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CITY OF CUPERTINO
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BUILDING DIVISION PERNIIT
CONT UCT1,6R I�l,4RMA N
BmLI)INC ADW.ES$;I,EVENS CREEK BLVD
/NA7MUE: b
BD — TO BE DETERMINED
PgRMIT NO.
k3040179
OWNIER''S
PERMIT IMUE DAM
EVERSH:LNE
7/07/2008
NE:
SANITARY NO. CONTROL NO.
ARCHITEC IENGLNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONfRAC TOWS DECLARATION
Job Descrl tion
1 heeby affirm that I am li¢vcd under provisions of Cbaptor 9 (mmmencin
with Section70f10)ofDiviaion3afge BusinmadProfmimr Code.andmyliceuci
, I MARUKAI SUPERMARKET NEW EQUIP INSTALL, 4
I. full force and .from
ue<nmassa L'e.K FOOFTOP
ITS, TRENCHING, SUSPENDEDCEILING, SOFFITS, INFRASTR.
Dam ARCHITECTSmDCLARATION
1 ualermnd my plans shall k used as public rccorN
Liccn¢d Pmfessianal
OW NEK-BUIDER DECLARATION
I batch, &Rom that I am oemp, from Ik Contractors Licenm Law for the
following region. (Sation 70313. Busircss and Professioos Cods: Any city Or County
which mquims . pmmit m Conswcl aux. )mpmve, dam oh. or mpoir my womum
prior W in bsi ammo, also mquims dm applicant for such Parmil to Gk a signal summcnl
' wl k a Keevcd Pu...ttodic"Anman of on Contractor's ua.m U. (Chapter 9
Sq. Ft. Floor AreaValuation
(commencing with Section an 70Of Division 3 of Ne Busirmas and Professions Cudc) in
$1500000
that k is Bump, dumadfirom and de basis for NC abged eumptian. My violation Of
6906008.0 N Number
Occupancy e
P YT'P
Section 7031.5 by airyappliunl far a pemlfl obit= Ne applicant in a Civil penally O
not mart Nan rive huMmd dollars (IM
❑ I. as owner of Ik popnty, a my wployw wIN aagp a Neer tole compewtion,
Required Inspections
will do Newark, and the swmum is not umnded or offered for$ale (SO .1(441. Baines$
and profeVWN Cade: T71C ConUmWrl Lionam Law dIX] Iql apply W as owlltr Of
,mopenY who build$orimpmmsthrreomand whodoessabwarthimmlfo Waugh his
awe mnploycm. provided that such imp mcmcnU ma nrotinmMed bralrertd forsale. If.
however. Ne building or improvement is sold within cone yav of completion. the owner -
builder will have thm burden of pm,dng that k did rot bold or impmm for purpose of
sal..).
0 1. as manor of Ik pmopeny. am euluavely eonuaming with liamed Conusomu in
Coostmm the pmjem (Sec. 7014, Business and Professions; Crede:) M Conmcmr$ Id-
cmue law arcs not apply W an owner of proputy who Wilds Or impCovcs Narcan, and.
who Conmcu for such pujems with a eantracmm($) Ifcensod puma., W the Co mactofs
Liceve law.
O l am exempt under Sea .B R P C for this mum
(berm, Dae
WORKERS COMPENSATION DECLARATION
I hoehundf th
y affirm molar Foully Of perjury oro Oe fallowing declandou:
I ha.0 and will maintain aCarlifcaus Of Callmnl W mlf-INOm farWalkCr$ COmpcn-
.
ation, as provided for by Scom. 3700017 the Labor Cmit, far dm perfarmanu of the
work for which this parmh is iimcd.
O 1 have W wiB malign Workers Compensation hosturnams. u nattoM by Sawn
3M of thc labor Code, far the performance of the work for which this permit is issued.
'
My Worker$ Compensation W... Cartier and Policy number ere:
Cartier: Polay, NO.:
CERTIFICATE OF UEMFTION FROM WORKERS
COMPENSATION INSURANCE
(This$eedoo tied notbecomithm d iftk permitbf xonehummad daRan ($100)
or [am)
1 ceAfy Not in the performance of the wart for which this permit is issued. I sisal not
Copley any person in any mannerm as W become subject W this Works$' Compensatk n
lawn of California Doe
Applicant
NOTICE TO APPLICANT. If, eMr making this Ccnificam of Exemption, you should
haeme subject W the Warkers Compensation provisions of the talon, Code, you most
' forWwiW..Ply with such provisions or this"Tit sag) is, dremW mated.
CONSTRUCTION LENDING AGENCY
1kmbyChandosthan h• nnagency fortk penform.sae of
the wars d(Scs. 7, Cho.
which Nis permit u iute0 (ser. 7091, Civ. Cl
Landers Na
Lendeh Md Md^.•
1 I unify that I ham toll this applienian and sum that the above infomntion is
-
Correct. I agree to comply with all City and county unlinuess and sum laws o lmall W
Wilding construction, and hemby author= mprem matins of Nu city to cins"Pon the
.Wm-mmudMd progeny fang
pavan porPosiowhich
(WC) agree W an. iMemaly and kap harmleu the City of Cupertino egaiul
j ii a
end exposcswhich may in any way scorns against aid Gly
may
C.Miaptumm, of
of thn Ranting of this W iL
A
APPLICANT D
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Signals. ofApplioHAZARDOUOU D.m
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will on applicantWilding
deliSu mifuture
,Chantmme2.andtehaalloud Safoll
by Bre Cupertino Municipal Code. CTapmr 9.11. and de Ho1N and safely
c c
oak. Oy. sss32(a)7
❑Ya, ONO
All roofs shall be inspected nor to an roofing material bei. Installed.
P P� Y g g
If a roof is installed without first obtaining an inspection, I
Will Ne epPliCanl or future building aaupam um equlpmcnl a deviw which
agree to remove
g P g
I ilavaNaos air eam.minanes u cieRand by the Bay Am Air Quality Ma sgcme.l
all new materials for inspection.
C,?
❑Ya ON.
I havemal thehua=m=6abmquimmcmuunderCMpmr6.95ofthe Califor.
nbHolNkSafnyCadesemiau75505,25533u Z53.I.6e dNmif Ne Wilding
docs not cmrcnlly have a irnanl that II U my rommmibility W notify the mculsnt Of the
Iryuimmcns which muss W ma prior W issu rox of a Cmufmam Of Occupancy.
Signature of Applicant Date
All roof coverings to be Class 'W' or better
Owner or authorind agent D,W
CITY / ,• ,<
TENANT IMPROVEMENT
CITY o'
CUPEkTINO PERMIT APPLICATION FORM
APN #
Date:
Building Address:
1 7
Mailing Address (if different from building address):
Owner's Name:
Phone #:
Contractor:
Phone #: rpPo
7,230
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone #: -70 /
y
Fax #:
Alternate Contact:
Phone #:
Fax #:
Valuation (cost of project):
p � d
Job Description (be specific):
't1 ;
AA f—It� 011f T 9 alt
� �
A 16 S U � t®/, -i rS 0 v
Tenant lunprovement Includes Re -Roof: Yes ❑ N If yes, number of squares
Tenant Improvement Includes Structural Yeo.,No ❑
Type of Construction (Usage Class):
Occupancy Type:
1 -A,11 -B❑ 11,111,V -A ❑ 11,111,1VV-B
Project Size: StandardX Larg Major ❑
Green Building: Attach LEED Checklist to plans and identify in sheet index.
LEED Points Achieved:
*** For Office Use Only*** Over The Counter ❑
1
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
IATINSP
Tenant Improvement
B
IA TI
Inspection
1ATIPLNCK
Tenant Improvement Plan
B
Check
1BTIINSP
Tenant improvement
B
1B TI
Inspection
1BTIPLNCK
Tenant Improvement Plan
B
Check
IETIINSP
Tenant Improvement
B
IE TI
Ins ection-Preschool
IETIPLNCK
Tenant Improvement Plan
B
Check -Preschool
1FTIINSP
Tenant Improvement
B
IF TI
Ins ection-Factor /Indust
1FTIPLNCK
Tenant Improvement Plan
B
Check-Factory/Indust
1HTIINSP
Tenant Improvement
B
IH TI
Ins ection-Hazardous
1HTIPLNCK
Tenant Improvement Plan
B
Check -Hazardous
IITIINSP
Tenant Improvement
B
11 TI
Inspection -Institutional
IITIPLNCK
Tenant Improvement Plan
B
Check -Institutional
1MTIINSP
Tenant Improvement
B
IM TI
Inspection -Merchandise
IMTIPLNCK
Tenant Improvement Plan
B
Check-Merchandise
/
1STIINSP
Tenant Improvement
B
IS TI
Inspection -Parking Garag
I STIPLNCK
Tenant Improvement Plan
B
Check -Parking Garage
IREROOFCOM
Re -Roof Commercial
B
1BSEISMICO
Seismic Commercial
B
BUS LIC
Business License
B
2of3
i fry
CITY OF
UP TIN
!11", WW's.1,111 1 1
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE # At& R6
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
bwle'-r , tractor Signature Date
21
SUBCONTRACTOR
BUSINESS NAME BUSINESS LICENSE
Cabinets & Millwork
Cement Finishing
v""
Electrical
2-9 t2
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
v'
Glass / Glazing
�✓
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
t/
Plumbing
Roofing
Septic Tank
V✓
Sheet Metal
V/
Sheet Rock
7-90
AZ
Tile
bwle'-r , tractor Signature Date
• 161
,,;�.,
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
OB ADDRESS:
J ' i� � , V /(-_ 0Ck
PERMIT
(U c l72
OWNER'S NAME: / r --
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: . — _" �a o�
e Date
Please check applicable subcontractors and complete the following information:
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date