10100047CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: OPI COMMERCIAL. PERMIT NO: 10100047
BUILDERS
OWNER'S NAME: UNION PROPERTY CAPITAL, LLC 1 445 LEIGH AVE I DATE ISSUED: 11/12/2010 1
OWNER'S PHONE: 4159898846 1 LOS GATOS, CA 95032 1 PHONE NO: (408)3774800 1
❑ LICENSED CONTRACTOR'S DECLARATION
License C L Lic. # �P 2
Contracto Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(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.
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. ' n ` � —
APPLICANT CERTIFICATION 1(�./�
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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date I Z /_D
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
permit is issued.
1 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
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
1 certify that I have read this application and state that the above information is
correct. 1 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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
COMM'L TI - RENOVATION OF EXISTING BLDG-
SELECTED
DEMOLITION, NEW NON -LOAD BEARING WALLS & NEW
SUSPENDED CEILING & LIGHTING(23700SQFT);NO RE -
ROOF
Sq. Ft Floor Area: I Valuation: $716678
APN Number: 31609029.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued 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, 1 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. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(s) should I 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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S ' ns 25505, 2553�, and 25534.
Owner or authorized agent. fQr Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work'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 Professional
Date
OF
CUPERTINO
CITY OF CUPERTINO
TENANT IMPROVEMENT
PERMIT APPLICATION FORM
APN # � 1 6 9 U Z�
Date:/V Z.,a
Building Address:
D
Mailing Address (if different from building address):
Tenant ❑ (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:
Phone #
G
i
Contractor: Phone #: a0) +577
C'e" -ZN C, Fax #: - V
Cupertino Business License: State Contractor License #:
ZG!® 8 ZS9e
Contact:
Phone #: 76/ - 5;
VAf7sot') -�. C-�1LGt5
Fax #:
Landscape Ordinance Compliance:
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 Submi 1 is required.
Compliance Method: ❑ Plant Type El Water B d et
J^o�b,Description (be specific): rAo.-4 sP1 .656,i.SnA-04 6eP4.
iJ�e �4/ T7tNI # /V+_ss 1 ,V 40V — Z0A0 A1ftWLA-r4 EGG f Ar,r� iNI�Lw f'��
onV caee G
Tenant Improvement Includes Re -Roof: Yes ❑ No M If yes, number of squares
Tenant Improvement Includes Structural Yes ❑ No` Z
Type of Construction (Usage Class):
Occupancy Type: 13
1-A, 1-B ❑ HAIVV-A ❑ IV -HT, V-B ❑
Valuation• d
Project Size: Express Standard. E 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*** Over The Counter 7 Revised 05/18/10
CITY OF
�1
CITY OF CUPERTINO
TENANT IMPROVEMENT
CUPERTINO PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1ATINSP
Tenant Improvement
B
1A TI
Inspection
1ATIPLNCK
Tenant Improvement Plan
B
Check
1BTIINSP
Tenant improvement
B
1B TI
Inspection
1BTIPLNCK
Tenant Improvement Plan
B
Check
lETIINSP
Tenant Improvement
B
1E TI
Inspection -Preschool
lETIPLNCK
Tenant Improvement Plan
B
Check -Preschool
1FTIINSP
Tenant Improvement
B
1F TI
Inspection-Factory/Indust
1FTIPLNCK
Tenant Improvement Plan
B
Check-Factory/Indust
1HTIINSP
Tenant Improvement
B
1H TI
Inspection -Hazardous
1HTIPLNCK
Tenant Improvement Plan
B
Check -Hazardous
11TIINSP
Tenant Improvement
B
1I TI
Inspection -Institutional
11TIPLNCK
Tenant Improvement Plan
B
Check -In titutional
1MTIINSP
Tenant Improvement
B
1M TI
Inspection -Merchandise
1MTIPLNCK
Tenant Improvement Plan
B
Check -Merchandise
1STIINSP
Tenant Improvement
B
1S TI
Inspection -Parking Garag
1 STIPLNCK
Tenant Improvement Plan
B
_
Check -Parking Garage
1REROOFCOM
Re -Roof Commercial
B
1BCBSC
Cal Bldg Standards
B
ALL PERMIT TYPES
Commission Fee
-'
1BSEISMICO
Seismic Commercial
B
1BUS LIC
Business License
B
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