09050013 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10090 N WOLFE RD CONTRACTOR:DOUGLAS ROSS PERMIT NO:09050013
:ONSTRUCTION INC
OWNER'S NAME: CUPERTINO PROPERTY DVLPMNT I,LLC '►09 ALMA ST DATE ISSUED:08/05/2009
OWNER'S PHONE: 4083431088 ?ALO ALTO,CA 94301 PHONE NO:(650)470-4700
❑ LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.# MECII F RESIDENTIAL r COMMERCIAL r
Contractor Date
TOB DESCRIPTION:NEW MIXED USE ROSEBOWL
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions PROJ-PARKING,FOUNDATION-GROUND FLOOR RETAIL,2ND
Code and that my license is in full force and effect. FLR COMMUNITY CTR-SHELL ONLY.DOES NOT INCL CONDOS
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 Sq,Ft Floor Area: Valuation:$12000000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31620037.ROSE Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.' Issued b; Date:
Signature Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6,95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
Section 3700 ot'the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,1 shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner orthed agent: $ S/U
become subject to the Worker's Compensation provisions of the Labor Code,1 must Date: I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANTCERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I cc-:ry that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
C( 1 agree to comply with all city and county ordinances and state laws relating Lender's Name
tom uing construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9 18.
Licensed Professional
Signature Date 0
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19800 VALLCO PKWY DATE: 04/15/2014 REVIEWED BY: MELISSA
APN: 31620037 BP#: 09050013 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 GENCO i
WORK 4/14/14- DEF# 1 -ALL RFI'S CONTINUE DEFERRED# 1 UNTIL FURTHER NOTIFIED).
SCOPE
-
A /
y ¢( 5
,,,5• c „tip:.( ..«:t! .,..�_ ...;; ,kms '..,,M.,4.*"_.r3v �'�✓,
n.
111.4irh.1 lao Check ck /S jc?<'.Plan
:49s?C:r• 6'i"i?1l°PFtO' .i�J1tFi?t'%..l art7r`Il F""e: lit(?..^...i'Dermi11`a.c-: .
j.177Ffst yiF:G.e,iY)a:, rj.:�r '�jp•r., )t... .f:i c''
19£tc9f,)i?4`/, 7�t,�:. 7r., r;.y t::>,• 7:•r,�, i ..
1-f!:Yf:._7.J 1.,,.CF•, t.aF.....tif.ji. I"f:f'..'
NOTE:This estimate does not include fees due to other Departments(Ge.Planning,Public Works,Fire,Sanitmy Sewer District,School
District,etc.). These ees are based on the preliminai information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS 6Fee Resolution 11-053 E . 7/1/133 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $278.00 ISTPLNCK
PME Plan Check: $0.00 0 # Deferred Submittal
Permit Fee: $0.00 $278.00 1DEFSUBM
Suppl.Insp.Feer Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Free: $0.00
0
Work Without Permit? 0 Yes (D No $0.00 G)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
�°f'.f.'.`i: Building or Structure 0
t7ttF%CL .,�i;J!'fJfi1C3'2r�C1PrL31?
Strong Motion Fee: $0.00 Select an Administrative Item
.Bldg Stds Commission Fee: $0.00
s ( SUBTOTALS $0.00 $556.00 x s TOTAL FEE $556.00
Revised: 04/01/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10090 N WOLFE RD CONTRACTOR:LAYTON PERMIT NO:09050013
CONSTRUCTION
OWNER'S NAME: CUPERTINO PROPERTY DVLPMNT I,LLC 9090 S SANDY PKWY DATE ISSUED:08/05/2009
OWNER'S PHONE: 4083431088 SANDY,UT 84070 PHONE NO:(949)429-6740
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
NEW MIXED USE ROSEBOWL PROJ OTHERWISE KNOWN
License Class AM Lic.# 47ZV:' AS 19800 VALLCO PARKWAY-PARKING,FOUNDATION-
Contractor 6rhn 4z;m, Date GROUND FLOOR RETAIL,2ND FLR COMMUNITY CTR-
SHELL ONLY.
I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1 -REMOVE MEZZANINE FROM RESTAURANT&
(commencing with Section 7000)of Division 3 of the Business&Professions REDUCE BY 12,565 S.F.-ISSUED 6/16/15
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000000
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 APN Number:31620037.ROSE Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 PE 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 1 ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequenceof the v( ��
granting of this permit. Additionally,the applicant understands and wil ply Issued by: Date:
with all non- ' ource regula' per the Cupertino Municipal Code,Section
9.18.
RE
-ROOFS.
Signatur Date*511,�L All roofs shall be inspe prior to any roofing in
being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
ElOWNER-BUILDERDECLARATION
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
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I 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(a)should I store or handle hazardous
I 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 I
performance of the work for which this permit is issued. will maintain compliance with_t e upertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, c ns �23 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date
permit is issued.
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
918.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10090 N WOLFE RD DATE: 06/16/2015 REVIEWED BY: MELISSA
APN: 31620037.ROSE BP#: 09050013 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition /Repair
PRIMARY Commercial Building Civil/Religious activities PENTAMATION
USE: in BQ zone? 0 Yes1 GENCO i
O No PERMIT TYPE:
WORK REV# 1 - REMOVE MEZZANINE FROM RESTAURANT& REDUCE BY 12,565 S.F. - ISSUED
SCOPE 6/16/15
�r 1,
efr:::iz,flea,,,(:;heck l 1<a:.plan Check
:i e.N ?z i"r rat Fee.
..tris:. le 1 crma Fee:
Other UeC'h.IY..7). (,)fJlf'!'.I�it1r;:L�jn,YJ, Li of erl-'/c ,rosy". Li
1.at.Yr.._.ijl..:.C.C.. Eir:r;..ndp..'ee:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitmy Sewer District,School
District,etc. . These fees are based on the reliminar information available and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS(Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 0 hours Plan Check,Hourly
Suppl.PC Fee: (j) Reg. 0 OT 1070 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT 1 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: IBCONSTAXC $0.00
0
Work Without Permit? 0 Yes (E) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
, SUBTOTALS `
$143 TOTAI3 FEE
$0.001 $143.( 0 y
00
Revised: 05/07/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 10090 N WOLFE RD
CONTRACTOR: LAYTON CONSTRUCTION
PERMIT NO: 09050013
OWNER'S NAME: CUPERTINO PROPERTY DVLPMNT I, LLC
19608 PRUNERIDGE AVE APT 5104
DATE ISSUED: 08/05/2009
OWNER'S PHONE: 4083431088
CUPERTINO, CA 95014
PHONE NO: (949) 429 -6740
0 LICENSED CONTRACTOR'S DECLARATION
r F_ F
BUILDING PERMIT INFO BLDG ELECT PLUMB
License Class -A 413 Lic. # ] 0/`a 2 3
r r �
Contractor L�4�� ('�nsyG,,,
MECH RESIDENTIAL COMMERCIAL
®,� Date(o V(a .2412
JOB DESCRIPTION. NEW MIXED USE ROSEBOWL PROJ OTHERWISE
I hereby affirm that I am licensed under the provisions of Chapter 9
KNOWN AS 19800 VALLCO PARK WAY- PARKING,FOUNDATION- GROUND
(commencing with Section 7000) of Division 3 of the Business & Professions
FLOOR RETAIL,2ND FLR COMMUNITY CTR -SHELL ONLY DOES NOT INCL
Code and that my license is in full force and effect.
APARTMENTS OR T US FOR RETAIL.
APARTMENTS ARE ON #09080116
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
Sq. Ft Floor Area:
Valuation: $12000000
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
APN Number: 31620037.ROSE
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
918.
180 DAYS' FROM LAST CALLED INSPECTION.
Signature G Date 6- ,26-,e0L? _
Issued by: Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
RE- ROOFS:
I, as owner of the property, or my employees with wages as their sole compensation,
All roofs shall be inspected prior to any roofing material being installed. If a roof is
will do the work, and the structure is not intended or offered for sale (Sec.7044,
installed without first obtaining an inspection, I agree to remove all new materials for
Business & Professions Code)
inspection.
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant: Date:
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I certify that in the performance of the work for which this permit is issued, I shall
Additionally, should I use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation laws of California. If, after making this certificate of exemption, I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
become subject to the Worker's Compensation provisions of the Labor Code, I must
Health & Safety Code, Sections 25505, 25533, and 25534.
forthwith comply with such provisions or this permit shall be deemed revoked.
0 � o ' aut oriz d agent:
d Date: A •,2h • 2412.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of work's
upon the above mentioned property for inspection purposes. (We) agree to save
for which this permit is issued (Sec. 3097, Civ C.)
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Name
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Lender's Address
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
ARCHITECT'S DECLARATION
Signature Date
I understand my plans shall be used as public records.
Licensed Professional