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11010134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20410 TOWN CENTER LN#295 CONTRACTOR. PERMIT NO: 11010134 OWNER'S NAME: FUND VIII CUPERTINO LLC1>0 GL _%LJ/ 7 f J DATE ISSUED:04/06/2011 OWNER'S PHONE: 4089730783 9 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r —7 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic:# (� �� MECH r RESIDENTIAL F COMMERCIAL� Contractor e 0%�Date 1 hereby affirm that am licensed under the provision of hapter 9 JOB DESCRIPTION:T.I BRACE TWO NEW WALLS,LIGHTS THAT WERE (commencing with Section 7000)of Division 3 of the Business&Professions INSTALLED FOR TWO OFFICES Code a•nd that my license is in full force and effect. 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 Sq.Ft Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:36940059.295 Occupancy Type: I certify that I have read this application and state that the above infoation 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 regulations per the upertino Municipal Code,Section 9.18. Signature to Issued by: Date:� lJ ❑ OWNER-BUILD R DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of A11 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 I,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: I,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 1 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(a)should 1 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 upertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's &Safety Code,Sectio 25505,25533,and 25534. 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 Owner or a ent forthwith comply with such provisions or this permit shall be deemed revoked. te: APPLICANT CERTIFICATION Cl LENDIN 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 cork'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 CITY OF CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM 1, �C) o\M APN#to� `�0 ��O . 2qS` Date: Building Address: a-ay fi e✓ LV, Svc�e 295 Mailing Address(if different from building address): o`3?0 Two, Ce,&A-e1 LV� Tenant Fj (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 0 No Tenant/Building Owner's Name: Phone#: 6ontractor: Phone#: !o Sp --2 c4(6-6 0 C/,( 1®vim Fax #: Cuperti o Business License: State Contractor License #: q L1_7 3 C)— C tact: Phone #:G 4�-0 -3g g -60 b O Aiao Fax/e-mail Landscape Ordinance Compliance: �(p(,0. 6 9 1C) 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 J.Qb Description(be specific): �)<rLce_ +Luv /`-���17 UVC3t�\ J t7rliCe IU e �k c6t�.-V5 (nFx� 1a.��r c� t K c, -a(l ed eCl-� t ca lit E sc�v c1�2 s Tenant Improvement Includes Re-Roof. Yes ❑ No [�p If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No Type of Construction (Usage Class): Occupancy Type: (b ImII/V-A ❑ II/III B, IV-HT, V-B Valuation: S O,&O Project Size: Standard, Large Major Green Building: Please complete Leed for commercial interiors checklist& attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved -- *** For Office Use Only*** Revised 12-06-10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 OONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: e�a� Q (� I.t v� 1�i PERMIT# 0t--'- 47" OWNER'S NAME: _ `' iL1 e���,w p Ltc, PHONE# (o60-�� GENERAL CONTRACTOR: e u Pvc-1 BUSINESS LICENSE# ADDRESS: 4 w.6 wfi CITY/ZIPCODE: q y 5 3 8r *Our municipal code requires all bu inesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND BCONTRACTORS AVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signatu 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 Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date - _ _ - ... - .S` `'' :3. '3;-r-"• _,�;.ate 51 15; CORIALIINDUSTRiAL rNTERrR µ ilvIPROVEMENTS CUVER SHEET .kY Assessors Parcel Number: Name of business. -A- w\10-)e-- D-�� �� PO-vt"0Z--- CD Proj ett address. ;) N 'Tw OeAey L v` `b*e- q Contac person. C Phone. t*0 ' - Fax. 1901-1 ZmA Current use of space. VD O&Cv 00JA2q CP W Proposed use. Building construction type. Occupancy Group(s) Cr s Occupancy Load. C= AlSquare footage of remodeled area. S 9-11 C> Is the building equipped with: Fire sprinkles? (Y}N; Fire alarm system? `� JAIL 2 J 2fl11 Number of floors in the building? Z On what floor(s) is work being done? Brief description of work. racy F. +wo Wa(l S 4)V\ (�- `�c�J vin. �� � i c1� � f'C�.�-►'�'�"�-I' �7 Code editions:2008 CBC -N)2008 CFC -N)2008 CMC N) 2008 CPC -N)2008 NEC -N) Effe 've 1/1/08 Are there any chemicals/hazardous materials to be stored at sit ,AC ,-, - N If above answer is yes,provide a list of materials and quan If job is involves food service,provide 3 extra plan sets for Health Department review. Commercial Plan Review Process Work BookPage-10-revised 1/1/08 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20410 town center lane. ste 295 DATE: 01/25/2011 REVIEWED BY: bob s. APN: BP#: 'VALUATION: 1$5,000 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 GENCOM USE: PERMIT TYPE: WORK t.i commercial offices ace add two new walls electrical switches and lighting. SCOPE Xlccb. Plan Check Womb. V"'i Elec.Plan Check 0.0 hrs $0.00 llz c:G. Pc,mi!1`01.: Plrrnh. P!vnii,,Fee: Elect.Permit Fee: IEPERMIT /11?rer Plumb?n.,Fa. Li Other Elec.Insp. 0.0 hrs $42.00 11c.c/i. 1,cc. :;,, 1G. hr.ryi. Fec.. l.;r:r. Insp. / �, NOTE. These ees are based on the prelindnary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 G . 7/1/10) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 40 l.f. Interior Partitions Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $538.00 IPARTICOMM PME Plan Check: $0.00 �2 Electrical Permit Fee: $0.00 $42.00 /BREMRECEP Recep/Switch/Outlets Suppl. Insp. Fee-.0 Reg. © OT 0.0 hrs $0.00 Electrical PME Unit Fee: $0.00 $63.00 IBREMFIXT Fixtures,Lighting PME Permit Fee: $42.00 Lonso-action K7.1 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? © Yes 0 No $0.00 0 Plannin Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRAVDOC $42.00 Building or Structure 0 i Strona Motion Fee: IBSEISMICO $1.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $86.05 $643.00 TOTAL FEE: $729.05 Revised: 01/15/2011