20366APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMIT NO.
10100 Torre Ave. Unit 166 .(111.1)
.20366_
wnere ams: Ph ane.
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
Contracure.Name: Lt.. N.
738-4444
BNLDINC-ELECTMCALPLUMBING-MECIIAMCAL
CATEGORY
CONi7tOLN
Architect/Enginser. Lk. N.
-QTY ELECTRIC PERMFF FEE
BUILDING PERMIT INFO
Address
[X EK
PERMITISSUANCE" 12
LICF.NSEDCONTR SDECLARATION
I hereby hSeodo MW).lamlkm3o(thderprovisionsa(Csal..0 d,ro .enc-
under
Inense 1 Section force of d effedn3ofehe BusinessandlsrofessioneCode,and m
license b in full fora and effect.
APPLIANCES -RESIDENTIAL
JOB DESCRIPTION
RCB
PANELS
Lianr Class Contractor
Date Contractor
O
201-1000 AMPS
ARCHITECTS DECLARATION
I understand my plane shall be used as public records.
trV
VV r
OVER1000AMPS
SQ. Fr. FLOOR AREA
$/SQ.FT.
SIGNSELECTRICAL
LIanxd Pmfessiosul
OWNER -BUILDER DECLARATION
IhembyafBrmthatlamexemptfmmtheContndoreLia wlAwforthe
SPECIALCIRCUIT/MISC
805 -
74.92
Tpap MErERORPOLEINST.
following reason.(Section 7031.5, Business and Profession. Code: Any city or
cmntywhichmqulrnapermitwwmns ct,alter,bmpmve,demlLsh,orrepalr
any structure prior wits Issuance, also requires the applicant for such permit to
0k a signed statement that he is licensed pursuant to the provisions of the
Contractors License Law (Chapter9(commencing with Section Tom) of Divi-
sion 3 oflhe Business and Professions Code) orthat he Is exempt therefrom and
POWER DEVICES
.
SWIMMING POOL ELECTRIC
VALUATION
the bask for the allaged exemption. Any, violation of Section 70315 by any
appliantforapermiteubjedstheappgcanitoactvilpes ityofnotmomthan
O��gp�q.rcEIESpT�.UgEq
$60,311.00
Ove hundred dollars (5500).
❑I, as owner of the property, or my employees with wages as their sok
NEW RESIDENTIAL ELECTR SQFf.
'
STORIES
TYPECONSTRUCTION
comparint ion, will do the work, and the structure Is not intended or offered for
sale (Sec. 7044, Business and Professions Code: The Contractors License Law
V—N
TOTAL:
QTY. PLUMBING PERMIT FEE
does not apply to an owner of property who Wilds or improve; thereon, and
who doossuch work himself orthrough his own employees, provided that such
Improvements are not intended oroffered for sale. If, however, thebuilding or
improvement k mid within one yearofcompleiagthe owner -W OderwBl have
tl)e„)huden of proving that he did not build or improve for purpose ofuk.).
L„f 4 a. owner of the property, am exclusively contracting with licensed
cornu m , to constmd the project (Sec 7014, Business and Professlom Code:
OCC. GROUP
R-3
RES. UNITS
FLOOD ZONE
APN
PERMIT ISSUANCE 12
The Contractor's Limns. Law does not apply to an owner of property who
builds or improve thereon, and who contra for such pikoject. with .
�R(+dor(.) licensed pursuant to the Contractors License Law.
Off, exempt under See B k P C for this reason
ALTER -DRAIN hVENT- WATER IFA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR, ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT N
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have • certi0ans
te of consent to self4raurs, a a
mrtifiateofWorkem'Compematianlr ru maaartlfkdcopythemof(Sec.
350& lab CJ
Policy N
ED'PER TRAP
SCHOOL TAX Y_ N _
RECE NN
GAS EA.SYSTEM-1 BJG401711ET5
PARK FEE Y N
RECEIPT M
GAS EA. SYSITM-OVER 4 (EA)
Co�any
BUILDING DIVISION FEES
fertlfled copy k hereby(umimed.
&Certified copy k (fled with the city inspection division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANC14ECKFEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
'
COMPENSATION INSURANCE
(Thi,.di..neednotbecompidedlftheper tkforanehundreddollan
Date Recei tg
BEWER-SANITARY-STORM EA 200F1'
WATER HEATER W/VENT/ELECT'R
ENERGYFEE Y_ N
PAID
(5100)alroJ
I certify that o me p person t any m work for which this permit Is c issued,
I shag nor employ any person f any manner at act to become subject m the
W Laws o(Glifomla. Date
WATER SYSTEM/TREATN'G
plicanCompensatbn
Applicant
NOTICE co APPLICANT: a after making teds Certifcation pro of Exemption, oft
should comsubject Lab
a Labor
the Workers' Compnovislnprothis
Date Remi tN
NEW RESIDENTIAL PLMB.' SQFT.
-
TOTAL:
forthit
Code, you mast forthwith comply with such pmvklons armk permit shall be
ode,yo grits be
aeenied rcvakad.
BUILDING FEE
464.00
SEISMIC FEE
4.27
CONSTRUCTION LENDING AGENCY
l hereby affirmthat there is a construction lending agency for the perform
ana of the work for whkh thio permit k issued (Sec. 3097, Clv. C.I
lender's Nam
Lender. Achim. a
I certl/ythm I heveread thkappliationand Catethattheabove Information32.13
Iscorrect. Iegmta comply with all city and county ordinances and elate laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE
QTY. 'act MECHANICALTERMIT, FEE,
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
relating tobuilding construction, and hereby authorba representatives of thio
city to enterupon the abovementlorud property for Inspection purposes.
(We) agreeto save, Indemnify an d keep harmless the City of Cupertino
ALTER OR ADDTO MECH.
Date Reeei tp
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL'
against liabilities, jidgmnk, costsand expenses which may N anywayaceme
agulnstsold yin co na h gran gofthispermit
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
Signatore of Applicant/Contractor (1—Date
o(HAus r HooD(W/DUCT -
CONSTRUCTION TAX PAID:
HAZARDOUS MATERWILSDISCLOSURE
HEATING UNIT (TO 10D,000 BTI!)
Date Recei t7(
Will the applicant or future building occupant store or hand Is hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.1 7, and the
Health and Eafdy Code Section 25537(a)'I
RYes No
ill the applianta tore Wilding occupant use equipment or devices
which emit Meardous air manta mivnts as defined by the Bay Area Air
ality Managemnt District?
"
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
S� .
VENTILATION FAN (SINGLE REED)
ISSUANCE DATE
DAI®T ,
ix_ '
BOILER -COMP OFm OR 100,000 BTIA
Yes ❑ Na
B0ILER-CDMP(0VER100,W0BTU)
have read the hazardous materials requirements under Chapter6.95 of
the California Health k SafetyCade, Sections 25505,75533 and 25534. 1
,r
�sIY sF% 1990
NEW RESIDENTIAL MECH. SQ.Fr
understand that ifthe building does not currently have a tenant, that R is my
mspmnsibllity to notify the occupant of the requimmenls which mat be rot
prior to issuance of a Certifiate ofO=pancy.
/f'
CRY of CunPrtIBA
ISSUEDBY:
-
Owner or authorized agent Data
TOTAL:
OFFICE COPY