20373APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address;
PERMIT NO.
A 0
373
10100 Torre Ave. Unit 173 (DI. l
G
oars ante: one.
Town Center Properties
CITY OF CUPERTTNO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contmene's Name: Lle. No:
738-4444
BUILDINGELECTRICALPLUMBINGMECH MCA11
CATEGORY
CO IROLp
Architect/Engineer. Lie. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
POWTISSUANCE 12
Ei KI K1
LICENSEDCONTRACFOR'SDECLARATION
T hereby affirm tbtlam Rcmeed under provisions o(Chapter9 (commrnc-
APPLIANCESRFADENFIAL
JOB DFSCKETION
PANELS
UPTO2D0AhM
Ingwllh5 dion7000)of DIvINon3ofthe Businesand Professions Code, and my
license Is In full torte and effect.
License Clan Lisp
Date Contractor
RCB
j) VV
701-IOOOAMPS
ARCHITECTS DECLARATION
I understand my plans shall be used as public remrds
OVER IODO AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Pro(essimul
SPFCIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
therebyafflrmtbtlamexemptfromthe Contractor's License lawforthe
669
74.92
TEMP METQ{ORI'OLE INST.
fo110wingreason.fliection7031.5,Businmand Profasslons Code:Anycityor
countywhich requires a permit reconstruct, alter, Improve, demolish, orrepair
any structure prior to its Issuance, also requires lheappBcant forsuch permit to
Rk a signed statement that he is Ikensed pursuant to the provisions of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Contractor's License Law (Chapter 9(commencing with Section 7000) of DWI-
elo.3 of the Business and Pmfemlons Code) or that he is exempt therefromand
VALUATION
the basis for the alleged exemption. Any violation of Section 70115 by any
applicant fora permit subjeRathe applicant to a civil penalty of not more than
OUTLEISSW ITCHESHXTURFS
-5O s 1,21 . OO
five hundred dollars ($500),
1, as owner of the property, y employees wit h wages as their sale
❑ra
NEW RESIDENTIAL ELFGTRSQ.FT.
STORIES
TYPE CONSTRUCTION
compensation, will do the work, and the structure b net Intended or offered for
.is (Sec. 700 Business and Professions Code: The Contractors License Law
_
V—N
TOTAL:
does not apply to an owner of property who builds or Improves thereon, and
whodoessuchwork hlmselforthmugh hisown employees, provided that such
Improvements are not Intended oroffered forsale. If, however, the building or
OCG GROUT'
R-3
015. I1NfI5
/
Improvement b sold within oneyearafcompletion, the invoo,bW lderwlll have
OLLIxirden of proving that he did rest bWld or improve for purpose of sale.).
L j L as owner of the property, am exclusively contracting with licensed
mormactom to construct the project (Ser. 7014, Business and Professions Code:
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
,
PERMRISSUANCE
12
The Contractors License Law does not apply to an owner of property who
Wilds or Improves ren, and theowho contracts for such pwisma with a
c9atiattorw licensed pursuant to the Contractor'sLlmve Law.
Lf I am exempt under Sec. B k P C for this maven
ALTER -DRAIN kVENT- WATER (EA)
FEE SUMMARY
BAIX FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, CONE).
FIXTURES PER TRAP
SANITARY Y_ N_
RECEIPT p
Owner Data
heWORKMANCOMPENSATIONDECLARATION
01reby affirm that 1 have a certificate of consent to self -Insure, or a
certificate of Workers'CompewHon Insurance ora certlficd copy thereof(sec.
3800, Lab
SCHOOL TAX Y_ N_
nFCEp.I' p
GAS EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y_ N_
RECEIPTR
Policy p
Co�an
EA. SYSTEM -OVER 4 (FA)
GAS EM
_
BUILDING DIVISION FEES
mmmpylsherebyfurnished,
ended ropy is filed with the city inspection division.
GREASE/INOUSDIL WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EXFMPr10N FROM WORKERS'
PAID
SEWER-SANRARY-STORM F.A.200FT
COMPENSATION INSURANCE
(This section need not be completed lithe permit ls forom hundred dollars
($IW)ml. .)
I emlythat Nthe performanceofthework forwMch Ud. permit is leaned,
Date Race{ [#
WATER HEATER W/VEM/ELECTR
ENERGY FEE Y_ N_
WATER SYMTM/TREATING
I shall not employ any person In any manner so as to bemmn subject to the
Workers'Compensatlonlawsof Callfomia. Date
PAID ,
NEW RESIDENTIAL PLMB. SQ.FT.
Applicant
Date Recei [#
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
TOTAL:
BUILDING
Code, you =at forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING ACINCY
SEISMIC FEE
3.57
TOTAL
ELECTRIC FEE
28.71
I hereby affirm that there is a constmetion lending agency for the perform-
ance of the work for which this permit is Issued (Se 3097, Civ. C.)
Lenders Name
I.endcre Address
I certlfythatl have read thisappllcationand statethat Iha.W ainf.rmatko,
Incorrect. l agresto complywith all cilyand county ordlnance and gate laws
relating to building construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for Inspection purpose.
(We) agree to save, Indemnify an d keep harmless the City of Cu pertlno
against llabWtles,judgments, costs and expenses which nay In any way acme
.gain t dCl c race.( 1% anti go(tht.psmut
��I� 1j�% _
PLUMBING FEE
o '^
�-..+�
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:.
8,74
ALTER OR ADD TO MECH.
Date Receipt#
AIR HANDLING UNIT(TO 10,OW CFM)
_ SUBTOTAL:
AIRI{ANDLINGUNIT(OVFRIO,000CFM)
CONSTRUCCIONTAX
�
Sigrutmmof Apphcant//CCmArk1m!`a�Cal�-- D1e
EXHAUST HOOD(W/DICT)
CONSTRUCTION TAX PAID:
HAZA RDOUS MATERMeSDISCLOSURE
Wllltheappllcant or future building ompantstore or handle hazardous
HEATING UNIT (TO 1001000 BM
Date Recei [#
material as defined by the Cupertino Municipal Coil , Chapter 9]2, and the
I kalth and Safety Code Section 25532(a)?
❑ Ye No
Wiiltheapplicant orfuture building occupant use equipment ordevims
which emit brand... air conga mi ants as defined by /he Bay Area AIr
Quality Management District?
Yes No
have read the hazy ous materials requirements under Chapter 6.95 of
the California Health k Safety Code, Sections 75505,75533 and 75534.1
understand that ifthebuildingdoes not currently have a tenant, that it is my
HEATING UNIT (OVER 100,000 BTI?)
TOTAL:
. %
VENTILATION FAN (SINGLE: RIiD)
ISSUANCE DATE
-R Iipis
IMID,
r
i'.,\1 i-� 1990
BOIER{OMP OHPOR 100,000 BTU)
BOILER-COMP(OVE 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
responsibility m notify the occupant of the mryirements wh lch at be met
prior to Issuance of a Certificate of Ocmpa racy.
City Of CBOpIfIBO
ISSUED BY. j'?'N Q-VL:f CCel
Owner or authorised agent Date
TOTAL:
OFFICE COPY