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10120040CITY OF CUPERTINO BUILDING PE%W__(. BUILDING ADDRESS: 10201 TORRE AVE I CONTRACTOR: DPR CONSTRUCTION INC I PERMIT NO: 10120040 I OWN'ER'S NAME: WOODMONT REAL ESTATE MANAGEMENT 11450 VETERANS BLVD G .;R'S PHONE: 4089828466 ❑ t LICENSED CONTRACTOR'S DECLARATION License Class Lic. Contractor DfK�LL` �� Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. N I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I 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 construction, 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 accrue against said City in consequence of the granting of 's permit. Additionally, the applicant understands and will comply with all no -p t source regulations per the Cupertino Municipal Code, Section 9.18. Signatur Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 (See. 7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which th� permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I 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 construction, and hereby authorize representatives of this city to enter up the above mentioned property for inspection purposes. (We) agree to save i ►ify and keep harmless the City of Cupertino against liabilities, judgments, c, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply w ith all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date DATE ISSUED: 02/09/2011 REDWOOD CITY, CA 94063 1 PHONE NO: (650)474-1450 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECH F RESIDENTIAL r COMMERCIAL f— JOB DESCRIPTION: 1 ST FLR- COMM'L TI IN AN EXISTING 3 -STORY BUILDIG.WORK ICLUDES NEW OFFICES,LOBBY & ELECTRONICS -RESEARCH & DEVELOPMENT LAB 4/6/11-REV:41- UPGRADE EXISTING ELEVATOR MACHINE ROOM TO MEET FIRE DEPT. ALTERNATE MEANS & METHODS -6/2/11 REV#1 ISS'D Sq. Ft Floor Area: I Valuation: $1627450 APN Number: 36941005.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Date: E RE -ROOFS: 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will JHeah n compliance with the Cupertino Municipal Code, Chapter 9.12 and the Safe Code, Sections 25505,25533, and 25534. ri a agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 TORRE AVE CONTRACTOR:DPR CONSTRUCTION INC PERMIT NO: 10120040 OWNER'S NAME: WOODMONT REAL ESTATE MANAGEMENT 1450 VETERANS BLVD DATE ISSUED:02/09/2011 OWNER'S PHONE: 4089828466 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `��� �� MECH r RESIDENTIAL r COMMERCIAL r Contractor pff- C'otilST2vLj1o� Date 7&& I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: I ST FLR-COMM'L TI IN AN EXISTING 3-STORY (commencing with Section 7000)of Division 3 of the Business&Professions BUILDIG.WORK ICLUDES NEW OFFICES,LOBBY& Code and that my license is in full force and effect. ELECTRONICS-RESEARCH&DEVELOPMENT LAB I hereby affirm under penalty of perjury one of the following two declaratio I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1627450 permit is issued. APPLICANT CERTIFICATION APN Number:36941005.00 Occupancy Type: I certify that I 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 construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all no oint source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date Issued byDater ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct.the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I mus r nut rized agen forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional TY OF CITY OF CUPERTINO v 1 TENANT IMPROVEMENT CUPERTINO PERMIT APPLICATION FORM APN# Date: 00 /7 Ad Building Address: F D2,o ` —rg) Mailing Address (if different from building address): Tenant ❑ (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? Yes ❑ No Tenan wilding Owner' Name: Phone#: Contractor: � Phone#: Fax#: C&-V _3-7-d �- Cupertino Business License: State Contractor License#: 8 q6 Contact: Phone#: 6 So.-3_�>7_� -- 6�--f l z-- �C.f� Fax#: qoo - Zc(ZZ-, Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq.ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Job Description (be specific): P1X1L-0[0J("-r . l LVKtr- I►-�c�uroE� l�c'_�L9 ' F9FF �0�� Y� qA)0 Tenant Improvement Includes Re-Roof: Yes ❑ No,�5 If yes, number of squares Tenant Improvement Includes Structural Yes ] No ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V II/M B, IV-HT, V-B Valuation: q," Project Size: Express El Stand,, Large ❑ Major ❑ Green Building: Please complete Iled 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 05/18/10