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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
Buildhor Pro ed Identification
B,iflding Address.)
10100 Torre Ave. Unit 170 (01.3
PERMIT NO.
20370 0 3 G V{7 0
Z17.—F. ante: one:
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT '
BUILDINCFELECTMCAL-PLUMBING-MECHAMCAL
5/10/90
C.ntracure. Name: Uc. N.
7 8-
CATECARY
CONTROL#
-
Architect/Engineer. Lk. No:
QTY ELECTRIC PERMIT- FEE,
BUILDING PERMIT INFO
Address:
PFZihETISSIIANCE
12
LICENSED CONTRACTOR'S DECUBATION
Iherebyaffirm that l am licensed under provisions o(Chapter9(commen
ingwith Secfon 7000).(DiNM.n3ofthe Bustaaand Pmfe msC<de, and my
11... I. I. full tomes and effect. �
Lt... Chea Llc#
Date Contractor
ARCHITECTS DECLARATION
lundemtandmyphmehagbeuwdupubllcrecordw
Licensed Profeaskmal
OWNER -BUILDER DECLARATION
I hereby sifrmthat I am e.empt from the Contractor's License Taw fmthe
fallowing reason. (Section 70115, Business and Professions Code: Anyclty.r
county which requhoa permit loconstmm
ct, alter, Improve, deolish,orrepair
anystructure pdortolta Wuance,aleorequl¢sthe applicant for such pertNtto
file a signed statement that he Is licensed pursuant to the provisions of the
Contractor's License law (Chapter 9(commencing with Section 7000) of Diel-
Mon3 of the Business and PmofessbmCode) or that he is; exempt lherefromaM
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant for a permit subject+ the applicant to a civil penalty of not more than
undred
five r71, ashwnerof the Xis.
I, ate owner l the property, or my employee with wages a there sob
compemafon,willdothe work+ndtheetrocture knot Intended or offered for
oak (Sec 7016, Bu. no and Piefeaaions Code: The Contractors Llcerue Law
does not apply to an owner of property who builds or improves thereon, and
who does suchwork himselforthrough hisown employees, provided that such
improve arms are not Intended oroffered for sale. If, however, the building or
Improvement issold within oneycarofcompletlon, the owner-builderwill have
tlW,kurden of proving that he did not build or Improve for purpose of sele.).
LJ L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7064, Businessand Prolesslom Code:
The Cmdract.r'. License Law doe not apply to a owner of property who
W Ild+ or Improve. thereon, and who contracts ct
for such piples with a
licensed pursuant to the Contractors Llceae Law.
IN am exempt under Sec. B & P C for this mason
APPLIANCESRESIDENMI,
]00 DESCRIPTION
RCB
PANELS
201-IODO AMPS
OVERIOWAMPS
SQ. Fr. FLOOR AREA
669
$/SQ.F7'.
74.92
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC
TEMP Mh7FRORI'OLE INST.
POWER DEVICES
SWIMMU NG IDOL ELECTRIC
OUTLETSSWITCHFSFIXTURFS
VALUATION
$510,121.00
NEW RESIDENTIAL ELECTR SQ.FT.
STORIES
TYPE CONSTRUCTION
V—N
TOTAL:
QTY, ,: PLUMBING PERMIT .FEE
OCC. GROUT'
R-3 '
RES UNIT'S
I
FLOOD ZONE
APN
'
PERMIT ISSUANCE 12
ALTER -DRAIN &VENT - WATER (EA) '
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSI DE FEE S
DRAINS FUCOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT 0
Owner Date
WORKMAN
ffiCOMPENSATION DECLARATION
❑I hereby arm that I have a certificate of consent to self-ln.urcor
mAlfimte of Workers' Compensation Insurance m a certified ropy thereof &c.
3800, Isb CJ
Pollry #
pD(gl1RES !'FR TRAP,
SCI{OOL TAX Y _ N_
RECEI N#
GAS EA. SYSTEM -1 INCA 0UTLE15
PABX FEE Y N
RECEIPT #
CAS EA. SYSTEM -OVER 4 (FA)
Co. an
BUILDING OI VISION FEES
rtlfed copy is hembyth the city
7.M.d copy h tike y fu the city Inspection division.
CERTIFICATE OF UEMPTION FROM WORKERS'
COMPENSATION INSURANCE
TThlssectkn need not be completed If the permit bforom hundred dollar
(910).rless.)
I¢rtay that Nthe perfornunce o(thewmk(orwNch lMa pemdt i. bossed,
I shat not employ any person In any manner so as to become subject to the
Workers'Compemw
atlonl,ssof Callfomia. Data
Applicant
NOTICE TO APPLICANT-. If, after making this Certificate of Exemption, you
should become subject to the Workers Compensation provisions of the Labor
Code, you moat forthwith comply with such pre lMom orthls permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there it construction lendingageruy forthe perform
anec of the work forwhlch this permit is Issued (Sec. 3097, Clv. Q
1<nder'a Name
I<nder'. Address
I certitythaT have read thbapplkatknand aatethatthe above information
at comer. i dgreeto complywith all cityand county ordinances and state laws
relating to building construRion, and hereby authorize representatives ofthh
city to enter upon the above-mentioned property for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cu pert Ino
against liabilities, judgments,costs and expenses which may in any way accrue
agaWt old hcone once. h an goI this permit.
r
GREASE/INDUSPRL WASTE INTERCEPTOR
PLANCHECKFEE
PAID
Date Recti [#
GREISETRN'
SEWER-SANITARY-SIDRM EA. 200PC.
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N .
PAID
Dale Recel t#
WATERSYSTEM/TREATING
NEW RFSIDENnAL PLMB. SQFr.
TOTAL:
BUILDING '
SEISMIC FEE
3.57
TOTAL:
ELECTRIC FEE
28,73
PLUMBING FEE
2
-
QTY. ' MECHANICAL PERMIT FEE'
MECHANICAL FEE
211-13
PERMUISSUANCE 12
FEES PAID:
.
ALTER OR ADD TO MECH.
Date Reeef t#
AIR HANDLING UNIT CTD 10,00 CFA)
SUBTOTAL:
,%
AIR HANDLING UNIT (OVER lB,000CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractorate
HAZARDOUS MAIL LS DISCLOSURE
Will the appndb the ure rtildingoicipant atom hhandle 9AZ and
af ty by the Cupertino Municipal Code, Chapter 9.12, and the
I{e❑altY. SatietyCadrle�—SeNioon25532(+)1
W.Ith is Safety
Will the applicant o ume building occupant use equipment or devices
which emit hazardous ab contaminants as defined by the Bay Area Air
CLLslily Management DlsWcti
I have read the J2 materials requlremenh under Chapter 6.95 of
the Caia.o t. Health & Safety Coda Sections 25505, 25533 and 25534. I
understand that if the building does not currently have a tenant, that it h my
responsibility to notify the occupant of the requirements which must be rat
prior to Issuance of a Certificate of Oceupancy.
77(}UUST HOOD (W/DI1Cn
CONSTRUCTION TAX PAID:
HEATING UNIT (10 100,000 BTU)
Date Recd t#
HEATING IWIT(OVER IW,OODBTU)
TOTAL:
C�
sf.76
VENTILATION FAN (SINGLE RESID)
ISO )ab,DATE
:II -! et1-'�Qgo
1 F
4,
Ul j//,,ns l 1 (t
't(BP,rIIDf1
ISSUE D BY:�- (.LuTbIak 1/C.[..1
BOILER -COMP QHP OR 100,000 BTU)
BOILER-COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQJ-7
Owner or authorized agent - 'Date
TOTAL:
OFFICE COPY