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20374APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Address: - - PERMIT NO. 10100 Torre Ave. Unit 174 (D1.4) 20374 i_nvrer.Name: - one: A Town Center Properties CITY OF CUPERTINO-BUILDING DIVISION APPLICATION I PERMIT BUILDING-ELFCTRICAI PLUM.BINGMECHANICAL 5/10/90 Contractors Nava: Lic. Na. 738-4444 CATEGORY CONTROLN Architect /Engineers Lw. Na: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address © X � T PERMIT IBSUANCE 12 LICENSED CONTRACTOR'S DECLARATION I herebyaon7OODatlamlkensefthdBupravblonsof Chapter9(rommrnc pr Section to. Dlvfect. tlheguslnenand ProlesalonsCode,anti my ingwit]Joe.. License Class Lk.N LimaIs In full form end ic.0 APPLIANCES -RESIDENTIAL JOB DESCRIPTION RL,B PANELS Date Contractor DECLARATION (understand my plana shall be used nspubEcmmrda. UP TO 2DO AMPS �ARCHITECTS V 701-1000AMPS OVER 1000 AMPS A SQ. FI. FLUOR AREA 5/SQ. FT. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION I herebya(fivn that l amexempt from the Contractor's LicenseLaw for the SPECIALCIRCUIT/M19C 669 74.92 TEMP. METER OR POLE INST. following reawn.(Section 70315, Business and Professions Code: Any city or countywhich requLm a permit to mmtmd, alieq Improve, demo W h, or repair anystmcture prinrto its wsuance,aho requleestheapplkant forsuch permit to file a signed statement that he is licensed pursuant to the provisions of the POWER DEVICES SWIMMING POOL ELECTRIC Contractors License Lew(Chapter 9(mmmencing with Section 7000) of DWI- son3 of the Business and Profe®IoesCods) orthat he Is exempt therefromand -VALUATION the basis for the alleged exemption. Any violation of Section 7m L5 by any applicant for a permit subjects the applicant to a civil penalty of not more than OUTLETSSWITCHESFIXTURES $50,121.00 NEW RESIDENTIAL ELECTR SQ'FT' five hundred dollars (8.500). n 1, as owner of the or my employees with wages as their sole STORIES TYPE CONSTRUCTION property, compensation, will do the work and the structure is not Intended or offeredfor "� t/ sale (Sec. 7044 Business and Processions Code: The Contractor's License Law V (t/ - does net apply toanowner afpropertywho builds orImproves themo,and who does suchwork himself orthrough his own employees, provided that such OCC.GROIIP RES UNITS Improvements are not intended oroftered for sale. It however, thebullding or TOTAL: ✓i P_ I Improvement lssold witMnoneyearofcompletlon,the owner-bullderwillhave tf�ntiurden of proving that he did not bund or Improve for purpose of saw.). u L as owner of the property, am exclusively contracting with licensed contractors, to constmot the project (Sec. 704q Business and Professions Code: QTY, PLUMBING PERMIT FEE FLOOD ZONE APN PERMIT ISSUANCE 12 The Contractor's License Law does net apply to an owner of property who wilds or improves thereon, and who contracts fear such peo acts with a yR1(actons) licensed pursuant to the Contractor's License Law. I� 1 am exempt under Sec. B 4 P C for this reason ALTER -DRAIN 4c VFM-WATER (FA) FEE SUMMARY BACK PLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. SANITARY Y N RECEIPT N Owner Data WORKMAN COMPENSATION DECLARATION Of hereby affirm that 1 have a certificate of consent to self-mours, ora mrtiflmteofWorkers'CompemationlmumnamamnlfWcopythemmf(Sec. lab CJ FIXTURES- PER TRAP SCHOOLTAX Y_ N_ ft_ T N GAS EA. SYSTEM -1 INCA OUTLETS PARK FFR Y N RECEIPT N polk oliry, Y Com say GAS EA. SYSTEM OVRR 4 (EA) BUILDING DIVISION FEES ified copy In herebyfurnished.the cid. Certified copy is filedhere with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID EA.7WP1'. COMPENSATION INSURANCESEWER-SANITARY-STORM (This section need not be completed If the permit Is for one hundred dollars Date Recti t# WATER HEATER W/VENT/ELECTR ENERGY FEE Y N (B100)or len.) I comfy that in the performance of the week for which this permit is Issued, WATEASYSTM/TREAUNG I shall not employ any person N any manner so n to become subject to the Workers! Compensation Laws of California. Date PAID Applicant NOTICE TO APPLICANT: If, after making this Csmflcam of Exemption, you should wmme subject to the Workers' Compensation proveforu of the Lew, NEW RESIDENTIAL PLMB. SQ.FT. Date Recet t# TOTAL: B �a Code, you =at forthwith comply with such provisions orthw permit shall be dmn d revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 3.57 Ihercbyaffirrethat there is a construction lendingagenry, forthe perform- ante of the work for which this permit w Issued (Sm. 3097, CIv.C.) Lender'. Name Lender'.Address velnforetlon 1 mrtilythatl havereadthisspplicaao. and sate that Neawm lammed. I dgme to comply with all city and county ordinances and sate laws TOTAL, ELECTRIC FEE 28.73 PLUMBING FEE 28 ,73 QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE 12 MECHANICAL FEE FEES PAID. relating to building corutructlon, and hereby authoriss representatives of this aty to enter upon the abircmentioned property for Inspection purposes. (We) agree to save, Indemnify an d keep harmless the City of Cu pen Lou against Liabilities, judgments,costs. sad expenses which may in any way acerue ALTER OR ADD TO MECH. Date Recei t# AIR HANDLING UNIT (1010,000 CFM) SUBTOTAL aga lest said City In rot quem .of egr ting m this permit. y/ /ph�r "SID AIR HANDWNG UNIT (OVER 10,000 CFM)) CONSTRUCTION TAX Signature of Applicant/Contractor ---- to FXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS M IALS DISCLOSURE Will the applicant or future building occupant store or handle havrdous material as defined by the Cupertino Municipal Code, Chapter 9.17, and the Health and Safety Code Section 25537(a)7 ❑ Yes No HEATING UNIT (TO 100,000 BTU) Date Recel t# HEATING UNIT (OVER 100,000 BTU) TOTAL: 0 VENTILATION FAN (SINGLE RESID) ISSI�AN(��ATE Will the applicant or uNrebuilding ocevpantuse equipment ordevices which emit ha,mMous air contaminants as defined by the Bay Area Air Quality Management District? 4Yes ❑ Nm haveread the hmardwematerialsrequimmentsunderChapter6.95of lC�ll,�• j j 1990 BORER -COMP OHP OR 100,000 BTU) BOILER -COMP (OVER 100,000 BTU) the Cslitornia Ileallh A Safety Cod, Seelons 25505, 75533 and 75531. 1 understandthat if the building does amavrmatlyhave atewnithatltismy le NEW RESIDENTIAL MFCH. SQ.FT. responsibility to notify the occupant of the euptim ants which must be met prior prior to Issuance of a Certificate of Occupancy. p l of Cnnatfinn ISSUED BXL L7 ,( Owner or authorised agent Date TOTAL: OFFICE COPY