy b hereby famished.
copy b Bled withh this city Inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANC14ECK FEE
GREASE TRAP
CERTIFICATE OF EXEM PTION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA. 2DOFf.
COMPENSATION INSURANCE
(This sedlon need rad be complded If the permit is for one hundred dollen
(S]IcorfmJ
I mm at la the periemunm olthe work for wNch lMs ptnnit b baed,
Date Rocei I#
WATER THEATER W/VENT'/ELECTR
ENERGYFEE Y N
WATER SYSTEM/TREATING
I .hall not employ any person In any manner w as to become subject to the
Wurkere CompensaOon Laws of California. Date
PAID
NEW RESIDENTIAL PLMB. SQFr.
ApplicaNOTICE
OTICE
NOTICEco become
Act PPLICANT.If,aftermaking thio Certificate ofExemption,ofthe,you
Workers' Cal car
sunt
Date Rcmi t#
TOTAL:
BUILDING FEE
LIQ nn
such provisinprovlsbnsoflhe
Code,shoulyou h%1ttce
Code, rthwith comply with such provisions or this permit shall be
deemed revoked.
r voked.
SEISMIC PEE
CONSTRUCTION
eons LENDING AGENCY
them b la(Sm3nding agency 7,CIv. .) perform
lhereby .ftheaf0rmtwhicreispern s tionIssued
Ince of the work for whkM1 IM1b permit V isered (Sec 3097, Clv. CJ
Lenders NamePLUMBING
Lenders Add. Address
I cottlythatl have read thisappllcationand stmethetheabou infimmolon219
ismmed. I dgmetocomplywlthallcityand countyordlnanmsand datelaws
.TOTAL
ELECTRIC FEE
2$,7,3
FEE
p'iv: „^ `MBCHANICAL'PERh1IT' ` FEE"
MECHANICAL FEE
73
PERMIT ISSUANCE
FEES PAID:
relating tobullding mnstmdion, and hereby authodee representatives of thio
chytoenterupontheabove-mentioned properly for impaction purposes.
(We) agree 1° save, IrWemnitts and keep harmless the City y Cupertino
against llabllltln,7.rdgmenre, mets and expenses which may In anywayacrne
-
ALTER OR ADDTO MECH.
Date Receipt#
AIRHANDLINC UNIT CI'010,000CFM)
SUBTOTAL:
s
agaWtuld Cl en¢ h an godthl.perrolt. O
AIR HANDLINGUNIT (OVER 10,00BCEM)
CONSTRUCTION TAX
Signature of Applicant/Contredor I soate
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
•.
HAZARDOUS MAT ALS DI SCLOSU RE
HEATING UNIT UO 100,(100 BTU)
Date Recei t#
Will the applicant orfuture building occupant store or handle haaardous
material as defined by the Cupertino Murdcipal Code, Chapter 9.1 7, and the
I health and Safety Code � .Srection 25532(a)I
Yea I__I No
'
HATING UNIT (OVPR 100,000 BTI!)
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE '
Will the applicantor future building occupant use equipment or devices
which emit harardous air contaMrunlsm defined by the Bay Ama Are
silty Management District?
u�L, Yes ❑n No
1I
PAID'
BOILER -COMP OH OR 100,000 BTU)
BOILER -COMP (OVER 100,D00 BTU)
(have read the hazeRus materials requirements under Chapter 6.95 of
the California Health&Safety Cods, Sections 75505, 25533 and 75534. 1
understand that if the building does not mrrenlly have a tenant, that it is my
r yy LL [Q7''I
I ..,I y ✓ �vJ�
NEW RESIDENTIAL MECH. SQ.Fr.
responsibility to notify the occupant of the requirements which moat be not
prior to issuance of a Certificate of Occupancy.
T� L /� .y
Ldltt{''tr BI I,.BBPt'lll(i
�� //
ISSUEDBY:J• AWTd VV6Ci -}`U
Owner or authodrad agent Date
TOTAL:
OFFICE COPY