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20365APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Pro'en Identification Building Addreea: PERMIT NO. 20365 10100 Torre Ave. Unit 165 (D1.1) 43w.sName: 11hose, ALDAM Town Center Properties CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT 5/10/90 c°^tv ro .Name: Lk.N°: 738-4444 BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROLM Arthitect/Enginrer. Lk. Na �'QTy ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address © F aLICENSED PERMITISSUANCE 12 CONTRACTOR'S DECLARATION Ihereby afn7OODaz DtAsiant mrefth.Bud under ...Is ofChapter B...h .canon force efeion3o(the BuslmssandlsrofessionnCade,and B... le In full force and d(ect. , APPL[ANCESRES(DENTTAL ]OB ppSCC$RBr7'IlnswitQN •, W� II_ PANELS License Claes LIe.N 1J(T! Date Contractor IM IQ 2DO AMEPS 701-IODO AMT'S ' ARCHITECTS DECLARATION I understand my plans shall be used as public records. OVERiOOOAMPS SQ. FT. FLOOR AREA S/SQ. Fr. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION - l herebyaffirenthat l am exempt fro .the C mractor.Liceese law for the 669 74.92 $PECIALCRtCUIT/M15C TEMP METER ORPOLE INST, 1u11owingreaaon.(Secti°^70315, Butlnessand Pmfessiom Cade:Anydtyor ceuntywhlch rcqu ma pemdtto mmtmM atter, impmve, demolbh,ormpair anystmMmpdertoltsbmancgaborequim.iheappbmnt(wr chpermitto' Ole a signed statement that he Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commenclng with Section 7") of Dlvl- of the Business and ProfessbtnCeds)°r that heb exempt therefromaM the the basis for the alleged exemption. Any violation of Beetles 70715 by any applicant for a permit subjectstheappgeant to a civil penalty of net more than POWER DEVICES SWIMMING POOL ELECTRIC OUTLETSSWI'PCIiFSnXTURES VALUATION $50,121.00 NEW RESIDENTIALELECTR SQFf. five hundred dollars ($SM. [31, as owner of the property, or M employees with wages as [hast sok STORIES TYPE CONSTRUCTION compensation, wRldo the work and thestrocNre bract intended or offered for sal. (Sec. 7D66. Business and Profeations Code: The Contractors License Law V -N does not apply to an msec, 4 property who build. or Improves Absecon, and hisown employees, providedthat such OCC.GROUIs RES. UNITS Improvements are net Intended or offend for sale. If, however, the building or Improvement b sold within one yearofcompletion, the.weer-bu0derwill have TOTAL: R-3 ., - tF�uedenofproving that he did not build or Improve for purpose of sale.). u L as owner of the property, am exclusively contracting with licensed coetractors to construct the project (See. 70K Business and Professions Code: QTy; _,:,� PLUMBING'PERMIT •= P TEE FLOOD ZONE APN ppgM77 ISSUANCE 1'2 The Contractors License law don not apply to an owner of property who builds or Improve thereon, and who contracts for ouch p(ojects with a cgR(p&or(.) 11...d pursuant to the Contractor's License Law. LJ I am exempt under Sea B 4 P C for this reason ALTER -DRAIN A VENT- WATER BIA) FEE SUMMARY BAIX FLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. SANITARY Y N RECEIPT 0 Owner Dare WORKMAN COMPENSATION DECLARATION hereby affirmself-insure,FIXTURES [:]I that I have a certificate of consent to self -insure, ora ertlfl.teo(Worlece Compensation Insurance or a certified copy thereof(Sec. M00, Lab C.) a PER TRAP SCHOOL TAX Y N -I REC 3117 N GAS EA SYSEM.1 INCE OUTLETS N PARKFEE Y N RGCF3 Co Cc AS EA. SYSTEM-0VER6(EA) GAS. BUILDING DIVISION FEES �myany L1C,ffified copy is hereby furnished. edified copy b filed with the city inspection division. GREASE/INDUSfRL WASTE INTERCEPTOR PLANCHECK FEE i GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID COMPENSATION INSURANCE ( hIssection need not becompleted If the pernat'.for ons hundred dollars SEWER.SANITARY-STORM EA 200FT Date ReCei [# HEATER W/VENT,/ELFLTR ENERGY FEE Y N PAID (1100)°ria...)WATER I certify that k the Performance ofthe work for which this permit is Issued, I shall not employ any person In any manner w an to become subject to the Worlum' Compensation Lawsof Cailforala. Date WATER SYSTEM/TREAITN'G Applicant NOTICE TO APPLICANT: If, after making this CekBicate of Exemption, you should become.ubjecl to the Workers'Compenatkn provisions of the Labor NEWRESIDENTIALPLMB. SQFf. Dale Recei [# TOTAL: - BUILDING Code, you must forthwith comply with such provisions orthb permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 3.5 IhercbyafRrm that there'. a construction lendkgagency for the perform aom of the work for which this permit Is Issued (Sec. 3097, Civ. C.) Lender's Name Lender'.Addie. I cedltythat I have read thbappllntionard statethat thesboveinformation Iscorect. Iagrretocomplywlthalldtyandmuntyordkanmandstaielaws TOTAL ELECTRIC FEL• 28.7 PLUMBING FEE -• QTY. ' ME&AWICAC�PERMffil FEE MECHANICAL FEE PERMIT ISSUANCE 12 FEES PAID: reiating to building wmtmdicq and hereby authorize representatives of thk city to enter upon the above-mentioned property for Inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cu Fenian against liabilities, judgments,costsand expenses which may is any way... Dale ReCel [# ALTERORADDTOMECH. AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL: 0 7 .gains this permit � o AIR HANDLING UNIT (OVER IO,000CFM) CONSTRUCTION TAX SlgmNneof Applicant/Contratior to EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MA ALS DISCLOSURE HEATINGUMT(MI00,0DOB7IM Will the applicant orfuture building occupant store or handle hazardous HeAth l as defined by the Cupertino Municipal Code, Chapter 9.17, and the IkalthandSazetyCodeSemon75537(a)7 Yes q.w Date Recel t# - HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN RESID) ISSUANCE DATE Will the appBcantm rebulldNg oc vpantuu eqme uipnt erdevlm which emit haeardous air contaminants as de0ned by the Bay Area Air Quality Management District?BOILER-COMP Y. ❑ No GHPOR 100,000 BTUI OILER-COMP(OVER 100,000BTU) 4PAI avemadthehmadousmteriabreViremnhuAderChaprter6.95of the Califomh Health h Safety Code, Sect tom 25505, 25533 and 75536. 1 understand that it the building does notcurrently have a tenant, that It is my •(r'} 1" r� i990 NEW RFSI DENHAL MECO. SQFT responsibility to notify the occupant of the requirements which moat he met prior to Issuance of a Certificate of Cheops my. City of Cunertinn ISSI$DBYJV-G` Owner or suthoriaed Per Daze TOTAL: OFFICE COPY