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08080178CITY OF CUPERTINO $KKtiNg� �aax°z,=v =-. •'`' - - BUILDING DIVISION PERNVIIT E:@UNT=RACTORINk'ORMATIQN ;, f? ,i, .;*-:" s.', •fur iv#'a�•=<.,„Pr ,h•^Y+:-. v'i'i BUILDING ADDRESS: PERMIT Nth. 20400 STEVENS CRK BLVD # 370 HILLHOUSE CONSTRUCTION 08080178 R'S NAME: PERMIT MUE DATE PROMETHEUS 140 CHARCOT AVE 09/22/2008 PHONE: SANITARY NO. CONTROL NO. (408)467-1000 ARCHITECTMNGINEER: BUILDING PERMIT INFO BLDG EIFLT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I Wrebr ,nim[ wr 1 full Tkmneea ower Pmvid.ns of gamer 9 (commencing with Section ?")of Division 3,afw Bassein.. And Poofcssiom Cade,pm my Ii --u T.I INTERIOR COMMERICAL "MARKET READY: NON— in full mice and enecs.7 S License ,8 Lr.. STRUCTURAL INCLUDE (M, E) NO PLUMBING Daw�Conuxmr C ARCHITELTS DECLAR N Cevlg O I uwcmm�J my plw NAZI W used u public recrrN Licensed Pmfessiorw OWNER -BUILDER DECLARATION I hereby affirm that I Am exempt from w Communes License law for the following reason, (section mJ 1.5, Business Aw Professions Calc: Any city or county which mspown A pemril in cimmun, .lux. improve, demull h, or repair any structure prior At its cosmic. also requires she applicant for such permit to file a signed statement Ihat W is licensed to the of do Conlracmes License law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions (commeming will, Sezu in 7MM of Division 3 of the BusineesAnd professions Code) or $95000 that he is exempt wrtfmm and the basis for the Alleged exemption. Any violation of Section 7031.5 by Any applicant for a permit subjects the applicant m a civil penalty of Number Occupancy Type not mon then five hundred dollen (scam 3 6 9 010 2 8 .qA p } YP Q I, as owner of Ne pmpvty, ser my emPloycns with wages u Heir role compensation, will dothe work, it wmocoun 6 notinnwed moffn d furmle(see. 7014, Business And Proressloru Cade The Costract.rs Limns Law dues, rot appy in su owner of Required Inspections proporrywho Wilda wimpmves wreon, and who doessuchworkhimAevmthmugh his awn employees, provided this such improvements Art not intended cr.nernd fwsAle. If. however, the Wilding or improvement is sold within one year of completion, the owwr- Wilder. w01 have w WNer of proving that K did ret Wile or improve for purpose of sa1eJ. ❑ L As owner of w mpen,, am exclusively convecting with Bmnsed mnoan as in co Strom w pmyect (Sec 7014. Bush. sew Pmfcs,dam Code:) The Consomme. Li- mase law dons not.pply in in owner of pmpeny who Wilds or improves wmon, and . who contracts for such pmjecm with aconlncmr(a) licensed pomuam in wConvamser's ns law. 11 am exempt under Sec . B & P C rot this, mason a icer Dau - WORKERS COMPENSATION DECLARATION I hereby afirm under penalty of perjury ww of w following declamtiarw , ❑Ilure end willmaintaina Certificaw of sstian, pre don Section 3700 of w tabor Code, for w RAarmsuce a( w thi for Performanceof ft r h mi work for which this permit is issuM 1 have uM will maintain Workers Compensation Insurance, an required by Sora n 3700.( w labor Code. for Ne peRormonce of w work rot which this permit is issued. My workers Com%i AAxm `Mw%w funic, and Policy, num rAre: Grtier. i K polity, No.;4W_Q !9 o � �k fuSER yf7E81MONFROM WORKERS' O P SA ON INSURANCE (This semina reed rot W completed if w permit is Forane humbeddoBArs (SIM) or Inti) 1 sonify met in we permrmanee of the work for which this permit is bound, l shall rpt employ any person in Any mannerso in in Western subject m we Werkeri Compensation Laws of Caliromia. Dow Applicant NOnCE TO APPLICANT. If. after making this Ccmfiww of Exemption, you Nwultl become subject m w Workers Compensation provisions of the LAW Cow, you in= foMwim comply with such provisions or this permit shall be dcemed revoked. - CONSTRUCTION LENDING AGENCY T Wreby afnnn must tun is a commons m lending agency for wperformance of Law work Iter which Ill Permit is issued (Sec. 31197, Civ, C.) L enters Name Leaches Address 1 cesst, that 1 have read this application and stew too can move infarce,no l cmtstt I agree or comply with All city and county ominArnes and Awe laws rotating in Wilding construction, .nd hereby wNorite representatives or this city to en erup m NC shove -mourned property for inspection I%) non, to Ann. indemnify and keep hmmkss w City of Cupcnlno Alignat ' whichpurposes. IiaMlidcsjndgments.consAnd cxperswwhich may in my way Amus Against said City in ccMA19"IlDcg n (Nis D'"ZI. APPLICANT UNDER AN AND WILL COMPLY WITH ALL ON -POINT SOURCE R s. Issued by: Dale J 2 Re -roofs Sign of Ap U Dow AZ HAZARDORDOUS MATFRIAIS OISCLOS RE Type Of Roof Willytapplicantwfuture Wilding wmpaptnomwandth eefnw io w Cupertino Muncie'pal Code. Chapter 9.13, and w HnsIN and Safety Health And now. swoon us33(.)T ❑Yue e All roofs shall be inspected prior to any roofing material being installed. Will thea leant or future building .co, rt use of or devices Mich PP e cA If a roof is installed without first obtaining an inspection, I agree to remove g p e asmrcmumrnsnu finedbYwBayArtaAirQuAlityMangemcnl Air all new materials for inspection. District? DYns Nu Ilam rtadwhAsaNa eFamryaJ3onquiterrondiumacrOupwrii.95offficcohror,domMiiN&SafcyxMAMi re understand Nuifw WoNrg metmyrespd2553A.1 Java nor currently haw. A tun l wl Il my reapowibililY w roti w o of w mquiremhntswbi u< rue tsmmceof.CcrlifeA raeno 011 Signature of Applicant Date All roof coverings to be Class'%¢” or better A T Owner or mNGncnI j paw =ile Edit Actions Details Links Favorites Help PI, III �r1,rC'm,�..,�n Permit Number 08080178 Status . -1 Master Number 1 APN 36901028.370 Project IQI Unit Apply Date x 08/22/2008 Permit Issue Date 09/22/2008 Certificate Issued 11/05/2008 Certificate Type Address Home - 20400 STEVENS CREEK BLVD Certificate Number Permit x Property Zoning Applicant Contractor " Defined Fields Permit Details Permit Type" 113 TI IQI TENANT IMPROVEMENT Usage Class ' 1 -A,1 -B IQI 1 -A,1 -B NEW Applied Value x 95000 Address20400 STEVENS CRK BLVD # 370 City/State/Zip CUPERTINO IQI Notes 1 APN 36901028.370 0 IQI IQI Unit Operator SylviaM Operator patg (Owner Name'I PROMETHEUS Operator PALM Use Default ❑ - PERMIT Address Home - 20400 STEVENS CREEK BLVD Permit x Property Zoning Applicant Contractor " Defined Fields Permit Details Permit Type" 113 TI IQI TENANT IMPROVEMENT Usage Class ' 1 -A,1 -B IQI 1 -A,1 -B NEW Applied Value x 95000 SQUARE FT. 0 Calculated Value 0 IQI US C-404 Type 437 IQI ALT: NON -RES, NON-HSKPG Permit Form x AUTOPERM - PERMIT Ownership 1 - Private Project Size STANDARD -STANDARD 'ermit issued 0912212003 anter permit status City/State/Zip CUPERTINO CA 95014 CA 95014 Purpose/Special Conditions T -I INTERIOR COMMERICAL "MARKET READY= NON- STRUCTURAL INCLUDE (M,E) NO PLUMBING FILMED 5/2011 Ir -n AAA n_f-.. SIF T SOK lire Back Jcr, Contractors #i Fees Imo, Plan Reviews Inspections I« Print Permit lt_a' Adjustments 11'Zo Holds --•5 r__.. o..,—:, J Close Permit I^,�Overrides Supplemental Fields Notes It�ijAttachments upZ _� 3F Lu �-4 PyU —O� unrly Yp0 Km A 0 Z Z Lia ; r7 Z UO V. E; OU ►F" -t Ice/] U BUILDING DIVISION PER1NUT BUILDING ADDRESS: PERMIT NO: 20400 STEVENS CRK BLVD # 370 HILLHOUSE CONSTRUCTION 08080178 OWNER'S NAME: PERMIT ISSUE DATE PROMETHEUS 140 CHARCOT AVE 09/22/2008 PHONE: (408)467-1000 SANITARY NO. CONTROL NO. ARCHr1ECTIENGINEER: 1 hereby affirm that 1 am licensed under pmvWons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code ,ptfd my license is in full force and cffe Oy License s h Lic. 0 \ Date Contractor i!. ARCHITECTS DECLAKA11ON C,,,44Zf, CF 0 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arry applicant for a permit subjects the applicant to a Civil penalty of not more than rive hundred dollars (SM. ❑ L as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employers, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li - come Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self-insum for WorkeesCompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. My Worker's Comj�nsationInsuranck carrier and Policy numbgr am: — d Carrier: L__. I11; Policy Nm• . agER&W ON FROM WORKERS O P S ON INSURANCE (Chis section need not be completed if the permit is formic hundred dollars (2100) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation previsions of the Labor Coda you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building constmction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way seem against said City in consequence of the g n f dtis permit. APPLICANT UNDER AN AND WILL COMPLY WITH ALL ON -POINT SOURCE Signatu of Ap t Date UCo tractor HAZARDOUS MATERIALS DISCLOS RE Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Muni pal Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? 1:3 Yes .70 Will 'the applicant or future building occupant use equipment or devices which emit hazardous air contammannrcfincd by the Bay Area Air Quality Management District? ❑ Yes No 1 have read die hazards arc s mquirements under Chapter 6.95 of the Califor- nia Health &Safety Cade, 25505, 533 and 25534.1 undcrsund that if the building dors not currendy have a ten r, that it' 'my respansibility to noti the o rp of the requirements whi ttslbr n 'a issuance of a Ccrtifica f Occup 7- o Owner or auth fined a nt Date BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description T.I INTERIOR COMMERICAL "MARKET READY: NON- STRUCTURAL INCLUDE (M,E) NO PLUMBING Floor Area 36901028. Issued by: Re -roofs Type of Roof $95000 Required Inspections Type Date;_, Z f -C� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "A" or better CITY OF CUPERTINO ,.. TENANT IMPROVEMENT CUPEkTINO PERMIT APPLICATION FORM .,36 q L:g ,.3 �0 e�PLOIPai7�? APN # � — o —1� O Date: ZZ�� Building Address: ;P -Hoo Awq cue &vb surte a3z Mailing Address (if different from building address): Tenant R (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner Tenant/Buildin Owner's Name: )0/QDR& EU - Ac&_ Phone #: & 73- 0!a Contract r: �IAU 10 tic 114ous�e C�a�� (; � Phone #: Y6 7Y1000 Fax #: 146 900 Contractor License #: ,3-93 66cp Cupertino Business License #: o�6 Contact:/ /�fR,iL . Jae�.+a.l Cit Phone #: A5-7/do a� Fax #: 4-16 %` 9'700 Alternate Contact: Phone #:� �,,W*94 00001VJ Fax#: el -X17®-0 Valuation (cost of project): Job Description (be specific): �ri�tr�(0� c UAe06(al AW) Tenant Improvement Includes Re -Roof. Yes ❑ No N:2 If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No F Type of Construction (Usage Class): Occupancy Ty�e• 1-A, 1-13 /91 II/III/V-A ❑ 11/111 13, IV -HT, V -B ❑ Project Size: Express ❑ StandardRD Large ❑ Major ❑ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Over The Counter ❑ Revised 8/08/08 } CITY OF CUPEkTINO + < / 7 (( e"�-61e/ / - Community Development ,�' 10300 Torre Avenue �!/� �� 7%/',0 Cupertino CA 95014 r Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: dolyoo s ewly& 370l-?, PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: 44 hoos.-P- a wf twO FAX # I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date f r i Owner/ actor Signature vo -.�a-Vp Date 9irzeo SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork V Cement Finishing Electrical Cbca )1 CHC, AI E Excavation A#4 Fencing lovh- Flooring: Carpeting es�s�,, to 6 t e" �. Linoleum / Wood AI Glass / Glazing 7'%70 Heating 4 -A 7`6WP 5Z�PqV l EC' 5 A&L 4�Z— ` W Insulation Landscaping Alk Lathing All+ Masonry Alk Ornamental Sheet Metal AV + Painting / Wallpaper J a uouglw ►tau,'! 0? _57 Paving Plastering Plumbing d� Roofing �Ilf3 Septic Tankf�- Sheet Metal Alh Sheet Rock Agladc-A) colt ON Tile V, f r i Owner/ actor Signature vo -.�a-Vp Date 9irzeo