20376APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Idemificatian
Building Address:
- PERMIT NO.
10100 Torre Ave. Unit 176 (D1.2)
20376
caner, Name Phone:
p
TDcen Center F o erties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractor'. Nana: LIc. No:
8-4444
BUILDINGELECTRICAL1MUMBINGMECIIANICAL
CATEGORY
CONTROLN
Architect/Engineer. Llc. Na:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address -
PFRMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
-
. I thatlam Rcensed laions of Chapter 9
APPLIANCESRESIDENI'IAL
JOB DESCRI'I'f0
PANELS
thS on7Dffirm
3ofthe uWne nd PmnWonsCoda,andm
It..I Section force of d affeon3afthe Bu,inessand Pro(nelonaCode, and my
- 5F(�
S 1�Rl,B "la
LI...,lnfuutorteande(tect'
License Class
l•
Date Contractor
Cocm
LIP TO 200 AMES
201-IODO AMPS
ARCHITECPS DECLARATION
I understand my plans aha5 be used a, public records
OVERIOOOAMPS
SQ. FT. FLOOR AREA
$/SQ.FT.
SIGNSELECTRICAL
Licensed Professional
SPECIAL CIRC[IIT/MLSC
OWNER -SOLDER DECLARATION
I herebyafRrenthat lamaampt from the Contractor's License Lawforthe
following —o. (Section 70315, Business and Profession, Code: Any city or
county which require, a permit to comWet, alter, Improve, demolish, or repair
669
74.92
TEMP. METER POLE (NST.
any structure prior to its Issuance, also requires the applicant for such permit to
file a signed statement that he is Licensed pursuant to the provisions of the
Cantvctorb License Law(Chapter 9(commendng with Section 7000) of DWI-
Mon 3ofthe Business and Prafotlons Ccde)orthe, he la eaempt therefrom and
the bash for the alleged exemption. Any violation of Section 7MIS by any
applicant fora permit subjects the applicant to a civil penalty of not mthan
POWER DEVICES
SWLi),UNG POOL ELECTRIC
OUTLEISSWITCHESFIXTIIRESore
VALUATION
$50,121.00
NEW RESIDENTIAL ELECTR SQ.FT.
five hundred dollars (5500).
❑I, as owner of the property, or my employees with wages as their sole
STORIES
TYPE CONSTRUCTION
compensation, wRldothe work and Nestrutlure Is not Intended or offered for
vie (Sec. 7044, Busiries, and Professions Cade: The Conto ctota License Law
V -N
does not apply to an owner of property who builds or Improve thereon, and
whodce„ms
uchworkblelforthrough hisown employees, provided that such
OCC. GROIB'
RES, UNITS
Improvements are not Intended oroffered tarsale. If, however, thebullding or
Improvement esold within one yearofcomplelbnlkl
, the owner-bucrw111 have
ttiLtIumen of proving that he did not bund or improve for purpose otaale.e.
LJ L as owner of the property, am exclusively contracting with licensed
contractor to constroci the project (Sec. 7044, Business and Professions Cade:
TOTAL:
QTY. PLUMBING PERMIT FEE
R-3/
FLOOD?ANE
APN
PERMIT ISSUANCE
12
The Contractor's License Law does not apply to an owner of property who
Wilds or Improves thereon, and who contracts for such ptojects with a
cgOtTactor(a) licensed pursuant to the Contractor's License Law.
LJ f am exempt under Sec B h P C for this reason
ALTEILDRAIN k VENT- WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RICER N
Owner Data
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate of consent to self-imure, or
certificate of Worke W Compensatlanlnsumm or • certified copy thereof (Sec.
380), Lab C.)
FIXNRF&PER TRA('
SCIfOOL 7A% Y N_
RECEIPT N
GAS F.A. SYSTEM -1 WC4OTTLETS
PARK FEE Y_ N_
RECEEnT N
Polity
C.
X
an
CAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
Ned copy b hereby furnished.
er ified copy b filed with the city inspection divlelon.
92
CREASE/INDUSITIL WASTE INTERCEPTOR
FEE
CREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
IThissedion need not be completed S the permit h for one hundred dollars
SEWER-SANTTARY-SIORM EA 200FT
Date Recei t#
WATER HEATER W/VEvr/eLEcrn
ENERGY FEE Y_ N_
(SWO)orless.)
I certify that In the perfomanceof the work forwhic n this permit is Issued,
WATER SYSTEM/TREATING
I shall not employ any person In any manner so as to become subject to the
Workers'Compensatbn Lawsof Calffornla, Data
PAID
NEW RESIDENTIAL PLMB. SO.Fr.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the WorkerCompensation provisions of the Labor
Date RecqjjL#
TOTAL:
iWILDIN G FEE
419.011
Code, you swat forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
3.5
I hereby affirm that there is a construction lending agency for the perform
ance of the work forwhich this permit Is Issued (Sec.3097, CIv.C.)
(ender', Name
Iendar',Addre,a
I certi(ythat I have read this appBcationand statethat <heabovelnfamutlon
isrorrect. l ngreeto complywith all cityand county ordinances and state laws
TOTAL:
ELECTRIC FEE.
PLUMBING FEE
MECHANICAL FEE
8
QTY. MECHANICAL PERMIT PEE
PERMIT ISSUANCE 12
FEES PAID:
,
relating to building construction, and hereby authorize representatives of this
city to enter u Pon the above�mentluned property for Inspection pu rposn,.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, udgment.,msband axpenses which may In any wayacaue
ALTER OR ADDTO MECH.
Date Receipt#
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
SD .71
against Bald ty In ancceepth gra ng of this permit./
AIR w.NDUNc UNIT rovm t(L000CFM)
CONSTRUCTION TAX
Signatureo(Appllcant/Contactor a
EXHAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAIR R DOES MAT LS DI SCLOSU RE
HEATING UNIT (710 10),(00 BTU)
-
Date Recei t#
Will the app0ca fit or humans building occupant store or hand le hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.1 7, and the
Health and Safety Code Section 2SS32W7
❑ Y. No
Will the applicant or turebunding occupant use equipment or device,
BEATING UNIT (OVER 100,000 BTU)
TOTAL:
�/
�p,%
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
Mich emit haaardous air contamirunb as defined by the Bay. Area Air
Q�iLlity Management District?
Y. ❑ No
have read the haza 0115 materials requirements under Chapter6.95 of
the California Health k SafetyCode, Stolons 25505,25533 and 25534.1
understand that lithe building does not currently have a tenant, that it is my
BOILER -COMP QIIP OR 100,D00 BTI)
BOILER -COMP (OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.Fr. -
,cepemihlllty to notify the occupant of the requirements which must be met
prior to issuance of a Certificate of Occupancy.
City of Cuoertinn
ISSUED BY:
Owner or authorized agent Date
TOTAL:
OFFICE COPY