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07110157CITY OF CUPERTINO K.�xww,rsx4�+':::.anAE•. xka.7 ,� "" BUILDING DIVISION PERMIT C, LINTRAGTUI2INi.F„(?ItMATIQ „}N,: BUILDING ADDRESS: 10123 N WOLFE RD #2138 TBD — TO BE DETERMINED PFJIMIT NO. 07110157 , OWNER' 01/14/2008 NE: SANRrARY NO. CONTROL NO. ARCHf1ECDPNGINEER: BUILDING PERMIT INFO BLDG EO PLUMB MECH O LICENSED CONTRACTOR'S DECLARATION Job Description 1 heeby affirm Nu I am Iiclwtl under provisions of Chapter 9 (cmmeneing with Section 7000 of Division 3 of the Business and Professions Code, and my "cone is TI, CONSTRUCT RSTRM, INSTALL CABINETS, PARTITION in tali forte ad off ea 0 Uansea.e. ue.g WALL Date ARCHITECTS CL ATION INSTALL ELECTRICAL. 1 understand my plans shall W used as pub c records Licensed Pmfcaskmal OWNER-BUILDER DECLARATION 1 hereby air,. that I am exempt from ate Conuacmes Lice. Law for the following mason. (Section 7031.3, Business and Professions Code: My city or County which require a leamit to consumer. Inc. Improve, dMenilM. v repair any suunum color In its iss.. also m9WTJ she applicant for such immil to Rle a signed Wlemenl Out be is Saved to de of de Canuac,rs lieu Uw(Chapter 9 Sq. Ft. Floor Area Valuation purcam provisions 50000 (commencing with Section 700M or Division 3 of the Business and Professions Cade) or that he is exempt therefrom and the Eau for that alleged eaempOan. Any violation of Number Occupancy e P cy •! P Section 7031.5 by any applicant rot a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (SIM. 316 2 0 0 3 7 , 0 1, as owner of Oar Property, a my employee with wager as their e4 cmpenwadon, Required Inspections will do the work and thcanoerurt 4 rot intended of offered for ask IS=. 7044, Business and Pofessiom Cure: The Commodes Uttn,e Law dead Out apply to an owner of property who buildaerimpoma Neren,and whodovauch work hiesselfor through his ,. own employees, provided that such lmprowmcu art not lnuust! aroffmd( wale. a• however, the building or Improvement 4 sold within orm you of compldan, me awner- builder will have W burden of proving that o did nor Wild or Improve for purpo a of sal..). 0 1, as owner of W progeny, am aclusively contracting with fiansed nearom on b comments the project (Sec. 7044, Evinces and Profession, Code:) The Conhacors U- «nwa law dace not apply In an owner of properly who Wilds or improve Merton, ad. wine coronets formals posters with a cnuanor(s) licensed purser., on the Coma ass'. Uceom Law. 0 lamvemptunder See .B &PCfvthlsmawn Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury, man of the fallowing dvlautiov: have ad will maintain aCWfiate ofCanannt to self -Insure far WorkeYa Compen. on, as provided for by secumn 3700 of six Labor Code. for the performama of the week fns which Otis perm4 4 umN. 0 1 have and will maintain Workers Compensation Insurance. as required by Section 3700 of the labor Code. for the performance ofthe work fm which this peanut is Woo ' My Wm1me pemadv lnwm artier and Policy number am: 6nkr. Policy No.: 11:5139 CERT F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cmu seeOm need net be completed if the porn t 4 fmonehundmd dall. (5100) or km.) 1 certify that in the performance of the work for which this ve mlt is issued, I shall not employ any PCMn In any memorial u b became subject to the Workeri Compensation Laws of Califomit Dm: Applicant NOTICE TO APPLICANT. If, after making this cenincate of Exemption. you should become subject be the Workers Compensation po taioms of the Ubec Cade, you must foMwith comply with such povisiov or this permit Mall W deemed restated. CONSTRUCTION LENDING AGENCY 1 W eby affirm that them is a connmction lending agency forme perforrence of the work for which this permit is issud (Sec. 3057, Civ, C.) ' dander's Name , Lenders Address I cNfy that I have rte this application and state that the move imformadon is ' correct. I agree m comply with all city and county oNlnsvv and sum laws missing o Wilding construction, and hereby aulboda representatives of this city to cnic upon the cove- manuoned Property for inspection purposes (We) V” to wave. indemnify ad leap harmless the City of Cupertino agaimt liabilities judgments, cos, ad vpoves which may in any way utxa against said City in consequence of the granary of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date t-! SOURCE RgGULATIONS. Re-roofs i —.. Type of Roof % � 1-14,-09d signat of Applian oat Dam HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future or handle material Coe. defined by the Municipal Chapter 9.12. Hansdov Cupertino Municipal Cie. Chaper 9.12 and Oe Health and Safety C Conn. seeress zss32(.)7 Sec 32(.)? All roofs shall be inspected to any roofing material being installed. Oyes ONO prior If a roof is installed without first obtaining an inspection, agree to remove Will the applicant or future Wilding Occupant van equipment or dcvim which .I harsNov air conmeninams as defined by the Bay Area Air Quality Management all new materials for inspection. In7 Oyu ONO 11ewmadthehvsudwsmamfials ne uimmenuumler Cltspur6.93ofteCaiifv- niaHealth &SainyCode, SOc- om 25705,23333 ad25534.1 undms,d Ovif to building dm ant c..uy lave a len,nk Out it 4 my respevibility to cdfy, the oavpanr, of the requiremenuwhldhou" met Signature of Applicant Date All roof coverings to be Class "B" or better Owne aathodrd agent Date CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM / APN #� G 02 � 0 a-? Date: Building Address: A/. e M4--1-4 c,, -rt n6 , Col Mailing Address (if different from building address): CA )103f Owner's Name: Phone #: ILI�idl Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: �r 171 T i,2 N Fax #: (o — o Alternate Contact: Phone #: o\ K Fax #: a8 31 8�0 Valuation (cost ofprojec : Job Description (be specific): Co►�c��.�G,,, i �,a�( C� b; kG�r o�s-� `� �q�rt,�; Otis( Tenant Improvement Includes Re -Roof: Yes ❑ No © If yes, number of squares Tenant Improvement Includes Structural Yes Q No ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, 1 1F ❑ 11, 111, V -lHR El"/ 11, 111, 1V V -N , 1� Project Size: Standard a Large❑ Major ❑ Green Building: Attach LEED Checklist to plans and identify in sheet indes. LEED Points Achieved: * ** For Office Use Only * ** Over The Counter ❑ CITY OF CUPERTINO TENANT IMPROVEMENT FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type ATINSP Tenant Improvement BUILDING Inspection ATIPLNCK Tenant Improvement Plan BUILDING Check BTIINSP Tenant improvement BUILDING I ,-( O Inspection BTIPLNCK Tenant Improvement Plan BUILDING Check ETIINSP Tenant Improvement BUILDING Inspection ETIPLNCK Tenant Improvement Plan BUILDING Check FTIINSP Tenant Improvement BUILDING Inspection FTIPLNCK Tenant Improvement Plan BUILDING Check HTIINSP Tenant Improvement BUILDING Inspection HTIPLNCK Tenant Improvement Plan BUILDING Check ITIINSP Tenant Improvement BUILDING Inspection ITIPLNCK Tenant Improvement Plan BUILDING Check MTIINSP Tenant Improvement BUILDING Inspection MTIPLNCK Tenant Improvement Plan BUILDING Check RTIINSP Tenant Improvement BUILDING Inspection RTIPLNCK Tenant Improvement Plan BUILDING Check STIINSP Tenant. Improvement BUILDING Inspection STIPLNCK Tenant Improvement Plan BUILDING Check REVCOMTI Revision -Tenant BUILDING Improvement 2 of 3 CITY Of CUPERTINO Assessors Parcel Number: Name of business. Project address. I (?) 2- ZV, R /yw�f2J3 Contact person. Phone. d 3�r- Fax. Current use of space. S� D °� . Ej, Proposed use. _..Building construction type. Occupancy Group(s) C.'> -, 1 Occupancy Load. a Square footage of remodeled area. j Is the building equipped with: Fire sprinkles? N; Fire alarm system? N Number of floors in the building? Z--- On what floor(s) is work being done? 2- . Brief description of work. Cz RtO kf0 0M , 7cc K2- 69 641)U-& . �uukitJ-- Code editions: 2001 CBC - N)2001 CFC. ' - N) 2001 CMC --P- N) 2001 CPC - -N)2001 NEC �- N) Effective 11/1/02 Are there any chemicals/hazardous materials to be stored at site? Y If above answer is yes, provide a list of materials and quantities. If job is involves food service, provide 3 extra plan sets for Health Department review. Commercial Plan Review Process Work BookPage -11- revised 4/28/04 CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: U, JEF t,-' PHONE # Q- -A GENERAL CONTRACTOR- FAX # I am not using any subcontractors: Signature Please check avvlicable ..subcontractors and complete the followine information: Date Owner /Contractor Signature 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 Owner /Contractor Signature Date ... . COMMERCIALIINDUSTRIAL INTERIOR . IMPROVEMENTS COVER SHEETCITY OF , CUPERJINO ~({-'2-0--D37Assessors Parcel Number: Name of business. , flo/d.eJA G"f~ ~ " Project address. ID) 2-5. JJ kJQ':f:e-!2d (hAt #2.J3~t / 0-tfU-trh ~ / CA CjQ))"f Contact person. JtG~' e. /dU,I4-11.fp-Phone. (J Fax. ~ _ C~e~~eof~~e. +/~~_·~D~/~-_~~~~O~(~·~~i~~~~~\@~~~, ~_~~ Proposed use. L ", a:, \ t'~, _~uilding construction type. Occupancy Group(s) __0=" _ Occupancy Load. ---------------~--~____r_+_---- Square footage of remodeled area. ---/----:...Cf-O--+/---,'--'S'--'l,la,....;\H.'3~tJ\\......_ ~--'--\_~_L Is the building equipped with: Fire sprinkles? (J) N; FJiI2n system? GJ N Number of floors in the building? 2-On what floor(s) is work being done? 2~. Brief description of work. CuvztiYtd cd-j2esrG Om ; hdldf. rall'>U:1s.,. CouJtU1,J;; Ptwkifi7fh s.. ( :J1/t.!Crwli.. ewr-fYt(d 1-1:-<~6'"1t-M. \L.Q:::\c.".. \ S'"pc.k-~ ""~ Code editions: 2001 CBC W-N)2001 CFC .. ,. -N)@-N)2001.CMC~~.:~ 2001 CPC . (tI-N)2001 NEC @-N) ," ~,:~ .. ~ Effective 1111102 ... Ifjob is involves food service, provide 3 extra plan sets for Health Department review . Commercial Plan Review Process Work BookPage -11-revised 4/28/04