11010137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20550 TOWN CENTER LN C
ONTRACTOR — PERMIT NO:11010137
OWNER'S NAME: CIVIC PARK CUPERTINO LLC 'A DATE ISSUED:03/04/2011
OWNER'S PHONE: 4084363671 PHONENO:
LICENSED CONTRACTOR'S DECLARATION TION: RESIDENTIAL COMMERCIALLJ
License Class G/D 63fLic.# ,V0 / ACANT UNIT AT THE VILLAGIO COMPLEX
Convactor /Q7t��t Date G FFICE, 1521 SF,NEW ADA RESTROOMS,
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 PARTITIONS,AND FUNCTIONAL SPACES TO BE
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and 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. Sq.Ft Floor Area: Valuation:$95000
1 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 APN Number:36955082.00 Occupancy Type:
permit is issued. w w
APPLICANT CERTIFICATION f�
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA S F M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 3 y
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature �/T/(� Date of 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this // / tl
permit is issued. Owner or authorized agent: I�t�+/ Date: Vzi
'e7� `"
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,atter making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a constriction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF
CITY OF CUPERTINO �3
TENANT IMPROVEMENT
CUPERTINO
PERMIT APPLICATION FORM
APN# 0 S
Building Address: �Oe�S;O -vow b
Mailing Address (if different from building address):
Tenant N (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 No
Tenant/Building Owner's Name: v Phone
ti NAU
Contractor: Phone #:
`1IR60 Fax#:
Cupertino Business License: State Contractor License#:
7Contact: ` ,ate �('C Phone - 0 Z
Fax/ -mail: U7
Landscape Ordinance Compliance: Vol ,
Landscape area in sq. ft. (includes all irrigated areas): N
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
Job Description(be s ecific :
tat VW_A4J-r V P LT-,T k V U4010
F �•
�CZ-�MI�, HT1��►U� Aa%)D FVN G�bAYgu\'CiE-5-
Tenant
Improvement Includes Re-Roof. Yes ❑ No If yes, number of squares
Tenant Improvement Includes Structural Yes 11 No
Type of Construction (Usage Class): Occupancy Type: B
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B Valuation: `� �51
060 �.".
Project Size: CounterEl Express 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
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 2 0p70 14 N fr N . PERMIT# l 10 /0 l
OWNER'S NAME: /4�N Ok PHONE# — 3a Z Z
GENERAL CONTRACTOR: r— 0 ti0— BUSINESS LICENSE# O / 0 b O 34
ADDRESS: Z o S Q 0 AV *VP. -f CITY/ZIPCODE: <24 f9viq
*Our municipal code requires all businesses 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 ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
ARCHITECTURE
PLANNING
{ GRAPHIC
QUYNH TRAN, LICENSED ARCHITECT
2767 DEER ISLE DREVE.SAN JOSE,CA.95121.PHONE=4023$031 Z CELL 408533,2062
LETTER OF VERIFICATION
PROJECT: DR.GUO DENTAL OFFICE TENANT IMPROVEMENT
20550 TOWN CENTER LANE
CUPERTINO,CA
CITY PERMIT NO. 11010137-CIVICPARK CUPERTINO,LLC
To whom it may concern:
This letter is to indicate that the duct chase showing on sheet M2.0 as EF/8 is no
longer needed.
Please take a note of it and call me if you have any questions.
Regards,
� -1 IR
Quynh Tran,
California Licensed Architect
)2nO
1(000i- CDS
50 CFM i
Won 15 CFM
PAN*'.
Ff
LrD,
100 aq!0
-0
4 FF)
Elf
Er
10
01
.�. � ' �� 8 C
0
6E) T CNA TO
OND FLOG
Q T CHIA
)
C
OcOND FLOO
7A
1 40
<
4-N pp,4
46t CF
2. a
Ll-1
LE
p 140