20368APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Addss:
PERMITNO.
Owner. 10re100 Torre Ave. Unit 168 (L1.2)
20368
Name: Phone:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
APPLICATION SUBMITTAL UA I E
5/10/90
Contracce'. Name: Lie. Nen
738-4444
BUfLDING-ELECTRICAloPLUMBINC-MECHANICAL
L 0
Archiled/E.ginse,. Lie No:
QTY ELECTRIC PERM(6 E
INFO
Address:
PERMITISSUANCE 12
uA,ex-t I'LUlAk! M�
LICENSED CONTRACTOR'S DEC�:.R;% ON
I hereby affirm that I am licensed under previsic C Are" (.cre.
i.g.1thSection 7UMofDwisloo3ofthellusineassam[Prof onsCodeandmy
j a
licame lain fell forcrand flact.
APPLIANCF-&RESIDENTIAL
JOB U�111014
PANELS
LI .. Cis a _LR, a
CB
Date Contractor
UP TO 2DO AMPS
201-1000 AMPS
ARCHITECTS DECLARATION
I understand my Placa Alex U be used as public records.
OVERIODOAMPS
SQ. Fr. FLOOR AREA
$/SQ.Fr.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 hembleaffirenthat I am exempt fromthe Contractor's License Law for the
following re,ann. (Secti.7031S, Businessand Professions Code: Any city or
eventywhich mquirana permit alter, Improve, demolish,ormpair
arYstrodure pdmtoitsIAaAarcgaIAsorAluimsthe Applies if- such-nitto
file a signed statement that he is licaresert pursuan". &Pn v".� of the
Contractor'. ties. Law (CIAA per 9 (on.,uriag with n M) of Divi.
sion 3 afthe Business And Pw4caCode) rtht he Is exempt therefrom and
deres
the basis for the Alleged exemption. Any violation of 1 11 �'Zy
A ",I __f lo�7
-PPB-.1 for. permit subjects the Applicant to At a
five hundred dollars ($5DO).
El1, as owner of the Property, or nryernpicyam with Rea as their sole
1,040
74'.92
S[MCIALCIRCUIT/MISC
TEIMP.MEITRORPOLEINST.
— POWER DEVICES
SWIMMING POOL ELECTRIC
—
OUTLETS-SW1TCHEs.RxnJRES
VALUATION
$77,917.00
NEW RESIDENTIAL ELFJCIR
STORIES
TYPE CONSTRUCTIONcompensation,
will do the work and the at a tied or offered for
sale (Sm � 41 7044, Bmisma ad Prf.i.. .es Licesse, la wV—N
does net apply to an owner of property who builds or Improves thereon, and
who doeswch work himself orthrosigh hisown employees,iderIthatsuch
___765C —GROUP�UNns
Improvements, are not Intended oroffered for We. It hebadldl.gor
Improvement Is sold within oneyearofcompletion, th Itullderwill have
TOTAL;
R-3
(IILLmrden of proving that he did not build o I
L d!71py ovamcblrgpvit� d
_j J, A. ..at of the property, am exclusively re". 'P me -�=
contractors to construct the project (Sm Code:
C
The b!
Contractor'. Lt.. Law does act Xp�'I�u .7m=rPkf=— who
builds or improves thereon, and who contracts fee sa jects with A
obaA) heamaxi pursuant to the C.mmuctce. Llcemetpr
lclo.( exempt under Sec. _ B is P C for this
QTY,PLUMBING PERMIT FEE
—
PERMIT ISSUANCE 12
IT �zONE
AFN
ALTER -DRAIN & VENT � WATER (EN
BACK FLOW PROTECT. DEVICE
.FEE SUMMARY
Owner -at.
DRAINS. FLOOR, ROOF, AREA COND.
FD(TURES- PER TRAP
SANITARY Y — N_
RECEIPT
WORKMAN COMPENSATION DECLARATI914
hereby affirmY
that I have a certificate of comeat to 41f.inmm, or a
mdtflateofWor�m'Compe�tionlmuranmmamdified copytheared (Sec.
3800, Lab C.)
Policy 0
SCHOOLTAX _N
=
BBC= a
GAS EA. SYSTM4.1 INCA OUTLETS
PARK FEE Y_ N
RECEIPT
Com
GAS. EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
P�Y'fled copy is, hereby fiennfishati.
s A rifted copy W filed with the city inspeal.o division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHE
-CK FEE
GREASE TRAP
CERTIFICATE OF EXEMPT ION FROM WORKE_RS'
COMPENSATION INSURANCE
(This secti.. need not be completed lithe permit 6 for am hundred dollars
($lMorless.)
I cartify that A the parlormance of the work for which this permit is Issued,
I hall ..I employ say Pa. m Any masarta, An As to become aubjact to the
WMkem'C=PAnAAti0ALAwa0fCAWmAIA. DAW�
ApplicAnt
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become �bjed toteWorkers' Compensation Imaons of the Labor
Code, you =at forthwith comply with such provisions or this permit shall be
deemed revoked.
PAID
Date Reocipt#
SEWER-SANTrARY.STORM EA. 20KIFT.
WATER HEATER W/VENT/ ELUCTR
ENERGY FEE Y_ N_
PAID
Date Recd t#
WATER SYSTEM/TRF.AIINC
NEW RESIDENTIAL FILMS. _SQ17r.
TOTAL:
D FEE
TOTAL:
SEISMIC FEE
-ELECTRIC FEE
1 5.46 11
38.00
CONSTRUCTION LENDING AGENCY
Ihereby affirm that them is a construction lending agency for the perforce,
Arco of the work for which this permit Is Batted (Se, 3097, Civ. Q
Lender's N.
Le.dee.Add.
Icartifythatl havereadthis.pplicatho.od sunathattanabowe InformationMECHANICAL
is correct. I agree to comply with AD cityand county ordinances and state lam
QTY. MECHANICAL' PERMIT FEE
PERMIT ISSUANCE 12
PLUMBING FEE
is
FEE
FEES PAID:
-no
—39.00
misting to building construdlers,.rul hereby --thorries, representatives of this
city to enter upon the above-mentioned Property fee inspection purposes.
(We) agree to sew, Indemnity an d keep harmless the City of Cupertino
against liabilities, Judgments, castsand expenses which may In anymyaccbu
Against :1;�dGi us of ofthis permit
4"
ALTER OR ADD TO MECH.
Date Rixefpt#
AIR HANDLING UNIT (To lit" CFM)
SUBTOTAL -
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
SigWm.f Appbcam,��
. CcntracuuMt.
HAZARDOUS MATEtM� q DISC' OS`URE
ID(HAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HEATING UNIT CID 100,Wo BTU)
. mWill the applicant or fmAm building occupant store or handle hau,ardous
material a, defined by the Cupertino Municipal Cade, Chapter 91Z and the
Date Receiptil
HEATING UNIT(OVER ID0,000 BTU)
TOTAL:
Health and Safety Code Section 25532(a)7
11yes, r] NO
VENTILATION FAN (SINGLE RESID)
—
ISSUANCE DATE
1011,11
1.01M
11 the applicant or futum building occupant use equipment or devices
which emit havomfous air comandunts as defined by the Bay Am Air
a,lity Management District?
BOILER -COMP OHP OR I00,0W BTM
Na
BOILER -COMP (OVER I00,000 BTU)
—
qhx�esrr.d the b.9 us materials requirements underChapter6.95 of
tMCalff.rnklle.Ith&Saf,AyC.de,Sedi..25505,25533.nd25S34.1
NEW RESIDENTIAL MECH._SQ.Fr,
—
understand that If the building door net currently have a tenant that It is my
responsibility to notify the occupant a the requirements which =at be met
prior to eauanca of a Certificate of Occupancy.
.City of Cunprtinq
ISSUED BY. -s-1.
A Owner or authorized agent Date
TOTAL:
OFFICE COPY