10010120 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10900 N TANTAU AVE STE 200 CON'T'RACTOR:APPLIED CONSTRUCTION PERMIT NO: 10010120
TECH
C 'R'S NAME: TANTAU INVESTMENTS LLC 1230 OAKMEAD PKWY DATE ISSUED:03/02/2010
O ',R'S PHONE: 6503299030 SUNP WALE,CA 94085 PHONE NO:(408)252-9990
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG 7 ELECT r– PLUMB
License Class Lic.# MECH 1— RESIDENTIAL f— COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:T.I ON 2ND FLOOR SUITE#200 FOR 46,565 SQ FT FOR B
OCCL PANCY NO EXTERIOR IMPROVEMENTS TO SHELL OR
(commencing with Section 7000)of Division 3 of the Business&Professions SITE.I:ESTROOM CORE AND STAIRS BY OTHERS UNDER
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 Sq.F:Floor Area: Valuation:$2000000
permit is issued.
APPLICANT CERTIFICATION APN Number:36909029.200 Occupancy Type:
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 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 `NITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 80 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued bye Date:
S ure Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All 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, inspe tion.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signc.ture 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 I hai a read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. Calil ornia Health&Safety Code,Sections 25505,25533,and 25534. I 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 Safe y Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. cont,iminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall mair tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's HeR ty Code,Sections 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 ag OJ
—0 C. ZO1 O
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I herby affirm that there is a construction lending agency for the performance of work'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 t—ilding construction,and hereby authorize representatives of this city to enter Lender's Name
I he above mentioned property for inspection purposes.(We)agree to save
.mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,and expenses which may accrue against said City in consequence of the
g ,nting of this permit.. _ditionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point a re dations per the Cupertino Municipal Code,Section
9.18. I unc.erstand my plans shall be used as public records.
ignature' <' Date Licensed Professional
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10900 N TANTAU AVE STE 200 CONTRACTOR: APPLIED CONSTRUCTION PERMIT NO: 10010120
TECH
OWNER'S NAME: TANTAU INVESTMENTS LLC 1230 OAKMEAD PKWY DATE ISSUED: 03/02/2010
OWNER'S PHONE: 6503299030 SUNNYVALE, CA 94085 PHONE NO: (408)252-9990
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT r PLUMB
License Class Lic. #
Contractor
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.
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
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
OWNER -BUILDER DECLARATION
I hereby 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).
I 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, 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
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 Iiabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit.,,.. _ditionally, the applicant understands and will comply
with all non -point >7eg lations per the Cupertino Municipal Code, Section
.a' /. � 9.18. ---\1
MECH RESIDENTIAL r, COMMERCIAL
JOB DESCRIPTION: T.I ON 2ND FLOOR SUITE #200 FOR 46,565 SQ FT FOR B
OCCUPANCY NO EXTERIOR IMPROVEMENTS TO SHELL OR
SITE.RESTROOM CORE AND STAIRS BY OTHERS UNDER
QevIslorl- t2e✓Ism FLAr,k -ur e P��n
Gj�nert'c. �I�t�l -17., Cus;-om Pic, rl -Fn t-
p� n o t c— Zss c1 S• to I O
Sq. Ft Floor Area: I Valuation: $2000000
APN Number: 36909029.200 ' I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by/�/�'����� Date: %p
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
He4j3r3afjty Code, Sections 25505, 25533, and 25534.
Date: O$ 06 zol O .
CONSTRUCTION LENDING AGENCY
I 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
I understand my plans shall be used as public records.
" Date 05',&/Z6 i v,
Licensed Professi
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10900 N TANTAU AVE
CONTRACTOR: APPLIED CONSTRUCTION
PERMIT NO: 10010120
TECH
OWNER'S NAME: TANTAU INVESTMENTS LLC
1230 OAKMEAD PKWY
DATE ISSUED: 03/02/2010
OWNER'S PHONE: 6503299030
SUNNYVALE, CA 94085
PHONE NO: (408)252-9990
❑ LICENSED CONTRACTOR'S DECLAARATION
r PLUMB r
BLDG r
� 36 6 q
BUILDING PERMIT INFO: ELECT
License Class Lic.# `' '
F_ F_
F
AA-�
Contractor A � AAp l ►eil Co,9�vch°Sate 3 2 12o f U ,
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: T.I ON 2ND FLOOR FOR 46,565 SQ FT FOR B OCCUPANCY
(commencing with Section 7000) of Division 3 of the Business & Professions
OM
NO EXTERIOR IMPROVEMENTS TO SHELL E ST EPERMI S.
CORE AND STAIRS BY OTHERS UNDER SEPERATE PERMITS.
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
Sq. Ft Floor Area:
Valuation: $2000000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31609029.01
Occupancy Type:
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
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 ion ly, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non-poin a re gu o s per the Cupertino Municipal Code, Section
9.18. ,
Signa Date 3 Z 'Lo to ,
Issued by: Date: 7 'L
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All 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
1—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:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I 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. I 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 I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Code, Sections 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 CodeI mJHeatt
er kr a orized agen . 7
3
forthwith comply with such provisions or this permit shall be deemed revoked.
Date: 2 ZG O ,
APPLICANT CERTIFICATION
CONSTRUCTION LENDING 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 work'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. ltionally, the applicant understands and will comply
with all non -point e� at' s per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
L
1 understand my plans shall be used as public records.
Signatur Date `�Z o 'to
Licensed Licensed Professional