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09120119CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: APPLIED CONSTRUCTION PERMIT NO: 09120119 TECH O : R'S NAME: TANTAU INVESTMENTS LLC 1230 OAKMEAD PKWY DATE ISSUED: 02/26/2010 OWNER'S PHONE: 4083994950 ' SUNNYVALE, CA 94085 I PHONE NO: (408)252-9990 I ❑ LICENSED CONTRACTOR'S fDE� 1CLARATION License Class /� 'Lic. #��vvw 1 Contractor A PRCJ (�J � Date�i� 661^ --/i 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. Ad itionally, the applicant understands and will comply with all non -point ou regu tions per the Cupertino Municipal Code, Section 9.18. / S are DateZ si �_ - ❑ 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 co—ect. I agree to comply with all city and county ordinances and state laws relating 'ding construction, and hereby authorize representatives of this city to enter L, . 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 urce regulations per the Cupertino Municipal Code, Section 9.18. � Signature � Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH f- RESIDENTIAL COMMERCIAL r— JOB DESCRIPTION: TAKING A COLD SHELL TOA A WARM SHELL WHICH INCLUDES: BATHROOM CORES, LOBBY & HVAC UNITS;NO RE -ROOF & THERE IS STRUCTURAL LOBBY WITH STAIRS AS Sq. Ft Floor Area: I Valuation: $2000000 APN Number: 31609029.01 1 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: [a 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 maintainc��ance with the Cupertino Municipal Code, Chapter 9.12 and the HealtCode, Sections 25505, 25533, and 25534. i _ Date: 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. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: APPLIED PERMIT NO: 09120119 CONSTRUCTION TECH OWNER'S NAME: TANTAU INVESTMENTS LLC 1230 OAKMEAD PKWY DATE ISSUED: 02/26/2010 OWNER'S PHONE: 4083994950 SUNNYVALE, CA 94085 PHONE NO: (408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESH)ENTI1:1S L �COMMERCIAL License Class Lic. # 3 Fl;� /w` TAKING A COLD SHELL TOA A WARM SHELL WHICH � INCLUDES: BATHROOM CORES, LOBBY & HVAC Contractor /�� �� es 5 Ate 7 / G / U UNITS;NO I hereby affirm that I am licensed under the provisionsof Chapter 9 RE -ROOF & THERE IS STRUCTURAL LOBBY WITH (commencing with Section 7000) of Division 3 of the Business & Professions STAIRS AS Code and that my license is in full force and effect. 4/14/2010-REVISION#1 RE -STRIPE ACCESSIBLE PARKING STALL, I hereby affirm under penalty of perjury one of the following two declarations: INFILL 3 CURB RAMPS & ADD ACCESSIBLE PATH TO SEATING I have and will maintain a certificate of consent to self -insure for Worker's AREA (PATIO OUTSIDE) Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $2000000 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 APN Number: 31609029.01 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 WITfIIN 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 DAYS FROM 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 granting of this permit. Additionally, the applicant u/ " stands and will comply Issued b Date: with all non-point-s'6ufce regulations p�efthy Cue 9- un'cir Code, Section RE -ROOFS: 9.18. •'� Signature - �li"' /Z� g���' .%" _/ ate 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 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 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 ATFa Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the-C-_pefr6 I Itli"nlcipal"Code Chapter 9.12 and 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 the Health& 3333 an34 Owner or authoDate: ) 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, 1 - 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 Lender's Address APPLICANT CERTIFICATION I certify that 1 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, ARCHITECT'S DECLARATION costs, and expenses which may accrut-a�am id City in consequence of the I understand my plans shall be used as public records. granting of this_perim . � �! �3_t ��� Date