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09070110 CITY OF CUPERTINO BUILDING DIVISION PERMIT1' TRR � �� '_ BUILDING ADDRESS: PERMIT NO. 10630 DE ANZA BLVD TUCKER CONSTRUCTION INC ngn7nilo PERMIT ISSUE DATE "NER'S NAME: TUC — =9 P.10NE: SA CONTROL NO. BUILDING PERMIT INFO ARCHrrFCr/ENGINEER: BLDG ELECT PLUMB MECH COMMER-"IAL DEMO u p O LICENSED CONTRACTOR'S DECLARATION Job Description U 51 hereby affirm that I am licensed under provisions of Chapter 9(commencing Mwith Section 7000)of Division 3 of the Business and Professions Code,and my license is w in full force and effec v�z Lice ass Lle•M n E-0 Date Contractor .a .. ARCHITECTS DECLARZr: - t C',V,-� 1 understand my plans shall be used as public recods v �yU LL to Licensed Professional o3 OWNER-BUILDER DECLARATION MI hereby allirm that I am exempt from the Contractor's License law for the following mason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct.alter,improve.demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement t' ,Ft.Floor Area Valuation _C that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 .t q Y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑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 ror sale(Sec.7044.Business Re tired Ins ectlons and Professions Code:The Contractor's License Law does trot apply to an owner of Requp property who builds or improves thereon,and who docs such work himself or though hill 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 Contractor's Li- cense Law does 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 Contractor's License Law. ❑I am exempt under Sec B&P C for this reason n� Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑[have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 Workees Compensation Insurance,as required by Section 7 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance ter,and Policy number arc: ^� ` Catrier��f�1�-� i 01% CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section treed not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date— Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z '. CONSTRUCTION LENDING AGENCY F~-t rA I hereby affirm that there is a construction lending agency for the performance of p�5 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendces Name az Lender's Address U 0 I certify that I have read this application and state that the above information is Vm'� corrccL I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W 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 in any way accrue against said City / U Z in consequence of the granting of this permit. L�Z�W�._Date�_ I '� (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S U C REGU TIQNSr� r Re-roofs SigatureofApplicant/Comractor- Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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 -,dc.Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes )kNo If a roof i.;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes *0 1 have read the ha7ardcus materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building d �dy tenant.thatitismyresponsibilitytonotifytheoccupantofthe re u mance of a Ccrufcatc of Occupancy. Signature of Applicant Date q All roof coverings to be Class". 'or better Owner or authorized agent Date CITY OF CUPERTINO szTZ07�• "' BUILDING DIVISION PERNHT G66RU, "OR"I1V�F�(DRll'IA�'Ig1�F BUILDING ADCRESS: PERMrr Nil. 10630 DE ANZA BLVD TUCKER CONST OWNER'S NAME PFR OISSUE DATE PHONE: S CONTROL NO. ARCHnECT/ENGINEFR: BUILDING PERMR INFO BLOC ELECT PLUMB MECH COMMERCIAL DEMO p p p p top LICENSED CONTRACTOR'S DECLARATION - - - 1 hereby affirm dote 1 am li¢,vm under provisions of chapter 9(commencing Job Description with Section 70M afDivit on 3ofNa Smitten,and Pmfcauou Cade.arui MY lieuse is in furl form and 0)R' C Z Lice aM I3c,g 31- Da¢ Conuaerar ARCHI7FLT5 DFL TONT ill I mdrnund My pwu awl M usa an publu l®Wa tdu a Ilsvtned Pmfeasiaw s OWNER-BUILDER m the Com ION a 0 I hereby(Sce that I . rump,from the fcWm 1,Ilrsnm law for Ne -D o which ng won.(Sectio 70L.5y m what. and Pmfudam Cady. m city mmnty tel S$ whirr ii;i.asu a panni,corm.the Ww,impmye,h permit t m e a si,my mmmem .zi oMMI inatMor 0iuiensedpalso i M the pmaPPlfunl for xommemi,I riliccomLnatlaupter9 • < Nte10)uling wit pumtm,70 00)of Divorc of theat Bushmen IJ¢osetaw(Wpw9 Sq.Ft.Floor Area Valuation $ Lhm e,emurith Section7000)and of lett,0)3 or that cseend Pm A" hCade)or - Ihu M u eampt there(som ea 00)MSB for tM Alleged emop,lan Any Nolulm of gectlae 7031.5 by airy applicant fm a permit subjeen the applicant to a civil penury of APN Number Occupancy Type nm mart dm five handed dollam(3500). ❑Lasawner ordiepmp misymPlaY dwoff a6caudsbmleampBusiMa, will do fessia leC do The 'meunne,I round L B d kastl apply W g4 rote of Required Inspections sod onym e,b Cade mite Ca ome,nr Imi who Law arca or apply ir m own.,big q P am amplay Wibaorimpot That mahimn.aMwho doe aaehwmkhlmaelfnr though bis ownmPlayra,pin,or aposuer al.Is gold than not year p[WM fm Mine hvwevee Ne bonding o ellen of emml haat within am old 9r mmplala0.ttr POmtof builder MB hone W bmdco of MowNg W,M dM m build a hnpmw far porpex of sale.). ❑4 u Dave of the Moran,m anmb,d ray conhMing with Ocmed mnvaerma m construct d0)Project(Sae 70th,Burinan and Pmhsdam Cade:)7be Camcmes Li- cmen law don no,apply m no owner W property who bWWs or ImpdeRa demon,and. who commis for such pmjc=with aconuamong)licensed pmum n the Camnnm1t IJxnx law. ❑Imnovp,under5re .B&PCrortbsRamo Owner Due WORKERS COMPENSATION DECLARAnON 1 herby&M m under Faulty of perjury ane orthe followug deciamlme ❑1 h mnM will munuin acnti0cam ofCarumtnxx-Insure rmwmFda Campm-. xtlor.u pnevided For by Section 7700 of the Labor Code,for the peAormaom of tin•. Woork for which Nis permit is ianed. DLI Mtn teal will maintain Workoes CompeuWon Wmmm.u required by section 7 of the Lrbor Code,fu the pcommmm of the work for which this permit Y laws. MY Warkcfs Compensation lnmuux err Policy Much.,am ami\yrvet...'C-m EfYoll`ry5+a.:.S^l�U Z�LI CEFrnECATE OF EXEMMON FROM WORKERS COMPENSAnON INSURANCE Cf Ms medical Mad cot be canphocd B dbc PRmb ho(m am huMRd do W n R 1007 or leu) 1¢tify Nat in the pesfomenm of the work for which rids permit is lmcc I"I nc, mploy any permn in my mm 0)r m a m become subject to tin Worland Cmpomdon I.or California.Dan Applicant - NODCE TD APPLICANT.Jr.aper making NB Certificate of Exemption.you should - become subject to Ne Workrls Campenudm provisions of the labor Code,yen a= 70 forthwith u w Nu comply with such Wovltiopewit shall be domed Rrakrd z= CONMUCDONLENDINGAGENCY IMRwhaRnm doer Nue Ya od(sec.3 .CW. gaeeyfmriteperformanmaf- X ti doe work fm wrier tar permit u isared(Sec.704(.Ch.C) Lmdce11 s NameUrnice D Z lendefa Aaw U O 1 caddy thte I Mva ter this appltcadm and cam taw the above ieformatiav u !" nmest 1 agree to comply with YI city sa cowry,aWlrwees and ewe Jews relating to SV" wilding commohm.aM be"mNadx repcuroutivu of Nu city n cow open the G abewe-mmtianed Property for impaction perp (We)ages m Mere,indemnify and keep Immolator lin City of CupcWm ogaiut .F.r rA Isabllitim,judgmmu.cost,and upeoxs which may In my my amc+gaunt Mid City J Z in consequence of the grating of this permit. q APPPP ICANT U ERSTANDS AND WILL COMPLY WRX'All NON-PPOIINrt Issued by: Date — J -6 `J \\ 22 Re-roofs Sigutme of HAZARDO APPIicaOm xAZAN00u5MATFRIAL9 DISCLOSURE Type Of Roof WIII the mpucmt or fou buildingnstomarandIe Inattention mahel u ntofincd e Cupertino Municipal Code.Chapter 9.12;met the Heald,and Safely Canto.Sectionio sss7x(a)7 ❑Yn �No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or rume building ocimp at use equipment ar de.hv wWeb If a roof is installed without first obtaining an inspection,I agree to remove rah hmudaM sir conamimme;u defined by am Bay Area Air Quality MUMPromr. r all new materials for inspection. Dwnc,7 ❑Yes *a 1 bate mad the hamedruu manriJa r imrnmrcarr Cbapw&95ofNa CWifan Wa HwN&SafnyCode.Smdmu155M.75533 andvJ53e.1mtlewend thd BNr MWS . rc 0Y eamune0u Itamyr.,pa miitywmdfythedmgmtofdo Rqe wide ataeamnM7w ttaamoraemdamnearoampnocy. Signature Of Applicant Date Owner ar aaNarvnd apcm \ con' All roof coverings to be Class'{"or better � 7 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36938038 . 00 DATE ISSUED. . . . . . . : 07/13/2009 RECEIPT #. . . . . . . . . : BS000008181 REFERENCE ID # . . . : 09070110 SITE ADDRESS . . . . . : 10630 DE ANZA BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : O.M. INC ADDRESS 1079 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, 95125 RECEIVED FROM . . . . : MARK TUCKER CONTRACTOR . . . . . . . : MARK TUCKER LIC # 27226 COMPANY TUCKER CONSTRUCTION INC ADDRESS .. . . . . . . . . : 1725D LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 287-1424 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 . 00 1.00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 10, 000. 00 1 . 00 0. 00 1. 00 0 .00 1BUSLIC FLAT RATE 1 . 00 114 .00 0 . 00 114 . 00 0 .00 1DEMOCOM SQ FEET - 0. 00 507 .00 0 . 00 507. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 623 .00 0. 00 623 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 623 . 00 master card --------------- TOTAL RECEIPT 623 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ----------------- 704 DEMO M:10 'Y ��.SS�E� � 4k I�•"F�+9'sF. �C�COlVIMERCIAL/INDUSTRIALwINTERIOR= � ��yaS{'S�'�`t}yw� f.F +�. C' •c-a e-, r :M.lae-a N�2rv': 'T _ 41Gxd F.F Y'd.k +, } z AY-. r `a"-��.�'��°`' y� c an c � N 4 c� a:� �S '�.} F f i^ S-z->t• ; i 3 �¢ 35t \, ?',�` J-�' � aC«'4 1"'s � kb ,.+-.ri 2Ezi- e. �.>�,�p a >�•' "z r.--... Assessors Parcel Number: hJame of business. A Qom. COQ /-� ��g�. (� �C�Ik 0 M toj C_ Project address. 6Q(/Q_ 5 . Contact person. C3 RJ O' MLN(LA- Phone. l{�i Fax. Current use of space. Proposed use. Bloom Building construction type. M Occupancy Group(s) Y Occupancy Load. t�'joo9 Square footage of remodeled area. O Is the building equipped with: Fire sprinkles? Y i Fire alarm system? Y�1 Number of floors in the building? l On what floor(s) is work being done? l Brief description of work. :W-Aartap .do,Nslrk.w t�: .r. e ea. 4.n a- -1-(±YA-MOW n ++ Code editions:2008 CBC 6 N)2008 CFC 2008 CMC (Y-N) ,i-r=RO V t►. 2008 CPC (Y -N)2008 NEC (Y -N) ny ACCORDANCE WITH THE CITY UA GUPERTINO CODES AND ORDINANO Effective 1/1/08 Are there any chemicals/hazardous materials to be stored at site? Y - - If above answer is yes, provide a list of materials and quantities. t of p a"' p:c:iications ue kept on thr ; .. . .Imes and R Is un lawful to maks •- s or elterMfonE If job is involves food service, provide extra plan sets for Health Department WnyiARie withuu ;,armisslon frena the building Dep' Cupertino. the stamping of It. i !nd speafiMolft iHALL NOT be heal t) p- mit or to be &. 1pprovel of the violation of any pmmsinn+ f any Citv rl Krmxnro +v Vain Cow Commercial Plan Review Process Work BookPage-10-revised 1/l/08 CITY OF'CUPERTINO ;� �D�. DEMO �.._. CUPEkTINO PERMIT APPLICATION FORM o IIC7 AP 0(-o Q 3 O3 Date: c Building Ad ess: Mailing Address (if different from building address): Owner's Name: \bZc� Phone: Contractor: Phone :tk6,Z Z9�-1 —�� (� (` 1 v-&C_r lss�S ,�s, Fax: 7-1?,-t VAIA�, Contractor License #: Cupertino Business License #: Contact ( Phone: (LVA Fax: Residential ❑ Sq Footage Commercial [X Sq Footage S,ozw Job Description: ` Valuation: \ 0 Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Please complete relevantportions,of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee-Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 5r 1BSEISMICRE Seismic Residential B Revised 01/07/09