20363ArrLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification -
Building Address: _
Tnrr, D
PERMITNO.
203623, 36e3.
WMr9 attic, Phohe:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION,/ PERMIT
5/10/90
C.M.cmr'sName: Lk. No:
738-4444
BUILDING-ELECTMCALPLUMBING-MECHANICAL
CATEGORY
CONTROL#
ArcMtM/Engineer. Lie No:
;QTY .. ELECTRIC PERMIT, FEE
BUILDING PERMIT INFO
Address
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
APPUANCESRFSIDENML
IMh Sec dRrm lhrilamlken3 ofthe erprovand Prof h orar9(commnc
fthe Budneuandpro(ueloneCode,and
Ingweh 1. fon 7(100)oforce And effecisiont.
license b in (u8 force and dfect.
_ ss Co
D
Date omnctor
LOB DESCRIPTION
S, e,. D
rahe R B
PANELS
201-10DDAMPS
ARCHITECTS DECLARATION
I understand my plans shall be used As public records
OVER 1000 AMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL -
Licensed Profs®tonal
OWNER -BUILDER DECLARATION
I hereby affirthat I Am exempt fronethe Contractor's Llan. Law for the
foil affirm that
reason.(Saction 7831.5, Budnessand PeAfessions Code: Any city or
ceuntywhkh requreu • permit tocoufiucq liter, bnprove, demolish, orrepair
anyetrodure paortoltsissuance,aleurequirmthe applicant for such permit to
file a signed statement that he is licensed pursuant to the provisions of the
Controdora License Law (Chapter 9 (commencing with Section 7000) of Owl.
slon3 of the Buslneasand Professions Coca) orthat he is exempt therefromand
the basis for the alleged exemption. Any violation of Seaton 70315 by any
applicant for a permit subjed,the applicant to a civil penalty of not more than
five hundred dolowner
of the
( Pro
❑1,asownerof theproperty,orhe employeeswithwagesan
,- ]3O
74.92
SPECULCBICNT/MIST
TFMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWITCHFS.FVVI URES
VALUATION
$54,692.00
NEW RESIDENTIAL ELECTR BQFT.
SLOWES
TYPE CONSTRUC770N
rtheresok
compensation, will do Business work, and lhescode:reknot Intended Lioffered(or
vie (Sec aptly Business Pro Code: The Contractors Licence law
V -N
to a Aperty
whorldoes not apply torn owner ofp rough who nempuilds orlmproovidedreoMand
whodaessuch work Mm.lfarthroughed owns.
OCC.GROUP
RES. UNITS
If,ho eprovidedthatsuch
improvement an is sold
intended e earofredfa sale. If, however, ild.,he Ill have
improvement bsdd withinoneyvara(complNloMthe owner-buBderwill have
11)5,[ Aden of pmving the he did M build or improve for purpose of sale.).
LI L as owner of the property, am exclusively om... .png with Ilrenxd
contractor to construct the project (Sec. 7011, Business and Professions Code:
The Contractor's License law don oat apply to An owner of property who
bu
Wilds or Improvn thereon, and who contracts for such Ibises with a
cgelpdor(s) Bnn.d rsu
puant to the Contractor's Lk n. Law.
LI I Am exempt under Sen B & P C for this mason
TOTAL:
..i
Q'ry; �` `� PLUMBINGPERMIfr` FEE•FLOD
PEI MIT ISSUANCE
12
ALTER-DRAIN &VENT - WATER (EN
R-3
'
TZNE
.
APN,
FLOW PROTECT. DEVICE
FEE
SUMMARYBACK
OUTSIDE FEES
DRAINS FLOOR ROOF,A
AREA, COND.
FIX'lllflFS PER TRAP
SANITARY Y N
RECEIPT0
Owner Date
WORKMAN COMPENSATION DECLARATION
E31 hereby affirm 1 have a certificate of consent to sciFin
SCIi00L TAX Y N _
certificatethat are, ora
of Workers'Compeuation Insurance or a onnifrd copy thereof (Sec.
RECEIPTNM
S
GAEA.SYSTEhf-I INC.!OUTLETS
PARK FEE Y N
RECEIPT N
3800, Lab C.)
Policy N
Com an
GAS EA. SYSTEM -OVER 4(EA)
BUILDING DIVISION FEES
rtlfied copy k hereby th the cid.
CertBled copy k filed with the city inspection division.
GREASEANDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
IT sealon need oat becompleted lithe permit tilorone hundred dollars
Ar
(9100)less.)
Ill Are emplothat y so as to b co a sub is hued,
Any pehe rson anye of manneworkr
I atoll not employ any person In any manner n u to become .bjeci to the
W plicae Compematlon Laws of California. Date
NCHICnt
NOTICEco esubjettothe agermakingpenCtio. peeof Exemption, you
should become subject to the Workers'Cempeuatkn orthiouofthe Lab or
Cade, You must forthwith comply with such proal tail ortFk permit shall be
dressed revoked.
PAID
Date Recef Pt#
E
SEWFILSANITARYSTORM A 200IT
WATER HEATER W/VFNT/ELECTR
ENERGYFEE Y N —
PAID
Date Reoei t#
WATER SYSTEM/TREATING
NEIN RESIDENTIAL PLMB. SQ.FT,
TOTAL:
BUILDING
TorAL:
SEISMIC FEE
3.85
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a couuucilon lending agency for the miperform
ance of the work for which this pert is Issued (Sec 3097, Civ. C.)
ELECTRIC FEEE
.29
Lender's Name.t
fcndcr's Adderne
I certifythat I luvereadthk appbatb,i and ataMthatlheaboveinformatlon30-25
Qrvi MECHANICdL PERMIT At FEE`
PLUMBING FEE
In 25
,
MECHANICAL FEE
PAID:
Iscorma. I agreeto comply with all city and county ordinances and nate laws
PERMIT ISSUANCEPEES
relating to building constmctlon, and hereby authorize mim sentztivsa of this
tltytoenterupon the above,nentkned property for inspection purposes.
e) agree to save, Indemnify an d keep har
(Wmiess the City of Cupertino
ALTER ORADDTOMECH.
ae P
—Date Reeei [#
agaWtBabilltln,jrdgmenG,coatea dexpens wAlch nayln anywayaavue
agaimt Bald���yyyyyy Inco ata h g of ala IL
h - o 4e//
AIR HANDLING UNIT (70 10,0DO CFM)
-
SUBTOTAL'
'.66
NR HANDLING [RVTT (OVER 10,1100 CIM)
CONSTRUCTION TAX
"
Signature of Appliam/Contractor /i Olt.
HAZARDOUS MATEDISCLOSURE
Will the applicant or futum building occupant store or handlch—dous
material as defined by the Cupertino Municipal fade, Chapter9.IZ and the
Health and Safety Code Seaton 25532(a)1
❑ Yes Lj No
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HFATINCUNIT O100,000BTM
Date Ravel Ile
HEATING UNIT (OVER 100,000 RTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
Will the applicant or futum building occupant use equipment or devices
which emit luvrdous air contaminants as defined by the Bay Area Air
Qu lity Management Diana?
❑ Yon ❑❑ No
(have read the hazardouematertalsrequimmnbunder Chapter6.95of
BOILER-COMPOHIPOR 100,0(0 BTU)'
BOILER-GDMP(OVER 100,000 BTU)
the Glifornk Health & Safety Code, Sections 15505,25533 and 15534.1
undenstan i that if the building don not currently have a tenant, that it is my
responsibility to notify the occupant of the m(ulrements which must be met
NEW RESIDENTIAL MECH. SQ.FT '
prior to Issuance of a Certificate of Occupa Ary,
City of Cunpo160
ISSUED YL QIIIU e_<_1TOTAL:
Owner or authorized agent Date
OFFICE COPY