20372APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pru'ect Identification
Building Address:
PERMIT NO.
'1 0 ^ n
20372
10100 Torre Ave. Unit 172 G1.1
G 3 G
tier.Name: ane
IAL
Town Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
C.mmad.e. Name: Lk. Na
738-4444
BULDING-ELECTRICALML BING-MECHANICAL
CATEGORY
CONTROL
Archlteci/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
PQthtITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby
actionmthall iv lice,°funder provisions o/Cssions9de,and c
Ingwlth in fanforceofUWmonJo(theBumnessandProteWonsCade,andmy
Manse b In fail fora and died.
License Clare Linty -
Date GantTECI
APPLIANCES
JOB DESCRIPITON
REB
S D 1 a r
V v
-
PANELS
[ understand my plans sisal be used u public records.
Ans shall CPSDEC ublicm moods.
11
OVER00AMI'S
OVER 1000 AMPS
SQ. FT. FLOOR AREA
S/SQ, FT.
SIGNSELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I herebyafBrmthat I am exempt from the Contractors License Law for the
following ... (Section 70115, Business and Professions Code: Any city at
cmntywhkh requlma permittommtmct, altep Improve, dermlbh, orrepalr
783
%4.92
SPECIAL CIRCUIT/MISC
TEMP.MEI'PAORIPOLE INST.
anystructom prkuto its Issuance, alsurequirntheappilcant forsuch permit to
file a signed statement that he b licensed pursuant to the provisions of the
Contractor'sLicense Lew (Chapter 9 (commencing with Section 700D) of Divi-
Mona of the Business and Professions Code) orthat he V exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any mo
applicant fora permit subjects the applicant too civil penalty of na re than
five hundred dollars ($500).
Ni. as owner of the property, or my employees with wages as their sole
POWERDEVICES
SWIMMING POOL ELECTRIC
OUTLETS-SWITCHESFIXTURES
VALUATION
$58,662.00
NEW RESIDENTIAL ELECTR SOFT.
STORIES
TYPECONSTRUCTION
compensation, will do the work, and the structure b nor intended or offered for
sale (Sec. 70K Business and Professions Code: The Contractor's License Law
V—N
does not apply to an owner of property who Wilde or improves t hernry and
who doessuch work hlmseBor through Ms own employees, provided that such
OCC.GROUP
RFS. UNITS
Improvements are not Intended or offered for sale. If, however, the building or
Improvement is sold within one yearofcompletion, the owner -bunker will have
TOTAL:
R-3
/
t1W.kurd an of proving that he did not bund or Improve for purpose of sale.).
" L as owner of the property, am exclusively contracting with licensed
rootattm to construct the project(Sec. 7016, Business and Professions Code:
The Contractor's License law don not apply to an owner of property who
Wilds or Improver themes, and who contracts such pteeds with a
coy(agor(e) Bmnsed pursuant to the ContnRor'a Llnme Law.
Ll l am exempt under Se. B k P C for this reason
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE 12
gLTER-DRAW &VENT -WATER (EA)
FEE SUMMARY
BAIX FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT N
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a arUOcam of consent to self -Insure, or a
artlflcate ofWorkars Compensation Insurance or a certified copy thereof (Sec.
3800, C.I
N
Policy if
FD(.I.URES. PER .�P
SCHOOLTAX Y_ N_
RECEI T Y
GAS EA.SYSTEM-i ING6OUILETS
PARK F7J: Y N
RECEBPT N
GAS. A. SYSTEM -OVER 4 (EA)
CeWRan
BUILDING DI VISION FF.CS
(fled copy is herebytehed.
crtlRed copy V (fled withh the city Inspection division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAIP
CERTIFVATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
p'hlssectlon need not W completed If the permit b Forane hundred dollars
Date RCCCI t#
SEWER-SAM.I.ARY-STORM FA ANTI•
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
(E700)er less.)
I arb/y/hat to the performance of thework forwhich this permit is issued,
I shall not employ any person In any manner as, as to became subject to the
Workers' Compensation laws of California. Date
WATER SYSII]M/TREAnNG
Applicant
NOTICETO esubjeAM:IL after making that Certificate provisionsofteLyou
ofthe Labor
should become mbjedtothe Workers'CompewUonprothia
Date Remi t#
NEW RESIDENTIAL PLMB.SQFT.
TOTAL:
CWgyou drevoet(orlhwlth comply with each provisions orM6 permit shall be
p
domed revoked.
U ING
455.00
SEISMIC FEE
4.13
CONSTRUCTION LENDING AGENCY
Ihemby' eofthe ffirmorkforwhicthat reisacomwction lending nnued(5.cc,3 ,Civ.ncy the perform
Lend er the work for which this permit V Lss.ed (Sec 3097, CIv.CJ
Lender's Nacos
Lendar'spddress
I artlfy that I have read thfsappllcaaonand statethat theabovefnformatlon
Iacorred. I dgreeto comply with all cltyand county ordinances and mate laws
TOTAL:
ELECTRIC FEE
31.58
PLUMBING FEE
11 SA
QTY. MECHANICAL PERMIT FEE
MECHANICALFEE
FEES PAID:
31
I PERMIT ISSUANCE 12
relating to building construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for inspection purposes.
(Wr) agree to save, Indemnify an d keep harmless the City of Cupertino
.,.feet liabilities,judgments, command expenses which may he any wayacaue
ALTER OR ADD TO MECH.
Date Recei t#
AIR HANDLING UNIT(TO 10,000 CFM)
SUBTOTAL:
against said Inc erne 11 gra ng o(thla permit
/9. lii�E.crn 5D��
AIR HANDLING UNIT (OVER IO,ODOCFM)
CONSTRUCTION TAX
i...�-
Slgmturc o(AppRcanUContra
E7([TAlJST HOOD (W/DUC'D
CONSTRUCTION TAX PAID:
HAZARDOUS MAT LS DISCLOSURE
HEATING UNIT CIO 100,000 BTU)
Will the applicant orfuture building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
I ealth and Safety Code Section 25532(a)2
YesNo
Date Recei t#
HEATING UNIT (OVER 100,DW BTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSHANGE.DATE
Wllltheapplin or utum building oc.pant use equipment or devices
which coot hazardous air contaminants as dell ned by the Bay Area Air
Quality Management District?
Yes MN.
havereadthe haza auamaterialsrequimmntsunder Chapter6.95of
1 M
1
110R.ER-COMP pFIP OR '00,0 BTU)
BOILER-COMP(OVIR10000 BTU)
the California Health & Safdy Code, Sections 25505, 25533 and 25536. 1
NEW RESIDENTIAL MECA. SQ.rr
understand that lithe building does not currently have a tenant, that it is my
mpomibllity to notify the occupantire
of the requirements which must be nest
prior to Issuance of a Certificate of occupanry
p
o f Cnnert�Dn
yIf. 1
ISSUED BY.NL # G•
Owneror authorized agent Data
TOTAL:
OFFICE COPY