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08050131
CITY OF CUPERTINO y r BUILDING DIVISION PERA41T BUILDING ADDRESS: PERMIT N0. 10123 N WOLFE RD STE FC16 TBD — TO BE DETERMINED 08050131 OWNER'S NAME: PERMIT ISSUE DATE RAJ MEKA 07/08/2008 PHONE: SAN1TiARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z O p LICENSED CONTRACTOR'S DECLARATION o o U 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description U w with Section 7000)of Division 3 of the Business and Professions Code,and my license is (TUTT I FRUTT I YOGURT) COMM'L TI NON—STRCTRL INC LD in full form and cffecL 3 i License Class Lie.a ELEC/MECH/PLMBNG 3 F Date Contractor t9 Lu RCHITE(rS DECLARATI a u 1 understand my plans shall be used as public records 4 Q y Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the C20 following reason.(Section 7031.5,Business and Professions Code:Any city or county Pi which requires a permit to construct,alter,improve,demolish,or repair any structure u Z} prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation f— (commencing with Section 7000)of Division 3 of the Business and Professiem Cade)err $65000 ERE that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �,F umber Occupancy not mote than five hundred dollars(2500). 316 2 010 0 .r�14 P.anC Y Type ❑I.as owner of the property,or my employees with wages as their sok compensation, wijldo the wart,and the structure is not intended or offered for sale(Sec.7044,Business , and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,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 Contractors U. cense Law dors 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 Contractors License Law. ❑1 am exempt under See ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of pejtrry one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- 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 Workers Compensation Insurance,as required by Section 3700 of the labor Code,far the performance of the work for which this permit is issued. ' My Workers C rope auon Insurance carrier and Policy number ate`,:v�q Cartier. PolicyNo.: CERTIFIC6TE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not be completed if the permit is for one hundred dollars($100) or Ins) I certifv that in the performance of the work for which this permit is issued,l shall not employ any person in any marmerso as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenifhcate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. ,'Z.,nom~., CONSIRucnON LENDING AGENCY E-r 1 hereby affirm that there is a construction lending agency for the performance of Gi the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is ' LL correct.l agree to comply with all city and county oNinances and state laws relating to 0 sen V building construction,and hereby authorize repretati6cs of this city o enter upon the above-mentioned property for inspection purposes Eft W (We)agree to save,indemnify and keep harmless the City of Cupertino against .y n.r!y) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. -�� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. �x 6� 7— F o� Re-roofs Signature o pplicanVConuacor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof �---- Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section zss3z(a)? ❑Ya Im`/o All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Ye IN. 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Cade,Sections 25505,25533 and 25534.1=demana d thatitilx building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must hie met prior to issuance of Certificate of Occupancy. Signature of Applicant Date Owne�thhori7zdagent ~ �'�Da` e All roof coverings to be Class's"'or better CITY OF CUPERTINO $ .«eg, >Xt"✓zw `� "`' BUILDING DIVISION PERMIT CON'T"'" TORINFORiVIATIONN Ha 'F,mcr„t 'tr°r .F.'iak 4'i. 31W.at'ra. s..3..a s_kw BUII,DINg ADDRESS: PERMIT NO. .1.O.L23 N WOLFE RD STE FC16 TBD — TO BE DETERMINED 08050131 WNER'S NAME: PERMSIISSUEDATE RAJ MEKA 07/08/2008 ONE: SANITARY NO. CONTROL NO. ARCHITECi/ENGINEER: BUILDING PERMIT INTO, BLDG ELECT PLUMB MECH a o LICENSED CONTRACTOR'S DECLARATION IOW Description "rd m 1 heruby M.that 1 sm licensed under provisions,of Chapter 9(commencing with Section TOM)of Division 3 of dec Etedrows and professions Code.and my liecroan is (TUTTI FRUTTI YOGURT) COMM'L TI NON—STRCTRL INCLD n din ren roree and affae.AQ ia'ai3 t;anseawaj Lic.g ELEC/MECH/PLMBNG Dam Conummr RCHITECTS DECLhRATI D 6 IundersandmypWuadmitWused epublic eod 6 5 Licensed Prurcssional 5 OWNER-GUIDER DECLARATION iF I herchy olTirm that I am'acrept from lite ComactaYs License Law for the COO following mean.(Section TITS 1.5,Businw and PruleaEans Code:My city Or county which manures a persalt m commend,alcor,improve,dcamuda.cur repair any museum _ZY priorm its issu en.alartiumas Nc applicant for such permit m file a signed suvment < thuseislicensed pursuant m Ne provisions,of do Comeacmfs,Liccese Law(Chapur9 Sq.FL Floor Area Valuation i�g (commencing wiNSation]000)afDivision3afthe Busircssand Professions Codc)ur $65000 — Nat he is exempt therefrom and the basis for Ne alleged eaennptiun My violadon of Section 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of umber Occupancy Type eat mart Neo five hundred dollen(55001 316 2 010 0 .Mjlt P Y yP ❑1,u owner of the papusy,m my wplayca with ws,ga u Near role compewtion, will do Ne work.and the structure is not intended oroffered for sale(Sm.7044.Bnsircss i ure RedIns actions and Professians Code:The Camracmfs License law loco ml apply m an owner of q p property who hui Ids or Impnows Nanton and who deco such work himmlr or through hu owncmployce,provided thatseh improvements mc Out intended oroBered fmsele.If. however.the building or improveree t l mid within arc year of completion.the ownv- buiMer ,will haw,the burden of poring Nat M did rot Wild or improve for purpose of sale.). 0 1.u owner of the property am eacluively convecting with licensed conuutw to construct Ne pmjee(Sec.7044.Business and Profesunns Cade:)The Conunem's U. . cew Law does not apply to an owner of property who builds or improves thereon.and. who cenuacu for such projects with aconummr(s)licensed pursuant to de Commerce. Licew law. ❑Iarnaenptmden Sec ,B&PCfothi3rta0m mer Daus- WORKER'S aleWORKER'S COMPENSATION DECLARATION 1 h meby alarm under pe sky of perjury arc of Ne(allowing declarations: ❑Ihaw ondwillmar bi SeC..37M ofCowmm mde.far me pd. Compen- ution,a pru h thi far by Section 3700 of the Labor Code.far de perfarmence of the wort for which this permit is ieueN ❑1 have and will maimun Workefa Compeumion Insvance,an ma,fired by Section 3700 of de labor Code,fm Ne pcRotmmen,of Ne work far which Nis permit is issued. ' My Wortrh C rope urian la.amen re and Policy number a : Carticc Policy No.: t 5,1 CE TIFIC F E)EMPIION FROM WORKERS' OMPENSATION INSURANCE (ITies sectile need mol ttcompleted lithe permit is foram hunthrddollars(SIM) or les) 1 certi(Y that in the performance or the wart fm which NW Fermat l wood.l dull mt employ anypermn in my manrcrm an m ecome subject to NC Waisma'Conpensadon Laws of CadifomiL Dam Appliarn NOTICE TO APPLICANT:Ir,after making this Ccrincate of Eumption.you should become subject m the Weaftes Compensation provisions of the labra Code•you mm ., z forthwith comply with such provisions or this permit shall he doemed revoked. .zn C' CONSTRUCTION LENDING AGENCY [-e 1 hereby am.Nm chert is a consusctim lending agency for the"form.of ai 7 the work for which Nl permit Is ieuW(Sec.3097,Civ.C) Qlattices Name z L<s 3 Address U Q I canary Nal I have read W.application YW sale Nm NC thaw information is W corme6l agree m comply with all city and commy ordbtYKa and sada dices,relating to 0 Wilding construction,and hereby amhmice repmsenatives of this city to cmen.peen the t I lrove-meetianed pmpeny for inspection purposes H y (We)agree to save,indemnify and keep harmlw 0e City of Cupcnino against h Iiabiiiti=a,judgmcns.cnsa and expenses which may in any way ac.ginslsud City U z in consequence of Ne granting of this pmmML APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT IBSUOd by: Date SOURCE REGULATIONS. Sngt �— vv �� Re-roofs aure or, ppter DamaRDOUS MATERIALS DISCLOSURE Type of Roof Will him appliantor future building eccupantmomo handle Honda anmamriu u deBmd by 0e Cu penina Municipal Code.Chaplet 9.12.and the HeelN and Safety uc,Section us3xfa)7 ❑Yu Er<o All roofs shall be inspected prior to any roofing material being installed. i Win the a Rant or future building rota at am If a roof is installed without first obtainingan inspection,I agree to remove PP e w ea Air Qu en dMana which P \ 'emit ons car emumisunu u defined by Ne Bay Area Air Quality Management all new materials for inspection. QYca Nu I have read de hvs,rdna maerius mquiremcnu under Chapter 6.95 of Ne Cilifor. nit Health&SafctyCedc,Sections 25505.25533 arW 25534.Imulemmnd Nm i(Ne Wilding does Out currently have a mnsn6 Net ler m m 4 my responsibility tifY the occupant of the manirtcn muwhichmust be m=l piarm issuwec cur.certircale araaparmy. Signature of Applicant Date Owner mNar.dagam aData All roof coverings to be Class'W'or better L o ' a L) m CL O m rr fo j ti a_ Q 2 u u CD cn Q A U V Q} H O CD 0 v a � F U u B v F CD zo Lo Q7 0 Q � U H CD F U a L� LU o O v S W F co a U p [5 O O H -a p N ULLJ F a I F P� O J p p p U d o Z Q)i w U i , SL � w LLI Z O c � W F W N � v' a F W a IL �Di - p LJ O U F a H Um I a -- x(D a �V ny cr; , c o a) cn Q _J U Q - Q U Q7 U U ( O a] .•Ay r„ ip Z a`�i a`Di aO`] U icri icriOL OL a a U LU LO a7 o p p LO �tM CD w Z LnZ w a > p co CD Z w Q . ~ > Q O o cn lL S W 00 OD 01) S m z z z w o Q Z p '� Z, Lo LO _ OD o U N Z I- , � ,� d 000 L 7 Ol ~ p m W ~ Cl) J p F- O O O f U F- — — Q Q rco CD 2, a7 O - a7 Q7 a} x 3 Qy N Q7 -0 a x x Q) -76C1 CO v� O x� O CL L.L > F- 0 x O u .V = E E x� v Z a� � T j w s t o _a 4 3 :5a ar ar a� O F- U S mCD v w x ° ti m n o - ° Q a� L) a) - E , —' E a� a� y a C3 m to a� ? n ar =� w a� �° o a a� a� 'a� a� S Q m U S a_ 0 a_ a -� �_ IL to c IL Q a- U U U d�o�oi�i CITY OF CUPERTINO TENANT IMPROVEMENT CUPEkTiNO PERMIT APPLICATION FORM APN # 3 ( r _ ® �l � Date: lP r Building Address: ®Iq- 1 W0t4r-aSTF- -F--(- I ("aPtg-fi/ren CA-9to 1 Mailing Address (if different from building address): Owner's Name: Phone#: � A jog - 110 -- 6-1 � a Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: it D+$ 061 Ci Fax#: Alternate Contact: I PDH` Phone#: Z4 © 2Lj-�- 09 Fax#: Valuation (cost of project): S ® D Job Description (be specific): , I (Pie J S 1'e-ucrrogAt) q.►CX-U G 4K- �4-6r--HA-fJ t cA-4,2,, PLv Mei tJ q Tenant Improvement Includes Re-Roof: Yes ❑ No [ If yes,number of squares Tenant Improvement Includes Structural Yes ❑ No ©' Type of Construction (Usage Class): Occupancy Type: 1-A5 11-B ❑ 115 111, V-A � 11, 1115 1 V V-B ❑ pj Project Size: Standard El--**' Large❑ Major❑ Green Building: Attach LEED Checklist to plans and identify in sheet index. LEED Points Achieved: *** For Office Use Only*** Over The Counter ❑ u; Community Development 10300 Torre Avenue n Cupertino CA 95014 Telephone(408)777-3228 CIV Of Fax(408)777-3333 CUPEIZJINO Building Department JOB ADDRESS: 1012-3 N1,, hJ )Gf�C- Aqp j St PL PERMIT # c.)PW J-No CA 61(901 0 �W SO l3 I OWNER'S NAME: 12AS NLE�--A PHONE # Oa(07 GENERAL CONTRACTOR: -f& D FAX # Cud S Ste- D 3) C1 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation r Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date