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06050225 CITY OF CUPERTINO 4 BUILDING DIVISION PERMIT 4bONTRACT,QR INFaO_RMATIQN BUILDING ADDRESS: VALLCO FASHION PARK PERMIT""".06050225 10123 N WOLFE RD STE 2080 OW NER'S NAME: PERMLT 155UE DATE Alk VALLCO FASHION PARK 06 NE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 [� �Cm j LICENSED CONTRACTOR'S DECLARATION Job Descrip I hcrtby affirm that 1 am licensed under provisions of Chapin 9(commencing ?X with Scedom7").f DivisionDRUMLED 3afthe Bus._ss and Professions Code.and my licence it ;may in full fo=and effect. SET PG&E ELECTRIC METER p z License Class Lie,a Dan—Ourilinsem, ARCHITECT'S DECLARATION JUN o$ 1006 1 m< I understand my pians shall he used as public recnNa do BUIL®I .ij� Lianscd Pmfcatiorul 5 OWNER-BUIIDER DECLARATION 00 I hereby.('Sons on I am exempt Wm the fessiinCo License Law for the p o which me reason.(Satan 1031.3,Business and improve, sstium Code:Any city or county m�+ which tequima a Permit m cmwvcL alar.improve,dcmnlLN.or repair wY stnucturt Cj(] °z< prior m as issuance.also equims the applicant forsuch Permiuo file a signed suamcm that be,is licensed powers to are provisions of the Con=wr's Lmve Law(Chapter 9 Sq.Ft. Floor Area Valuation C (commencing with Section 11)14))of Division 3 of the Business and Professions Cede)or u $ Nat be is exempt themfmm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicwt 10 a civil penalty of APN WdrAller u u Occupancy Type vel mom than five hundred dollars(SSW). 0 1,as owner of the propmty.or my employees with wages as their hole ampenation, will do the work end thesbuctum Is not inanded or offered for sale(Set.1094,Business hod Profeasoas Code The Conuacmra License Law docs rot apply to w owner of Required Inspections property woo Wilds m improves abandon.and who does such work himself or dwugh his own employee.provided that such improvements are not intended ora@red for ale.R. however.the building or improvement is veld within one year of completion.the owner- builder will have the burden of proving taut he did not b aki or improve far Purpn¢of ale.). as moaner of Ne Amps",and ucluslvely contracting with Barred contractors b Construct Urc project(Sec.7094,Business am Pmfetdau Code)The Contra noes U. cone Law river not apply to an owner of property who brlldi or Improv dYROn.and, who contracts for such projects with amnusctvr(s)licensed pursuant to dm Commodes License law. 0lam eapmor on rte .B At PC for this method Owner \\ D.so /ORKER'S COMPENSATION DECLARATION I y affirm under penalty of perjury one of the fallowing decimations: 1 have and will maintain a Cettificae of Consent to self-insure for Worker'sComport- anon,as provided for by Section 3700 of the Labor Code.for du performance of the work for which this permit is issued. 0 I have and will maintain Workefs Compeasatidn Inwmna,as required by Section 37W of the Laba Cade,for the perform..c f the wort for which dda permit ts issued. My Workces Compensation Wurwa carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE man action recd out bccompletcd if the permit is for one huddmddoBan($100) a or less) 1 certify Nor in the performance of are work for which this permit is issued,1 shed not employ any pereen in any mannerwu�p yceome bjcclmthe Worken'Compewtion Laws of California.rs•.-- nC'-1fi—O( Appliarm ` _� NOTICE TO APPUC :If.after making this Cci iricae of Exemption,you should become subject m the a s Compenadon pro Wont of thd labor Code-ydu muss .,O forthwith comply with such provisions or this permit shall M deemed revoked. Z y CONSTRUCTION LENDING AGENCY I--' I hereby affirm due dert is.cowmctinn knding agency fmthe'dormer¢of ai the work fur which this permit Is issued(See.3097,Civ.C.) GLenders Name z Lender's Address U Q 1 comfy that I have mad this application and sum thm the above information is B. F correct.I.,me in comply with all city and county muina as and some laws rel.ting to pU building construction,and hereby authorie representatives of this city to enter upon the above-mentioned PmPcny for impaction purposes. H 0.Wi (We)agree to ave,indemnify and keep harmless the City d(Cupcnino agalml V) limilitics,judgrecrts.casts and expeducs which may in any way amuagainst inst said City U aZ in coruryucmx of the granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOU ULA11 s. I '5-QIC-04 Re-roofs Signuu of ApplianUCOnOwmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applianl or future building oaupwt same or haridk havardous maarial as defined by Ute Command Municipal Code.Chapter 9.13,and the Health and Safety Code,Section % ❑ 3w— All roofs shall be inspected prior to any roofing material being installed. Ye Will the applicwt or turn.building occupant sew equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove emla fi v m us air Conuminwo as defined by are Bay Ama Air Quality Management all new materials for inspection. District, / 0Ye Qflu 1 have mad the Woman.mamriaU rtq.iranenu under Chaper 6.95 of the Calirin, ns Heal""&SafetyCede,sectors 35505,25533 and35534.1 understand thmifthe Wilding does not currently have.ensue it is my respenraddly to Wdry Ne occupwt cal the mquircin List bane rlormIssuanceofaCertificateofQawcY. Signature of Applicant Date S- Owner ondrizcd agent peaw- All roof coverings to be Class "B"or better ' is Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building De artment JOB ADDRESS: PERMIT # a N. wAao 0 060sd zZ-r OWNER'S NAME: Uu I(co lfkl I r PHONE # 7 GENERAL CONTRACTOR: 0 FAX # aL —0 3 o I am not using any subcontractors: )4 ,Signature Date Please check applicable subcontractors and complete the following information: 60 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 • Owner/Contractor Signature Date CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: Zmyw COPY #Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31620037 . 00 DATE ISSUED. . . . . . . : 05/26/2006 RECEIPT # . . . . . . . . . : 34570 REFERENCE ID # . . . : 06050225 SITE ADDRESS . . . . . : 10123 N WOLFE RD STE 2080 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VALLCO FASHION PARK ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : JOSEPH GOODWIN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : VALLCO FASHION PARK ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : WEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- -------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMMISC FLAT RATE 1 . 00 27 . 58 0 . 00 27 . 58 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICOM VALUATION 50 . 00 0 . 63 0 . 00 0 . 63 0 . 00 ------ ---------- ---------- ---------- TOTAL PERMIT 101 . 44 0 . 00 101 . 44 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - ------------- - -- ---------- ------------------ OTHER 101 .44 MASTERCARD TOTAL RECEIPT 101 . 44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • CITY OF CUPERTINO OJC50 g 2b C&OF PERMIT APPLICATION FORM CUPERTINO APN # �I t/1 _ `� . 031 Date: S� 2S,Q 6" Building Address: 1V Mailing Address (if different from building address): 16Q)-3 N. Wo Sac e4 Cl Owner's Name: Phone#: y a 3 UGC CU ' h aC � — 0 Contractor: y� License#: N Contact: �S Phone: -)7 /-3631 Cupertino Business License#: Joe G6 of k Fax: 70 5-v3 70 Building Permit Info: S e PC4F E(e C Y i C I ale e r Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ � jo Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �oOccupancy Group: Type of Construction: No N�e_ Please check this box if the project is a second-story addition: El Project Size: Standard ❑ Laze ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING MW 1 of 3 . ' CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantit Fee ID Fee Description Fee Group . BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPF'IXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER , Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lightin Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Ap aratus ELECTRICAL BREMNRApP Rem Non-Res ADDliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 2 of 3 C(i CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3 cF '� j 4-1 fy C oUl, oQo��o(' N 'D r r�Qo r 9 �9 &, O SEARS ..TH.Amff.�>u ' IF a Ix)wl«c 3 �' FRESx(a010E SvwrtrbxAnc, d. e` y =LfuxFn[axcsxeoors e a s C rQ W a e ���T> ®Q IF SMFORRIAEEYES m� (^• 1 ^y � /}�� r . ♦b o s i `r i u cgary oaR ,• f e I ' 1R © E t g. 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