20360APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Buildian Project Identification
Building Address:
PERMIT NO. 0 O
10100 Torre Ave. Unit 160 (A1.2),
2
OwnersName: one.
Town Center Properties
-
CITY OF CUPERTINaBUILDING DIVISION
APPLICATION / PERMIT
5/10/90
ConcosNa.ct+ NaLk. Na
738=4444
BUILDINGELECnUCALPLUMBINGMECHANICAL
CATFLORYCONTROL#
Arohked/Engincer. ' Lk. No:
,Q ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add.
IPFRhITISSUANCE 12M
LICENSED CONTRACTOR'S DECLARATION
[hereby e(firmtFut lam licensed under prwblons o(Chapter9 (mmmrnc-
Inarse l Section force andefalon3ofthe BustneeeandProfealonsC.de,and my
license b In full form end died.
APPEANCESRES[DENTUL -
JOB DESCRIPTION�
PANELS
Ll.Date Clam Lk.#
Date Contractor
201-IODO AMTS
ARCHITECPS DECLARATION
I understand my plamah li bemed u pul,kremrds.
OVERIODOAMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATIONSIPECGLCIRCNT/#LSC
Ihembyaf .that Iamexemptfromthe Contred.e.Limn.e Lawforthe
1 , 115
74.92
TEMP, METER OR POLE INST.
following ma,on.(Sectlon 70315, Business and Professions Code: Any city or
county which requires a permit to construct, alter, Improve, demolish, or repair
any smicture prior to its issuance, also requires the appRmnt for such permit to.
file a signed statement that he is; licensed pursuant to the provisions of the
POWER DEVICES
.
SWIMMING POOL ELECTRIC
Contractor's License Law (Chapter9(mmmendng with Sedhm 7000).( Divi.
son 3 ofthe Businnsad Profemloro CWe)orth.l helsexempt therefromand
VALUATION
the ba W for the alleged exemption. Any vlolatlon of Section 70315 by any
app0mntforaper tU bjedstheapphcanttoadWipemlyo(na mmtUn
OUILETSSWITCHESFIXI"URFS
$83,536.00
live hundred dollars ($500).
❑I, as owner of the property, or my employees with wages as their sale
NEW RESIDENTIAL ELECTR e'Q.FT•
STORIES TYPE CONSTRICTION
compensation, will do the work and the structure It not Intended or offered for
ale (Sec 70K Runde.. and Profmoa Code: The Continuities Umme Taw
V_N
TOTAL:
don not apply to an owner of property who builds or Improves l hermit and
who doeasuch work hlmselfor through We own employees, provided that such
Improvementsro
are net Intended for sale. If, however, the building or
.00C.GROUIa RES UNITS
R_3
improvement beold within mayearofcompldon, the owner-bullderwill have
U"Mm of proving that he did not bund or improve for purpose of sale.).
" L as owner of the property, am exclusively contracting with licensed
to construct the project (Sec. 7000, Buslnea a id Pmfenloru Code:
..
QjY., l`[t. , PLUMBING PERMIT FEE
FLOOD TINE APN
pptMTT ISSUANCE
12
The Comvdori ruse law does napply to an owner of properly who
builds or Improves thereon, and who comrade (or such Irkpoo s with a
opp.cmde) licensed pursuant to the Contrad.e. License Law.
& P C for this rean
L i I em exempt under SmB w
ALTER -DRAIN& VENT- WATER W -A)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE "
OUTSIDE =LS
DRAINS -FLOOR, ROOF, AREA, GOND.
SANITARY Y_ N_
RECEIPT 0
Owner Deem
WORKMAN COM PENSATION DECLARATION
❑1 hereby alf0m that I have • certlRnte of consent to .tI-Insure, or a
mrtifimle&Worken Compossation Insurance or a certBled copy thereof (Sec.
Poli lab CJ
FIXTURES- PER TRAP
SQi00L TAX Y_ N_
RECEIPT #
GAS B.A. SYSTEM.1 IJC.IOUIMETS
PARK FEE Y N
RECEPr #
Policy #
Co�an
GAS EA, SVSH M-0VER d (EA)
BUILDING DIVISION FEES
b herebyFurnished.thcity
LJ[Bed fled copy
crtlpyls(Ikd with the dry inspection division. ,
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHL•CK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
SEWER -SANITARY -S DRM EA pOF[
COMPENSATION INSURANCE
(rhls.ecti.n need not be completed tithe permit Is foram hundred dollars
($100)or tem.) mlo
rtifylhat the performance of thework forwhlch this permit issued, ued,
Date Races ted
WATER HEATER w/VENT/ELl)CTR
ENERGY FEE Y_ N—
WATER SYSTEM/TREATING
I
I shall not employ any person m any manner so a to become subject lathe
Workers Compensation Lawe.(Callfomia. Date
PAID
NEW REEDENT[AL PLMB. _SOFT.
Applicant
NOUCE TO APPLICANT. If, after nuking thisCertRkale of Exemption, you
should become subject to the Workers Compematlon pmvuiom of the Labor
Date Receipt
TOTAL:
IL
567.50
Code, you =at forthwith comply with such provision orthls permit shelf be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.88
I hemthIs a com udion lending agency for the perform
ance of the work for which this permit b blued (Sec. 3097, Civ. CJ
Lender's Name
Lenders Address
Itamiythall have read tMeapplimtonand statethatthe above Information
bmrred. l agree oc.mply with all city and county ordinances and nate law.
TOTAL
ELECTRIC FEE
39.88
PLUMBING FEE
QTY. t•t•;' 1 MECHANICAL. PERMIT ,'s FEE'
MECHANICAL FEE
39 88
PERMITISSUANCE 12
FEES PAID:
relating to building comtrodion, and hereby authodae repreeentatives of this
city to enter upon the above-mentioned property far Impaction purposes,
(We)agree to save, Indemmy an d keep harmless the City of Cu pert ino
against Rabllitles,judgments, costs and expenses which may In any way accrue
ALTER OR ADD TO MFLH.
Date Recei W
AIR HANDLING UNIT CFM[
SUBTOTAL:
h Y& -D
age but said G n cane . ca of to atln f this permit.
�`_ 5 /� /O
_Y/
AIR HANDLING UNIT (OVER ]O,ODOCFM)
CONSTRUCTION TAX
Sig®tumof AppOmnl/Contnon, -7D tee
EXHAUST HOOD(w/DUCT)
CONSTRUCTION TAX PAID:
I
HAZARDOUS MATER DISCLOSURE
Wllltheappllcant orfutum buddtngocnvpant store or handle havrdous
HEATING UNIT(TO 100,000 BTU)
Date ReceI ted
material as defined by the Cupertino Munldpal Cade, Chapter 9.12, and the
Health and Safety Code Section Section 25532(a)?
[:]Yes _ No
Wllltheappllmnt oruturebuildingoavpantuseequipment ordevi.
HEATING UNIT (OVER IW," BTU)
TOTAL:
—f
VENTILATION FAN (SINGLE RESID)
ISSUATE
which emit hexaml. a4 contsmiro t... defined by the Bay Area Air
Quality Management Dist rid?
Ya n Nou
have read the bus ous materials requirements under Chapter 6.95 of
`� jy0
BOILER -COMP GH POR LORO(D BTU)
BOILER-COMP(OVER 100,000 BTU)
the California Health & Safety Code, Sediom, 25505, 25533 and 25531. I
understand that if the bul)ding does not currently have a tenant, that it is my
.
NEW RESIDENTIAL MECH. SQ.FT.
resporuibllity to notify the occupant of the requirements which must be met
„ tr �f ��)f1P,ifID11
prior to issuance of a Certificate of Occupancy.
yl}M-
J
ISSUEDRY: u
Ownor.r authorized agent Date
TOTAL:
OFFICE COPY