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08020047�akk�jj �E Z. i tLntF� JR!U I; bO3 -Z� I° RE 0z Z r V. ❑z UC yOy,, U2 CITY OF CUPERTINO Ts'',vYsfi1gk,,g-� rygyy QJai BUILDING DIVISION - PL` lUYUT 4QNTIUGTC � 7 Boll.gllbrYA�T1 WOLFE RD TBD - TO BE DETERMINED PERMIT NO. 08020047 OWNER'S NAME: PERMITffiUEDATS CUPERTINO SQUARE LLC 03/25/2008 NE: SANITARY NO. CONTROL NO. ARCHITECI'fENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH 0 0 0 0 LICENSED CONTRACOR'S DECLARATION Job Description p 1 hemby affirm We, I Me I'icnsed under provisions of Chapter 9 (Commencing with Sunman 7000) of Division 3 of me Business ad Profession, Code. And my license is T.I.- TWO NEW BTHRMS NEAR EXISTING MANAGEMENT in full Lim. g OFFICE IN HALLWAY ONE. NO SANITARY CONDITIONS. Dam Cougar ARCHITECTS DECLARATION I undtnuod my plus Nall W used u public mcorda Livens fcPmfc...M OWNER- BUILDER DECLARATION I hereby affirm that 1 em dsempt from the Contactar's Llamas Lew for the following mean. !Section 7131.5. Business and Pmrtutions Cade: Any city m county which O, Puma a Permit to Construct, alkc improve, demolish, or repair try mature Sq. Ft. Floor Area Valuation prior On its issuance, aim rectums men applkat for such Permit to file aaigned stoemem Conuactais License lsw(chapter 9 that he is licensed purmani W the provisions of the prefosuma CCOO) $80000 (commenting w'im Section 7000) or Division 3 of the Busioea ache or me, W is exempt therefrom and the Was for me alleged meap l... Any mad ken of 31620096 umber - Occupancy e p y Typ Section 70313 by My applicant for a permit subjects me appliCMLto a civil Penalty of not mom man Ow hundred dollars (5500). . a� wi wirewagerumekae. cmmPeoducas Required Inspections do the moot dprosionsmmyotinumers will damewark umvwe isrwrs 7o 14, Bmircv rdoes Cede: LieressLaw at apply an anger or ons cove The Canbacmh LI¢nse Low aces at apply q P no and o ngushwarthirese r pro arty am edmroslehim s, provided ed mutatiuman man e as not for ale IL ownemployeruiprovidedmvmch nt year ofdmoRemtl o Is aid mo awusr- however, me Orimprovement la sold within am yesr ofimproe for buildv M sew the burden of proving mat o did not dtiW m improve for puryase of as the en purring ' ass. L, u awusr of me property. sm ueluaively Combating with licensed Contractors In 7 wmmm me project (Sec. 7044. Business and Pmfessians Code:) The Cmbaskr's Li- come Law does not apply an am Owusr of property who builds or impreves demon, and. whoconuactsfarsu h pmjeou with a mntrsecter(s) licensed PMMM1 W mm CombacmY. I3ceru t Law. f or del n ❑ yam vamp WORI ER'COMPENSATfON DECLARATIODN 1 hereby affect under penalty of perjury one Of err following deelamdam: have and will mountain a Catifea, of Consent to self -huum fee Worker's CmnPCM Ion, as provided fee by Section 3700 of the Isom Code, for the pesformmee Of me were for which this permit is laved ❑ I have mad will maintain Worker's Compensation Instates, u required by Section _ 3700 of dm labor Code. fer dm ped-nname of me work for which this permit is lased ' My Worker's Compensation Ism. artier end Pull, number tae: Carrier. Policy NO.: CERTIFICATE OF EKEMMON FROM WORKERS' _ COMPENSATION INSURANCE - Cnda acem n used no tbecanplumd ifthe Permit is rmous hundred dollars (SIM) or Won) I Cori that in rfmm9o�epI work Iw whab this permit u issued. I shall not employ anyPe anvlftauhfr W° Wb .mbjectWmCWOrken'CompmsWm Iowa of Calir T/ rr /-v AppBCant k NOTICE A POCANi: IL aai making this Certifies of Emm fi n. you M WW become subject W mC Worker', Compensation provisions of me Labor Colt, you mesa forthwith comply with such provision m this permit shall o deemed revoked. 1 CONSTRUCTION LENDING AGENCY I hereby all. that mart is a tonsbuWnn huming,gency fm me performaer of dss work for which this Pettit us wood (Sin 3097, Civ. C) ' Lender's Name Lender'. Address I I CeNfy that I hew mad that application ad suss mat the above informWun u Caneci. I agree W comply with ali City and County ordinances and stain laws relating W Wilding convection. and hereby mmmire MpmsemmmS of thin city W enter upon du move- mentioned property for inspection purposes 1 (We) agme W am, indemnify and keep hannlea f City of Cupenina against I liabilides,judgmunts, caw and e.Pemca which may in any way mmne agilna aid City is co a I'm e granting of this Permit APp IT U�E STApIpS AND WILL COMPLY WITH AII��.. NO POINT Issued by: Date C J SO GNS// �6 c/ d Re -roofs Sigature ar Applicanomete HAZARDOU S MATERIALS DISCLOSURE Type of Roof Will these forum build gaerupmtr CupemOr 9.12. ad th Run ad a eeRusd by the Cupenim Muni ' Cads Oupssr 9.11. ad the Health ad Safety Code. section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will Nc applicant or forum Wilding occupant use equipment ar devious which it heaardnv air cmWninenta u and by dss Bay Area Air Quality Management all new materials for inspection. t Y. No I have mW the hare,duw makdW mrryiremutsmde,CTapkr635 ofthe other. nitllulded:safery Cads. ScWmu25505.25533 sWif53a. l uodcnund mollusc ilding ban rot cwre dy hew • L It' m- +pocslbilitY W notify atop t of the requirem, mw ar t ma ancedrbakas P Q) b Signature of Applicant Date All roof coverings to be Class "%¢" or better Owner or etmonrte agent ,k CITY OF CUPERTINO TENANT IMPROVEMENT CUPEkT�NO PERMIT APPLICATION FORM 0 W2 60 ZIP-2 APN # _ j l u 0m, ©q Jul. fI'C_ Date: �.� �' 0 C6 Building Address: o l _-3 AA G,/D -4c le a( , Mailing Address (if different from building address): Owner's Name: Phone #: �' n D Gcc� re , ��� 77 Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: Li .7 .2 Fax #: S— 03 ?0 Alternate Contact: Phone #: Fax #: Valuation (cost of project): gam, j-o o ec- 6J Job Description (be specific): %Gcl D htz ud ,dcc.�ro drh -S it �r if t� i Ski ALy y Tenant Improvement Includes Re -Roof: Yes ❑ No IAN If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No EU Type of Construction (Usage Class): Occupancy Type: 1 FR, l lFR ❑ 11, 111, V -lHR [f 11, 111, lV V -N ❑ A_ Project Size: Standard 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 lATINSP Tenant Improvement B 1ATI O� Inspection 1 ATIPLNCK Tenant Improvement Plan B Check 1BTIINSP Tenant improvement B 1BTI Inspection 1BTIPLNCK Tenant Improvement Plan B Check lETIINSP Tenant Improvement B IETI Inspection lETIPLNCK Tenant Improvement Plan B Check 1FTIINSP Tenant Improvement B 1FTI Inspection 1FTIPLNCK. Tenant Improvement Plan B Check 1HTIINSP Tenant Improvement B 1HTI Inspection 1HTIPLNCK Tenant Improvement Plan B Check lITIINSP Tenant Improvement B HTI Inspection l ITIPLNCK Tenant Improvement Plan B Check 1MTIINSP Tenant Improvement B 1MTI Inspection - 1MTIPLNCK Tenant Improvement Plan B Check 1RTIINSP Tenant Improvement B 1RTI Inspection 1RTIPLNCK Tenant Improvement Plan B Check 1STIINSP Tenant Improvement B 1STI Inspection 1 STIPLNCK Tenant Improvement Plan B Check 2 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 CITY OF Fax (408) 777 -3333 CUPEi�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: L�4 PHONE # d , 7 ' ,,D 8 GENERAL CONTR AMR. FAX # L,5 I am not using any subcontractors: Signature Date Please check anolicable.subcontractors and complete the followinz information 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