11040141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N WOLFE RD STE 100
CONTRACTOR: SAN JOSE CONSTRUCTION I PERMIT NO: 1 1040141
OWNER'S NAME: SEARS ROEBUCK AND CO 1 1210 COLEMAN AVE I DATE ISSUED: 09/19/2011
nWNER'S PHONE: 8472867538
L_ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #2���
Contractor �*` Cs"r:!5r Date
1 hereby affirm that I am licensed under the provisions of Ch pter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certifica a of consent to self - insure for Worker's
Compensation, as provided for by ection 3700 of the Labor Code, for the
performance of the work for which�this permit is issued.
I have and will maintain Worker's `F ompensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
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 acc�ue a st sa City in consequence of the
granting of this permit. Additionally e applic t understands and will comply
with all non -point so ce regulation per the C pertino Municipal Code, Section
9.18.
Signature Date
1 uereby 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 (Sec.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).
1 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 this permit is issued, 1 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
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
gr- -ling of this permit. Additionally, the applicant understands and will comply
I non -point source regulations per the Cupertino Municipal Code, Section
Date
SANTA CLARA, CA 95050 1 PHONE NO: (408)986 -8711
BUILDING PERMIT INFO: BLDG f— ELECT F_ PLUMB F
MECH r RESIDENTIAL COMMERCIAL I
JOB DESCRIPTION: BAY CLUB ATHLETIC CLUB- TENANT IMPROVEMENT
COMMERCIAL RETAIL BUILDING(69,300SQFT) CONVERT TO
ATHLETIC CLUB, NEW CAFE, STRUCTURAL,INCLUDES
Sq. Ft Floor Area: I Valuation: $10500000
APN Number: 31620080.100 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b • Date:
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 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
maintain compliance with the pertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Secti ns 5505, 25533, and 25534.
Owner or t thorized agen '
Date:_
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of «ork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profession
SEARS HOLDINGS 11D V01V I
/O /Gtr Al /» /P 5k- 100 �
J. Kai Gibron, Esq. �,6,%
Vice President -Real Estate Law and Amt
Management - -
Sears Holdings Management Corporation
3333 Beverly Road, BC -116B
Hoffman Estates, Illinois 60179
Writer's Direct Dial: (847) 286 -9341
Fax: (847) 286 -3803
August 10, 2011
VIA OVERNIGHT MAIL — NEXT DAY DELIVERY
Piu Ghosh
Associate Planner
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
RECEIVE
AUG 11 V
BY:
RE: Construction Permit for Sears, Roebuck and Co. at Vallco Shopping Mall
Dear Ms. Ghosh,
As you know, Sears, Roebuck and Co. ( "Sears ") is looking to lease a portion of its
Cupertino full -line store to Western Athletic Club. In order to meet the construction
timeline for this project, Sears would like to obtain a conditional permit while Sears and
the City work through some outstanding items. In consideration for the City of Cupertino
agreeing to issue a conditional permit, Sears agrees that:
By August 301h, Sears will submit civil drawings showing i) the connections
between the ADA path and the sidewalk, including confirming that no digging
will be performed in the root zone of the trees; and ii) the correct location of the
ADA paths.
No work will be done in the right of way until the plans are approved by the City
and the City's Consulting Arborist.
Sears will use its best efforts to cooperate with the City to finalize the Letter of
Credit acceptable to the City Attorney and the Director of Community
Development.
In light of the above, Sears respectfully requests that the City issue a conditional permit
as soon as possible. Should you have any questions, please do not hesitate to contact me.
Thank you.
Sincp Pely,
J. Kal Gib on
cc: Dolores Guarnaccia