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09080116CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON CONSTRUCTION PERMIT NO: 09080116 OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 19608 PRUNERIDGE AVE APT 5104 DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 CUPERTINO, CA 95014 PHONE NO: (949) 429-6740 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # 7! /�1-5-2 Contractor 1,Y —Wr j6,&� n Date I hereby affirm that I am licensed under the am licensed under the provisions f Ch ter 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 -p,,* t urce regulati r 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 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 BUILDING PERMIT INFO: BLDG r ELECT J_ PLUMB r— MECH J_ RESIDENTIAL F COMMERCIAL f— JOB DESCRIPTION: ROSE BOWL -MIXED USE RESIDENTIAL/RETAIL 476,016 SQFT-INCLUDES 204 APARTMENTS, COMMON AREAS FLRS 1-6 (383,913 Sq. Ft Floor Area: I Valuation: $46000000 APN Number: 31620037.38CONDOS 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: �_7_1&,_ 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 Hoea �-'ge.j Sections 25505, 25533, and 25534. O er ra: 11-196 12, Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 9090 S SANDY PKWY DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 SANDY, UT 84070 PHONE NO: (949) 429-6740 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL n License Class—�_ Lic. #_ ROSE BOWL -MIXED USE RESIDENTIAL/RETAIL 476,016 $ SQFT-INCLUDES 204 APARTMENTS, COMMON AREAS Contractor Date l�" /s FLRS 1-6 (383,913 ... I hereby affirm that I am licensed under the provisions of Chapter 9 REV # I - REMOVE MEZZANINE FROM RESTAURANT &REDUCE (commencing with Section 7000) of Division 3 of the Business & Professions 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $46000000 Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620037.38CONDOS Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITHIN 180 D -S-9PE T ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, 180 D INSPECTION. judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will com ssued by: Dat / with all non -point u ce regulations per the Cupertino Municipal Code, on 918. Signature l Date S / E -ROOFS: All roofs be inspected shall 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 ❑ OWNER -BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three g California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous performance of the work for which this permit is issued. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the pertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se7*�,505.255 ,and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: f l 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 Lender's Address I APPLICANT CERTIFICATION certify that I have read this application and state that the information correct. above is 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, granting and expenses which may accrue against said City in consequence of the of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with 918. all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 9090 S SANDY PKWY DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 SANDY, UT 84070 PHONE NO: (949) 429-6740 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL (� ROSE BOWL-MIXED USE RESIDENTIAL/RETAIL 476,016 License Class J Lie. # q 5 �. S g SQFT-INCLUDES 204 APARTMENTS, COMMON AREAS Contractor a9 1A .f.Date e)[O ted FLRS 1-6 (383,913 11/27/12- DEFERRED #1- FABRICATION & INSTALLATION I hereby affirm that I am licensed under the provisions of Chapter 9 OF METAL STAIRS 1 THRU 7 - ISSUED 6/6/14 (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: $46000000 0 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. APN Number: 31620037.38CONDOS Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAY �iolI UANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DA M D 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 A granting of this permit. Additionally, the applicant understands and will com ssued Date: Z with all non-point source regulations per the Cupertino Municipal Code, Section 9 18. RE-ROOFS: Signature Date 6 bl 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 ❑ OWNER-BUILDER DECLARATION inspection. 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 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, Section 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this p is issued. Owner or authorized agent: �_ Date: �/A permit t 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 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 CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 19608 PRUNERIDGE AVE APT 5104 DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 CUPERTINO, CA 95014 PHONE NO: (949) 429-6740 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIALL] License Class f7 Lie. #127i65 RASE 19OWL-MIXED USE RESIDENTIAL/RETAIL 476,016 Contractor ? 7 Date < SQF -INCLUDES 204 APARTMENTS, COMMON AREAS "RS I hereby affirm that I licensed am under the provisions of t - 9-M (commencing. with Section 7000) of Division 3 of e� Profession Code and that my license is in full force and effec 1/10/13- DEFERRED #2- FABRICATION & INSTALLATION OF I hereby affirm under penalty of perjury one of th ollllowing two declarations: STRUCTRAL TRUSS MEMBERS FOR THE ROOF OF THE BLDG - I have and will maintain a certificate of consent to self -insure for Worker's ISSD 2/8/13 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: $46000000 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. APN Number: 31620037.38CONDOS 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WIT 80 DAYS OF PERMIT ISSUANCE OR 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 180DA OM LAST CALLED INSPECTION. granting of this it. A it�onall a applicant understands and will comply Issued by: Date: / with all non oint ourc regula i n er Municipal Code, Section / 918. Si natur '` 3 g ate 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. ❑ /, 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: I, as owner of the property,.or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 (5ec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous. Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation will maintain compliance with t uper ' opal Code, Chapter 9.12 and Health 'ons Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this the & Safety Code, S 5 05 3d i permit is issued. Owner or authorized aged - Date ¢ G 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 066 STRUCTION 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 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 granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. With all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 9090 S SANDY PKWY DATE ISSUED: 08/14/2012 rNRHONE: 4083431088 SANDY, UT 84070 PHONE NO: (949) 429-6740 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] sROSE BOWL -MIXED USE RESIDENTIAL/RETAIL 476,016 Lic. # % SQFT-INCLUDES 204 APARTMENTS, COMMON AREAS - t a I am censed under the pLrovisions of Chapter 9L/16R(383,913 with Section 7000) of Division 3 of the Business & Professiions oeanthat my license is in full force and effect. 2/8/2013 - DEFERRED 0 NEW ELEVATOR CONSTRUCTION, 7 ELEVATOR CABS & HOISTWAYS RANGING FROM 2 TO 7 STORIES- ISSD 6/12/2014 I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-in*.1e,lb leer's Compensation, as provided for by Section 3700 of the L e, fo;for performance of the work for which this permit is is Sq. Ft Floor Area: I have and will maintain Worker's Compensati6ip) gurance, as prov' by Valuation: $46000000 Section 3700 of the Labor Code, for the performance ofAt i 0 or which this permit is issued. �� APN Number: 31620037.38CONDOS 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITH -IN 18� DAYS OF P IT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR ` 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 understands and will comply Issued by: Date: CO- /0/ - with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Signature Date 2 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. 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: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 the Cup ti Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2535Z5 25533„and 25534. Section 3700 of the Labor Code, for the performance of the work for which this y// permit is issued. Owner or authorized agent: Date: 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 1 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 1 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 CUPERTINO FEE ESTIMATOR - BUILDING DIVISION MDDRESS: 19800 VALLCO PKWY DATE: 06/16/2015 REVIEWED BY: MELISSA PN: 31620037.38COND BP#: 09080116 *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIUSE: Commercial Building Civil / Religious activities PENTAMATION in BQ zone? Cl Yes Q No PERMIT TYPE: 1 GENCOM WORK REV # 1 - REMOVE MEZZANINE FROM RESTAURANT & REDUCE BY 12,565 S.F. - ISSUED I SCOPE 6/16/15 '�' � �'` Y` _ 2 / < ^,''r Y � ��`f z c6 � c.t'.ri � _ "� a �" �. _. �. ,;€ � X ✓¢ . ?vteC:P2. IS7td/j %.i1C'4r' �•�itrir3 .� l:1. �i:Zf1 f.,TteC�i" Fi� �';i'x3° tICC;i' Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 <:. c..: r {, licci, 1'c : t»i° 1'ee: u / l':ttli^rt:,y r2t'r7'11 hrs $0.00 1'[Ctr%: x'/CC. Penn Ti (W/m.tech. Ins'p. �tt;.�.%t: $0.00 Suppl. Insp. Fee:) Reg. 0 OT 0.0 hrs ilfee'Y, feisp. i'c'c': l wrrb..�%:Sjl..�''C'P: PME Unit Fee: $0.00 .i"' Is'IeC...liIs ..i'CSe: MTV! Thk Construction Tax: IBCONSTAXC -- --------------✓-�� .`»� .� �.••�• _-F., tntnttta It. V. rtunu6ug, ruvllc works, Irire, aanitaty J'ewerDistrict, .School _ _ __ ___ . ___..._..„, FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/131 ,, , , ,,, K, FEE unu ure QTY/FEE vru urz ea'tttnule. uonracr rue tie t or aaawt into. MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: (j)Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:) Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 7 )na ez11..Jac rrnc;rtrcr; it n .1 'e: c; Strong Motion Fee: $0.00 Select an Administrative Item $143 00T©TATS FEE $143 00 Bldg Stds Commission Fee: :..>,.� $0.00 $0.00 Revised: 05/07/2015 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19800 Vallco Pkwy DATE: 06/28/2012 REVIEWED BY: A. Salvador PC FEE ID APN: BP 0: 09080116 "VALUATION: $46,000,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in B zone. Q 9 Cl Yes a No PENTAMATION PERMIT TYPE• 1 R2 WORK New 5 -Story Mixed -Use Building (Superstructure Only): Tvpe V-A Apartments (383,913 s.f. • Type 1-A SCOPE Retail (22,760 s.f.); Type 1-A Restaurant (37,067 s.f.); Type 1-A Community Center (32,276 s.f.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-A,111-A,V-A 383,913 $0.00 IR2PLNCK $120,728.6( IR2INSP A-2 I -AJ -B /37,067 O,p IA2PLNCK $37,299.34 IA2INSP A-3 I -A,1 -B O 32,276IA3PLANCK $0.00 $22,694.66 JA3INSP M (Mercantile) I -AJ -B 22,760 IMPLNCK $15,335.28 IMINSP TOTALS: 476,016 $0.00 ;> $196,057.88 t:°"w"I 0;l4rrtii,-7MI1011 1°� ets. y%"fl 4f S Tf A Y i t J i- R �`�N 4 `fir ,1 i J t •,.;> Plat;( %iE'rti t'Jtirrrt t'ifn? (i,C'r,r; Plan Check Fee: Hourly Only? Q Yes 0 No �r'c'>. Pr;•rr:21 /'r:' t'ii•urf,. f"rr»att 1'i..t, ... �(',;rrrlt r <•; 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee:196,057.88 Suppl. Insp. Feer Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the Prelimina information available and are on1 an estimate Contact the n t or addn'1 FEE ITEMS (Fee Resolution 11-053 L' . 7,'1/11) FEE QTY/FEE in o. MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 �� hours Plan Check, Hourly $0.00 Suppl. PC Fee: (D Reg. 0 OT 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee:196,057.88 Suppl. Insp. Feer Reg. 0 OT O,p Fhrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 204 # new units' $354,334.26 (rIili?lliltri.lt;Y' I'i'F'. Cl E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: PLLONGRNGC $123,764.16 Select a Non -Residential E) Building or Structure 0 A t:°"w"I 0;l4rrtii,-7MI1011 1°� ets. Strong Motion Fee: IBSEISMICO $9,660.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1,840.00 i SUBTOTALS ` 685,656.30 $0.00 `'' ,. TOTAL; FEE $685,656.30 Revised: 06/30/2012 CITE' OF CUPERT INO 07 RiE'i V F.q'I'YA4A'Pn12 _ PTTTT "TXT! "TX7-Y0T4',7kT OCCUPANCY TYPE: ADDRESS: 19800 Vallco Pkwy DATE: 06118/2012 REVIEWED BY: A. Salvador PC FEE ID APN: BP#: 09080116 '`VALUATION: $64,800,000 "PERMIT TYPE: Building Permit PLAN CHECI{ TYPE: New Construction PRIMARY Commercla! Building USE: Civil /Religious activities in BQ zone? Yes No PENTAMATION PERMIT TYPE: 1 R2A WORK SCOPE New 5-Sto Mixed -Use Building (Superstructure Only): Type V-A Apartments (383,913 s.f. • Type 1-A Retail (22,760 s.f.); Type 1-A Restaurant (37,067 s.f.); Type 1-A Community Center (32,276,s.f.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID / BPI�F S BP FEE ID R-2 (Apartment) II-A,III-A,V-A� 383,913 , IR2PLNCK $120,728.6 1R21NSP A:=I-A,I-B` 37,067 142PLNCK $37,299.34 IA2INSP A-3 Cz/ I-A,I-B 32,276 ,/firs 1A3PL I,�CK $22,694.66 1A31NSP M (Mercantile) I-A,I-B 22,760 PME Permit Fee -$0.00 1M LNCK $15,335.28 1AffNSP TOTALS: 476,016 $0.00 _. :,;:`>; ' >:i.,,. ` $196,057.88 - -- FEE ITEMS Tee Resolulion I1-053 F '. 7,'1,'11) ---------------.•-•.•--•..•-•-....-•-... FEE� ., QTY/n,E v.rr u<r wr..•r<ccc. a.V....... a.. —./" V[ U{l[/{{ f f[{ MISC ITEMS V. Plan Check Fee: Hourly Only? Q Yes 0 No /$0.00 0 hours $0.00 Plan Check, Hourly Suppl. PC Fee: (R) Reg. O OT 0,0 hrs�� � $0.00 PME Plan Check: $0.00 Permit Fee: t 196,057.88 Suppl. Insp. Fee:Q Reg. Q OT 0.0 ,/firs $0.00 PME Unit Fee: $0.00 PME Permit Fee -$0.00 �O C.(� / �' � _� ����{J�oC•P y e, Construction Tax: IBCONSTAXR , 04 units 354,334.26 Q Work Without Permit? Yes No $0.00 Advanced Planning Fee: �' _1_ -fee: 123,764.16 , b _ fi -elect a Non -Residential r/' '3,11.ding or Structure Ic. R Select an Administrative Item 0 A46) /T7 / � Stron.P Motion Fee: IBSEISAECO $13,608.00 131dg Stds Commission Fee• IBCBSC $2,592.00 $UB OTAI✓S.. 690,356.30 $0.00 .., ::_'::`.;::::.. .. ; TOTALED::' $690,356.30 Revised: 06/30/2012, CITY OF CUPERTINO I +I FEE ESTIMATOR - BlPILDI G nrvrRIox ' -,A 41r _ 19800 VALCO PARKWAY DATE: 01/10/2013 REVIEWED BY: MELISSA JimADDRESS: APN: 316 20 037 BP#: 09080116 *VALUATION: Iso. xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: • g Plumb. hisp. Fee: PENTAMATION PERMIT TYPE: 1 GENCOC WORK FABRICATION & INSTALLATION OF STRUCTURAL TRUSS MEMBERS FOR THE ROOF OF BLDG SCOPE -,A 41r _ Me& Plan C.'Fieck Plumb. Plan Check Elec. Plan Check lLtRCh. Iaertnil Fee: Phimb. Permit Fee, Elec. Permit Fee: Other illech. Insp.E3-L- Other Plumb Insp. Other Elec. Insp. Ak:ch. Insp. Fac: Plumb. hisp. Fee: Elec. Insp. Fee: AUIZ: 1ms estimate does not include•jees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are havod an Jho nroliminary infnrmafinn ounilnhla and nra nah, na avd fa rn.fnnf fha 7)onf fnr —d,4"'l infn FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (2) No $0.00 ® hours $532.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee:. (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 •Suppl. Insp. Fee:E) Reg. Q OT 0 0 hrs $0.00 PME Unit Fee:: $0.00 PMEPermit Fee: $0.00 Constr;u ion .Tax: Adihinistrative .Fere:. Work Without Permit? 0 Yes (D No $0.00 .Advanced Planning Fee: $0.00 ® hours $532.00 Inspections 1STINSP Inspection, Hourly Trvvel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg; St& Commission Fee: $0.00 SUBTOTALS, $0.00 $1,064.00 DOTAL FEE $1,064.00 Revised: 10/01/2012 l� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19800 Vallco Pkwy DATE: 06/28/2012 REVIEWED BY: A. Salvador PC FEE ID APN: BP 0: 09080116 "VALUATION: $46,000,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in B zone. Q 9 Cl Yes a No PENTAMATION PERMIT TYPE• 1 R2 WORK New 5 -Story Mixed -Use Building (Superstructure Only): Tvpe V-A Apartments (383,913 s.f. • Type 1-A SCOPE Retail (22,760 s.f.); Type 1-A Restaurant (37,067 s.f.); Type 1-A Community Center (32,276 s.f.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-A,111-A,V-A 383,913 $0.00 IR2PLNCK $120,728.6( IR2INSP A-2 I -AJ -B /37,067 O,p IA2PLNCK $37,299.34 IA2INSP A-3 I -A,1 -B O 32,276IA3PLANCK $0.00 $22,694.66 JA3INSP M (Mercantile) I -AJ -B 22,760 IMPLNCK $15,335.28 IMINSP TOTALS: 476,016 $0.00 ;> $196,057.88 t:°"w"I 0;l4rrtii,-7MI1011 1°� ets. y%"fl 4f S Tf A Y i t J i- R �`�N 4 `fir ,1 i J t •,.;> Plat;( %iE'rti t'Jtirrrt t'ifn? (i,C'r,r; Plan Check Fee: Hourly Only? Q Yes 0 No �r'c'>. Pr;•rr:21 /'r:' t'ii•urf,. f"rr»att 1'i..t, ... �(',;rrrlt r <•; 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee:196,057.88 Suppl. Insp. Feer Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the Prelimina information available and are on1 an estimate Contact the n t or addn'1 FEE ITEMS (Fee Resolution 11-053 L' . 7,'1/11) FEE QTY/FEE in o. MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 �� hours Plan Check, Hourly $0.00 Suppl. PC Fee: (D Reg. 0 OT 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee:196,057.88 Suppl. Insp. Feer Reg. 0 OT O,p Fhrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 204 # new units' $354,334.26 (rIili?lliltri.lt;Y' I'i'F'. Cl E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: PLLONGRNGC $123,764.16 Select a Non -Residential E) Building or Structure 0 A t:°"w"I 0;l4rrtii,-7MI1011 1°� ets. Strong Motion Fee: IBSEISMICO $9,660.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1,840.00 i SUBTOTALS ` 685,656.30 $0.00 `'' ,. TOTAL; FEE $685,656.30 Revised: 06/30/2012 CITE' OF CUPERT INO 07 RiE'i V F.q'I'YA4A'Pn12 _ PTTTT "TXT! "TX7-Y0T4',7kT OCCUPANCY TYPE: ADDRESS: 19800 Vallco Pkwy DATE: 06118/2012 REVIEWED BY: A. Salvador PC FEE ID APN: BP#: 09080116 '`VALUATION: $64,800,000 "PERMIT TYPE: Building Permit PLAN CHECI{ TYPE: New Construction PRIMARY Commercla! Building USE: Civil /Religious activities in BQ zone? Yes No PENTAMATION PERMIT TYPE: 1 R2A WORK SCOPE New 5-Sto Mixed -Use Building (Superstructure Only): Type V-A Apartments (383,913 s.f. • Type 1-A Retail (22,760 s.f.); Type 1-A Restaurant (37,067 s.f.); Type 1-A Community Center (32,276,s.f.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID / BPI�F S BP FEE ID R-2 (Apartment) II-A,III-A,V-A� 383,913 , IR2PLNCK $120,728.6 1R21NSP A:=I-A,I-B` 37,067 142PLNCK $37,299.34 IA2INSP A-3 Cz/ I-A,I-B 32,276 ,/firs 1A3PL I,�CK $22,694.66 1A31NSP M (Mercantile) I-A,I-B 22,760 PME Permit Fee -$0.00 1M LNCK $15,335.28 1AffNSP TOTALS: 476,016 $0.00 _. :,;:`>; ' >:i.,,. ` $196,057.88 - -- FEE ITEMS Tee Resolulion I1-053 F '. 7,'1,'11) ---------------.•-•.•--•..•-•-....-•-... FEE� ., QTY/n,E v.rr u<r wr..•r<ccc. a.V....... a.. —./" V[ U{l[/{{ f f[{ MISC ITEMS V. Plan Check Fee: Hourly Only? Q Yes 0 No /$0.00 0 hours $0.00 Plan Check, Hourly Suppl. PC Fee: (R) Reg. O OT 0,0 hrs�� � $0.00 PME Plan Check: $0.00 Permit Fee: t 196,057.88 Suppl. Insp. Fee:Q Reg. Q OT 0.0 ,/firs $0.00 PME Unit Fee: $0.00 PME Permit Fee -$0.00 �O C.(� / �' � _� ����{J�oC•P y e, Construction Tax: IBCONSTAXR , 04 units 354,334.26 Q Work Without Permit? Yes No $0.00 Advanced Planning Fee: �' _1_ -fee: 123,764.16 , b _ fi -elect a Non -Residential r/' '3,11.ding or Structure Ic. R Select an Administrative Item 0 A46) /T7 / � Stron.P Motion Fee: IBSEISAECO $13,608.00 131dg Stds Commission Fee• IBCBSC $2,592.00 $UB OTAI✓S.. 690,356.30 $0.00 .., ::_'::`.;::::.. .. ; TOTALED::' $690,356.30 Revised: 06/30/2012, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc )_ Theee fees are haled an the nreliminary infnrmatinn availahle and are anly an estimate. Cantart the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) 19800 VALLCO PKWY DATE: 0411512014 REVIEWED BY: MELISSA 1WADDRESS: APN: 331620037 BP#:09080116 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition I Repair PRIMARY Commercial Building USE: 0.0 PENTAMATION 1 GENCOM PERMIT TYPE: $0.00 4/14114 - DEF # 4 - ALL RFI'S CONTINUE DEFERRED # 1 UNTIL FURTHER NOTIFIED .PE fSCOO =# $278.00 NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc )_ Theee fees are haled an the nreliminary infnrmatinn availahle and are anly an estimate. Cantart the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes ) No $0.00 2 hours $278.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 =# $278.00 Deferred Submittal IDEFSVBM Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes (D No $0.00 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: $0.00 $556.00 TOTAL FEE: 1 $556.00 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 9090 S SANDY PKWY DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 SANDY, UT 84070 PHONE NO: (949) 429-6740 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL n License Class—�_ Lic. #_ ROSE BOWL -MIXED USE RESIDENTIAL/RETAIL 476,016 $ SQFT-INCLUDES 204 APARTMENTS, COMMON AREAS Contractor Date l�" /s FLRS 1-6 (383,913 ... I hereby affirm that I am licensed under the provisions of Chapter 9 REV # I - REMOVE MEZZANINE FROM RESTAURANT &REDUCE (commencing with Section 7000) of Division 3 of the Business & Professions 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $46000000 Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620037.38CONDOS Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITHIN 180 D -S-9PE T ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, 180 D INSPECTION. judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will com ssued by: Dat / with all non -point u ce regulations per the Cupertino Municipal Code, on 918. Signature l Date S / E -ROOFS: All roofs be inspected shall 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 ❑ OWNER -BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three g California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous performance of the work for which this permit is issued. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the pertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se7*�,505.255 ,and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: f l 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 Lender's Address I APPLICANT CERTIFICATION certify that I have read this application and state that the information correct. above is 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, granting and expenses which may accrue against said City in consequence of the of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with 918. all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION MDDRESS: 19800 VALLCO PKWY DATE: 06/16/2015 REVIEWED BY: MELISSA PN: 31620037.38COND BP#: 09080116 *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIUSE: Commercial Building Civil / Religious activities PENTAMATION in BQ zone? Cl Yes Q No PERMIT TYPE: 1 GENCOM WORK REV # 1 - REMOVE MEZZANINE FROM RESTAURANT & REDUCE BY 12,565 S.F. - ISSUED I SCOPE 6/16/15 '�' � �'` Y` _ 2 / < ^,''r Y � ��`f z c6 � c.t'.ri � _ "� a �" �. _. �. ,;€ � X ✓¢ . ?vteC:P2. IS7td/j %.i1C'4r' �•�itrir3 .� l:1. �i:Zf1 f.,TteC�i" Fi� �';i'x3° tICC;i' Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 <:. c..: r {, licci, 1'c : t»i° 1'ee: u / l':ttli^rt:,y r2t'r7'11 hrs $0.00 1'[Ctr%: x'/CC. Penn Ti (W/m.tech. Ins'p. �tt;.�.%t: $0.00 Suppl. Insp. Fee:) Reg. 0 OT 0.0 hrs ilfee'Y, feisp. i'c'c': l wrrb..�%:Sjl..�''C'P: PME Unit Fee: $0.00 .i"' Is'IeC...liIs ..i'CSe: MTV! Thk Construction Tax: IBCONSTAXC -- --------------✓-�� .`»� .� �.••�• _-F., tntnttta It. V. rtunu6ug, ruvllc works, Irire, aanitaty J'ewerDistrict, .School _ _ __ ___ . ___..._..„, FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/131 ,, , , ,,, K, FEE unu ure QTY/FEE vru urz ea'tttnule. uonracr rue tie t or aaawt into. MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: (j)Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:) Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 7 )na ez11..Jac rrnc;rtrcr; it n .1 'e: c; Strong Motion Fee: $0.00 Select an Administrative Item $143 00T©TATS FEE $143 00 Bldg Stds Commission Fee: :..>,.� $0.00 $0.00 Revised: 05/07/2015