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07110156 j << CITY OF CUPERTINO n�,� BUILDING DIVISION PERMIT U � � � ` BUILDING ADDRESS: PERMIT NO. 10123 N WOLFE RD J T CONSTRUCTION 07110156 OWNER'S NAME: PERMIT ISSUE DATE CUPERTINO SQUARE LLC 1720 OCALA AVE #B 01/24/2008 PHONE: SANITARY NO. CONTROL NO. (408) 234-4340 ARCHITEC IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH D O O D 0 o p LICENSED CONTRACTOR'S DECLARATION v f= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Code,and my license is T.I. THEATRE EXT PATH TO SIDE WLK RENVTN y in full force and effect - ? License Gass Lic.# _ n—m Date Contractor . ARCHITECTS DECLARATION Jac,, 1 undersand my plans shall be used as public records / 'yV r;.trp ti Licensed Professional y� OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from the Contractor's License Law for the E:20 following reason.(Section 7031.5,Business and Professions Code:Any city or county K$F6 which requires a permit to construct,alter.improve,demolish,or repair any structure y Z y prior to its issuance,also requites the applicant for such permit to file a signed statement that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation A Fz-$ (commencing with Section 7000)of Division 3 of the Business and Prgflessions Code)or $60000 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 ofumber Occupancy Type not more than five hundred dollars($500). 31620037 . 16 2 0 0 3 7 .ft [11,as owner of the property,or my employees with wages as their solc compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License law does noLapply to an owner of q P property who builds or improves thereon,and who doessuch work himself or through his awn employees,provided that such improvements are not intended orotfered for sale.IG however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did notbuild or improve for purpose of sale.). ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cede)The Contractor's Li- ccnse Law does not apply to a ner of property who builds or improves thereon,and. who contracts Cor such pro'c ith ntractor(s)licensed pursuant to the Contractees License Law. - ❑I am exe der Se B&P C for this reason Owner J Y1 ly Dale WORIMM COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure Cor Warker'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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work.for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Polity No.: CERTIFICATE OE EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars(S100) or less.) 1 certify that i fo 0 the work for which this permit is issued,i shall not employ any i any cr o to become subject to Ore Workers Compensation Laws of Cali a. 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 z forthwith comply with such provisions or this permit shall.be deemed revoked. z" CONSTRUCTION LENDING AGENCY F~.r►�+ I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.Q LL)Q Lender's Name Lenders Address U 0 1 certify that I have read this application and state that the above information is w correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (Wc)agree to ,i cmnify and keep harmless the City of Cupertino against rF"y to IiabiIid=dgmcnis, osis d expctscs which may in any way somite against said City U z in co f th gran o f this perm)L n � � ►� APP N ST AND WILL COMPLY WITH ALL NON-POINT Issued by:s4vDate / C� SOU E L Date Re-roofs Signature of AppliantlContracior HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future buii0hIrg occapantstore or handle hazardous material as defined by the Cupertino Manic' I Code,Chapter 9.12,and the Health and Safety Code, Section 25532(a)? C]Yes All roofs shall be inspected prior to any roofing material being installed. No Will the applicant or Tulare bu' ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants cfined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes Nu 1 have read the hazardous materials requirements under Chapier6.95 of the Califor• niaHealth&USafCode, 505, 33am125534.lunderstandthatifthebuilding does not ch vc at iirespnsibility a notify the occupant or the rcquiremen et 'or to ofaCcrdficatcofOccupaoey.. Signature of Applicant Date Owner Iherizcd age Dae All roof coverings to be Class"B"or better j << CITY OF CUPERTINO n�,� BUILDING DIVISION PERMIT U � � � ` BUILDING ADDRESS: PERMIT NO. 10123 N WOLFE RD J T CONSTRUCTION 07110156 OWNER'S NAME: PERMIT ISSUE DATE CUPERTINO SQUARE LLC 1720 OCALA AVE #B 01/24/2008 PHONE: SANITARY NO. CONTROL NO. (408) 234-4340 ARCHITEC IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH D O O D 0 o p LICENSED CONTRACTOR'S DECLARATION v f= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professions Code,and my license is T.I. THEATRE EXT PATH TO SIDE WLK RENVTN y in full force and effect - ? License Gass Lic.# _ n—m Date Contractor . ARCHITECTS DECLARATION Jac,, 1 undersand my plans shall be used as public records / 'yV r;.trp ti Licensed Professional y� OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from the Contractor's License Law for the E:20 following reason.(Section 7031.5,Business and Professions Code:Any city or county K$F6 which requires a permit to construct,alter.improve,demolish,or repair any structure y Z y prior to its issuance,also requites the applicant for such permit to file a signed statement that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation A Fz-$ (commencing with Section 7000)of Division 3 of the Business and Prgflessions Code)or $60000 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 ofumber Occupancy Type not more than five hundred dollars($500). 31620037 . 16 2 0 0 3 7 .ft [11,as owner of the property,or my employees with wages as their solc compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License law does noLapply to an owner of q P property who builds or improves thereon,and who doessuch work himself or through his awn employees,provided that such improvements are not intended orotfered for sale.IG however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did notbuild or improve for purpose of sale.). ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cede)The Contractor's Li- ccnse Law does not apply to a ner of property who builds or improves thereon,and. who contracts Cor such pro'c ith ntractor(s)licensed pursuant to the Contractees License Law. - ❑I am exe der Se B&P C for this reason Owner J Y1 ly Dale WORIMM COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure Cor Warker'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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work.for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Polity No.: CERTIFICATE OE EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars(S100) or less.) 1 certify that i fo 0 the work for which this permit is issued,i shall not employ any i any cr o to become subject to Ore Workers Compensation Laws of Cali a. 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 z forthwith comply with such provisions or this permit shall.be deemed revoked. z" CONSTRUCTION LENDING AGENCY F~.r►�+ I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.Q LL)Q Lender's Name Lenders Address U 0 1 certify that I have read this application and state that the above information is w correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (Wc)agree to ,i cmnify and keep harmless the City of Cupertino against rF"y to IiabiIid=dgmcnis, osis d expctscs which may in any way somite against said City U z in co f th gran o f this perm)L n � � ►� APP N ST AND WILL COMPLY WITH ALL NON-POINT Issued by:s4vDate / C� SOU E L Date Re-roofs Signature of AppliantlContracior HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future buii0hIrg occapantstore or handle hazardous material as defined by the Cupertino Manic' I Code,Chapter 9.12,and the Health and Safety Code, Section 25532(a)? C]Yes All roofs shall be inspected prior to any roofing material being installed. No Will the applicant or Tulare bu' ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants cfined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes Nu 1 have read the hazardous materials requirements under Chapier6.95 of the Califor• niaHealth&USafCode, 505, 33am125534.lunderstandthatifthebuilding does not ch vc at iirespnsibility a notify the occupant or the rcquiremen et 'or to ofaCcrdficatcofOccupaoey.. Signature of Applicant Date Owner Iherizcd age Dae All roof coverings to be Class"B"or better CITY OF CUPERTINO TENANT IMPROVEMENT CUPEkTwO PERMIT APPLICATION FORM APN# (P a D 2 7, C)q? Date: Building Address: 1,9/23 N !lo'/' ,! Mailing Address (if different from building address): Owner's Name: Phone#: �u�eif'�o S�uore1 LL Contractor: - i hone#: 7&79- 14Eev , lot i .JrJS�iCtG// Fax#: Contractor License#: Cupertino Business License#: a p Contact: Phone#:14;oso,haw Dom- D y Fax #: Alternate Contact: Phone#: Fax#: Valuation(cost of project): 20:19 o-z� Job Description(be specific): �' � lya�iE �a0 ria�`ial-L. Tenant Improvement Includes Re-Roof Yes ❑ No j�' If yes,number of squares Tenant Improvement Includes Structural Yes ❑ No ❑ Type of Construction(Usage Class): Occupancy Type: AJ 1 FR, 11FR 11, 111,V-lHR ❑ 11, 111, 1V V-N ❑ yid Project Size: Standard Large❑ Major❑ Green Building: Attach LEED Checklist to plansand 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 ATINSP Tenant Improvement BUILDING �2 y Inspection ATIPLNCK Tenant Improvement Plan BUILDING Check BTIINSP Tenant improvement BUILDING Inspection BTIPLNCK Tenaht Improvement Plan BUILDING Check ETIINSP Tenant Improvement BUILDING Inspection ETIPLNCK Tenant Improvement Plan BUILDING Check FTIINSP Tenant Improvement BUILDING Inspection FTIPLNCK Tenant Improvement Plan BUILDING Check HTIINSP Tenant Improvement BUILDING Inspection HTIPLNCK Tenant Improvement Plan BUILDING Check ITIINSP Tenant Improvement BUILDING Inspection ITIPLNCK Tenant Improvement Plan BUILDING Check MTIINSP Tenant Improvement BUILDING Inspection MTIPLNCK Tenant Improvement Plan BUILDING Check RTIINSP Tenant Improvement BUILDING Inspection RTIPLNCK Tenant Improvement Plan BUILDING Check STIINSP Tenant Improvement BUILDING Inspection STIPLNCK Tenant Improvement Plan BUILDING Check REVCOMTI Revision-Tenant BUILDING Improvement 2 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CFV Of Fax(408)777-3333 CUPEt�TINO Building Department JOB ADDRESS: /o/�?-g PERIVUT# 4'7110 OWNER'S NAME: o PHONE`# 440�`= GENERAL CONTRAC R: FAX# I am not using any subcontractors: TSD 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 Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock T' er ontractor Signature Date