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08060147 CITY OF CUPERTINO � � BUILDING DIVISION PERMIT " - PERMIT NO. BUILTI5Cj,APr S' RD OPI COMMERC--AL BUILDERS 08060147 1�J(J l PERMIT ISSUE DATE 'VNER'SNAME: 06/23/2008 GARY LESSING 1445 LEIGH AVE SANITARY NO. CONTROL NO. PHONE: /408077_4800 BUILDING PERMIT INFO ARCH1TECffENGiNEER: BLDG ELECTPLTMECH re Z LICENSED CONTRACTOR'S DECLARATION Job Description uC I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing TI FOR OFC :3LDG INTER ONLY NO STRUCT. RE-NEW Z w with Section 7000)of Division 3 of the Business and proCeasioro Code,and my license is =y in full force and effect. b 6 2 s Y pERMI T #0 7 0 0 212 & ONLY TO PAY 1/2 FEES AND ALL v�Z License Clas Lie.N D I_ G ARCHRECI'SDFFCCLAR�N INSPCTIONS TO BE ON #07060212 i < I understand my plans shall be used as public records iyU Grn Licensed Professional y g OWNER-BUILDER DECLARATION ' r hereby affirm that 1 am exempt from the Contractor's License Law for the j:no following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to convect,alter.improve,demolish,or repair any structure "rn prior to its issuance,also requires the applicant for such permit to file a signed statemem S Ft Floor Area Valuation z< that he is licensed pursuant to the provisions of the Contractor's Liccimse Law(Chapter 9 q $65000 K F (commenring with Section 7000)of Division 3 of the Business and Prof rssions Cade)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of �,pp��f Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 7 2 0 0 0 2 .`17�V not more than five hundred dollars(5500). 0 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(Sec.7044,Business Required Inspections and Professions Cote:The Contractor's License Law dos not apply to an owner of 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.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the pmject(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 pmjects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec. B&P C for this reason vner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I 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. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cork:,for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number are: Carrier. L Fu"� Policy No.: 11 1-1318 Lf CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be competed if the permit is formic 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z OZ CONSTRUCTION LENDING AGENCY E.m►r I hereby alarm that there is a consructian lending agency for the performance of �i> the work for which this permit is issued(Sec.3097,Civ.C.) it,Q Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is I.T; correct I agree to comply with all city and county ordinances and state laws misting to 0building convection,and hereby authorim representatives of this city to enter upon the Uabove-mcndoned property for inspection purposes O m (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,cosu d expenses which may in any way accrue against said City / n V Z in consequence of the g ti of this permit. Date V L ►� APPLICANT UND DS AND WILL COMPLY WITH ALL NON-POINT Issued by: S( SOURCEREG L, _ K—D-0- Re-roofs Signature of Applicant/Contractor Dae T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle baiardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety 'ode,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes Will a roof is installed without first obtaining an inspection,I agree to remove ll 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? [3 Yes 1 have mad the hart materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code. on:2M5,25533 and 25534.1 tmdcrstarud that if the building docs not currently ha t.that it is my responsibility to notify the occupant of the mquim=ntsw metprior toissuartccofaCertificye'or Cyp � Signature of A)plicant Date 6j All roof coverings to be Class'[ "or better Owner or authorvcd agent Date o � y7 CITY OF CUPERTINO TENANT IMPROVEMENT CUPEkTINO PERMIT APPLICATION FORM APN# .3 Date: Building Address: 10ob 0 ,5� s2J. Mailing Address (if different from building address): I0661 Du,1 V? Owner's Phone#: Name: Contract r: Phone#: 0 PT_ Co rc�� c�f�-r�� Fax #: L1 OY 3? --'( SO Contractor License#: -916 2 5� I Cupertino Business License#: Z 6 6 Contact: Phone#: �) dy--3 7� L f�o D evuh OV,rr Fax #: Alternate Contact: Phone#: Fax#: Valuation (cost of project): 6 S o vv Job Description(be specific): ` Tenant Improvement Includes Re-Roof: Yes ❑ No jj�k If yes,number of squares Tenant Improvement Includes Structural Yes ❑ No F� Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/Ill/V-A § 11/111 B, IV-HT, V-B [] A Project Size: Express ❑ Standard&I Large ❑ Major❑ Green Building: Please complete Leed for commercial interiors checklist& attach it to the application or if applicable, include in plans & slieet index _ LEED Points Achieved *** For Office Use Only*** Over The Counter ❑ Revised 6/16/08 CITY OF CUPERTINO TENANT IMPROVEMENT FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1ATINSP Tenant Improvement B 1A TI Inspection 1 ATIPLNCK Tenant Improvement Plan B Check 1BTIINSP Tenant improvement B 1B TI T 1&00 Inspection 1BTIPLNCK Tenant Improvement Plan B Check 1ETIINSP Tenant Improvement B 1E TI Inspection-Preschool 1ETIPLNCK Tenant Improvement Plan B Check-Preschool 1FTIINSP Tenant Improvement B 1F TI Ins ection-Factory/Indust 1FTIPLNCK Tenant Improvement Plan B Check-Factory/Indust 1HTIINSP Tenant Improvement B 1H TI Ins ection-Hazardous 1HTIPLNCK Tenant Improvement Plan B Check-Hazardous lITIINSP Tenant Improvement B 11 TI , Inspection-Institutional JITIPLNCK Tenant Improvement Plan B Check-Institutional 1MTIINSP Tenant Improvement B 1M TI Ins ection-Merchandise 1MTIPLNCK Tenant Improvement Plar. B Check-Merchandise 1 STIINSP Tenant Improvement B 1S TI Inspection-Parking Garag 1 STIPLNCK Tenant Improvement Plan B Check-Parking Garage 1REROOFCOM Re-Roof Commercial B 1BSEISMICO Seismic Commercial B BUS LIC Business License B 2 of 2