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15060049 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15060049 19600 VALLCO PKWY(316 20 108) 2401 208 ST STE C5 TORRANCE,CA 90501 OWNER'S NAME. (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED:10/26/2015 OWNER'S PHONE.(408)777-3081 PHONE NO:None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO. License Class CONTRACTOR-GENERAL Lic.# Contractor Date 08/31/2016 —BLDG _ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH_RESIDENTIAL—COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION SUITE 160-KULA SUSHI,TENANT IMPROVEMENT(2462 SQft) 1 hereby affirm under penalty of perjury one of the following two declarations: REV#4-INSTALL(N)PARTITION TO DIVIDE KITCHEN AND DINER 1. I have and will maintain a certificate of consent to self-insure for Worker's AREA,CHANGE DOUBLE DOOR TO SINGLE DOOR.ISSUED 3/14/16 Compensation,as provided for by Section 3700 of the Labor Code,for the REV#3 Revised roof top platform detail Issued 01/20/16 see permit B- performance of the work for which this permit is issued. 2016-1224 2. I have and will maintain Worker's Compensation Insurance,as provided for by DEF#1-CHANGE KITCHEN EQUIP(RICE COOKER)& Section 3700 of the Labor Code,for the performance of the work for which this SHOW STRUCTURAL DETAILS FOR ROOF TOP EQUIPMENT- permit is issued. ISSUED 12/15/15 APPLICANT CERTIFICATION I certify that I have read this application and state that the above REV#2-RELOCATE ROOFTOP EQUIPMENT AND CHANGE information is correct.I agree to comply with all city and county ordinances COUNTER LAYOUT AT SERVICE COUNTER-ISSUED and state laws relating to building construction,and hereby authorize 11/25/15 representatives of this city to enter upon the above mentioned property for REV#1-CHANGING HILTI BOLT TO REDHEAD AT SOFFIT inspection purposes. (We)agree to save indemnify and keep harmless the HANGER-ISSUED 11/24/15 City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Sq.Ft Floor Area: Valuation:$300000.00 Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. APN Number Occupancy Type: Signature Date 316 20 108 OWNER-BUILDER DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 180 DAYS FROM LAST CALLED INSPECTION 1. 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) Issued by Legacy 2. I,as owner of the property,am,exclusively contracting with licensed Date: 10/26/2015 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: RE-ROOFS: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any roofing material being installed.If a roof is Compensation,as provided for by Section 3700 of the Labor Code,for the installed without first obtaining an inspection,I agree to remove all new materials for performance of the work for which this permit is issued. inspection. 2. 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 Signature of Applicant: permit is issued. Date: 3. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Worker's Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE Labor Code,I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the be deemed revoked. California Health&Safety Code,Sections 25505,25533,and 25534. I will APPLICANT CERTIFICATION maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that I have read this application and state that the above information is Health&Safety Code,Section 25532(a)should I store or handle hazardous correct.I agree to comply with all city and county ordinances and state laws material. Additionally,should I use equipment or devices which emit hazardous relating to building construction,and hereby authorize representatives of this city air contaminants as defined by the Bay Area Air Quality Management District I to enter upon the above mentioned property for inspection purposes. (We)agree will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and to save indemnify and keep harmless the City of Cupertino against liabilities, the Health&Safety Code,Sections 25505,25533,and 25534. judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands Owner or authorized agent: and will comply with all non-point source regulations per the Cupertino Municipal Date: Code,Section 9.18. 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.) Signature Date Lender's Name CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19600 VALLCO PKWY CONTRACTOR: TSUKURU USA CORP PERMIT NO: 15060049 OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC OWNER'S PHONE: 9497481796 LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Plf-Illeo Contractor iJI�K(rf;2Gf Er i' Ca,Q f' Date 12 1 T 201-r 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. Date 171 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) 1, 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 2401 W 208TH ST STE C5 DATE ISSUED: 10/26/2015 TORRANCE, CA 90501PHONE NO: (310) 516-1945 JOB DESCRIPTION: RESIDENTIAL E COMMERCIAL SUITE 160-KULA SUSHI,TENANT IMPROVEMENT (2462 SQ FT). DEF # 1 - CHANGE KITCHEN EQUIP (RICE COOKER) & SHOW STRUCTURAL DETAILS FOR ROOF TOP EQUIPMENT - ISSUED 12/15/15 Sq. Ft Floor Area: Valuation: $300000 I APN Number: 31620108.19600 ( Occupancy Type:: I PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 X-S-OFIIMIT ISSUANCE OR 180 LLED INSPECTION. Issued y: 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. 1 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent:,�"��� "'� 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional _ 1 CONSTRUCTION PERMIT APPLICATION CO'MMILIN1 Y DEVELOPIAENT'DEPARThliENT- l3UILD IN'G D1V1S10N " 10300 TORRE AVENUE • CUPERTINO, CA 85014-3255 v r C U P S RT I til 0` (406) 777-322B, FAX (408) 777-3333 - buildinplaicupetino.Ora ❑ 1.�bW WNST2UCTION ❑ ADDITION . ❑4T10? 1177 9 REVISICN t DEF—WED OpIGiN d.L ?ram , - P;zoI-tcr fDDP��s %/ P o V / Il ed �G� IC'4�1 tea` -�4 ".ZG LIC 5iiTY`r8 01v)dE?. NA1 n[ , I P iOitr ` / ' ` ? `- 40 �_.� Sipa-TAD,7P. 5 r (dL f�� C,iY, 57Aia,Zu' /Oj`] II �( COt4PlNY AA>, W COh*iACT N's �k // U -5A / �tJ! PHOh? 9ID" Gr`! 7`J t N.SII, j .d STP.rs, f.D,?P.5S5 � !V,9 l W -ZO-AA t S- I CITY, STATB, Z3 �•-- f �vJ1 GC' r� z� / k 7.4.XX k �1� �L%Z �e ❑ o11ga Q ONT-iL.sL --R ' El ow)zrzAcZawr K CO',— ACT OR ❑ COInM'LCTD? f,C—M ❑ fAC'IaiicCT ❑ ENGD ❑ il \•?iOPEIt ❑ kf k -t cowl-J,CTORKf.1r LIC2T`5HA71k4?ER LIC 5iiTY`r8 BUS. LIC i# COt4PlNY AA>, W ti•MfiI, LCL -2 �� cu —L4 gp„){ STMT f9D 5 Z 6 �a �� CTTY,STAe`rZI? T d' w� �A C O PHO tw J1 �-&I -; I Y' e `' P3C'nTfzCrr�vGilvtrRNf1J3 y-��'��� ,- `' L10EhrSEItUi,�LR , I BUS. Lir- A fj s-i9e / colr,rWYN.1I.s� i7 i:•Irf.,-L ?a:.f,�� STars ADDR°ss D / ,2- I CITY, ar, ATE, ztz1 �1�! ` � (A II P Ian Z DsCP*MITION OF wOP.K r tAusiiNv ua Pr u: uscu OSI CONSM T\7'c I rSTOPMR U5$ IYPE OCC. J SQ PT, VALUATION (S) EX15rQ AUyZOOR. D2A.0 TOV.L I BAT�•ROOM R=.90DELlfi8A P_.40i)ELIYTA REMODEL AREAIKT- 1 PORC-R&R A DECK I -MA T0V1D:-CiVPO$C*1jeY .A WRAG=lsPT DETACH I } C DyrLLDJC LLh,� S: is 4 SECOA'D IINI'r ❑ Ys II SP -CO: D SI.ORY [DY S BEING ADDED? 0 N I ADDITION? ❑l0 P.--APPUCATION EJIM- i 'ME S. PRO\RD° COPY OF j IS T.T{E SLD G AN ❑ YES .� • .�.o-.r >n- r'.'s:.„_ � "= _=-`- -•-_ "= PLiA7u' j•!G APPL R ❑ NO ?LAT'TTL.'G APPROVAL L=iTcZ 17:ICY.�tR 801,iE, (,] NO _ _ ' US By my signature below, I certify to each of the following: I an the proper) o\;rer or authors ed aee-,t to ac P .the property 01N-ner's behalf. I hav read this application and the bfcrm tion I have provided is cored I have read the Description of Work and verily it Is accurate, I ems, ee to omp]y with all applicable local ordinnc£s and State lays relating to bull ng construe • cut, o- ze r£presen atives o'i Cupertino to enter the above -identified p. opmV for inspection pu,-poses. Signabire of Appl icantl,0. ent: Dat SUTPi•g'.k!—' IT A,L TFO-UfATION REQUIREED P 2` 'T . ` INM,71 J tio-I pernif o P -0-10— P_ _ MEN lti£\v'SFD Or1+IIlltiici?iJ d;.re p1 eon de o i f..r _.. ``� •y;_� RF __ Jr - gS �' r1_'L� . - _. _ttGT_'•p.. --` existing b! d ng(s), Dein OJ tioi] permit IS T.Ouired p? t0 iS u'l v _� x—_ Ems'_11 , iJ i Ifor su�Ic£ of b_ _dia, Y = g ., ,, r pe„rit for new building. ` y �g ,` _COrrrleeWBldGS: hDVW0 aCOM Jet£dHIzuidas Materials Dieclass-g form if ?-']Y Ja=s HF-terialsae being used as Dart of this project. MIMES. -r �3 SIN:� �--• ate' -_ � �:,� Copy 0`1 Planriing A4piDV a.I Z,£u£i or Me,.i•R: with P1 a. prior i0 -tib,-,--vim- ^`T . �� `�T^•r„� r submittal of Building Permit application, r7o ,`,'' y'y _•' ° -- ��- v Bl g4pp_20t1.aocrevised06/21/1'1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDI RIG DIVISION 10300 TORRE AVENUE - CUPERTINO CA 951114-3255:] (408) 777-322€3 FAX (408) 777-3333buiilding d cuts a,ar it ljo(,- bo 1 } NJ --W CONSI lit.ICTION (_j Af')DI'T'ION A ,: ERATION 1 `I`I U RE?VISIOi1T _' DEFERRED ORIGINAL PERMIT 41 PltJit("I`:11)tI121:3ti iF F I I Lt) f m r'. (p. f t `w i}< APN14 F :.. {1tvH1ZNi1Mi fir ernr >.+a -t'`,.,`,-* j��>•°t'yFt,:.a"` NFt(7NL �.,--r$'F..n.� 1>-hTr1t1.. StRt'l:rAt)t)Rt$fi C17`�'. StA"li.11i F' r F : TFC { FAX E' q G14>'p Ix CONEAf`T' N -NIF 7�t �f.W, €�..f _FFx rti :r' :. ?r.,:r"'t' :„t P110M. " .:1'i.�•t, - T F ATAIL, r r : - ....._..� __... _._ � I �i.�.,�.ysp.:;,r--p tF�i.3rt�•?v�'F�'�a r .r..k�F?•-f .C^ S"TREFt ADDRI SSyI CI"1y,411:tE,LIF 57 6 ❑ E)WNI Ii ❑ OWNI t:-I3kilLDER © C)WNER. A61 N I CON ntAC TOtt ® C;ON'TIiAC`roR AGENT j ❑ ARCItrE7;.C•r ©3.\GiiRaiuGii ❑ DEt`t�I..OPUR' ❑ TENANT CONTRAC'F01', 14'4I1: ee-! f I L'ICENSE,NMER LICENS"E'l"1PE BUS, LIC r•": oftf - 8 A< -1 t ", ti x }f_„': -'' f7t t r# T d t,51. I t•t)MPANYNY.ML-. E-4SAi1 !..•.� t'yt` " .✓' —jf._K J{a �-»€s'LFi.;, `�". :s .. `#- cd .. i.e-rz f+ ', ,'.SP L FAX,/ ��...y ;•,:i2 } , .. 7 CITY- 5I A"Pti, 2.IP ^•� '� r,--�� - -� } s,Li r'f Y J PHONE ; g r, t.9�an,./,....ta e4. ARt,tt7kE.t�[.SoftNFa:;RTtiAitis: y� WCI tS[:NG[tir31R Bus LIG:. lc)n�I'I FANY hAt4I J., vl �_, j� a£ }g. ,.,_j�� j I-ivY}SII. � FAX t S`PRrI:="I-At.TDRk-Ssittl c7TY,S ATI? Z111�` •orf, " ` F`' ice ; PH<)?a;t4 jt7ir 7 y 01 -SCRIP HON OF llit)RR. FAISIIV( US PRi)postl)U%t: CONSTI TYPI, j ).-ST'OtHwS - 8 A< -1 t ", ti x }f_„': -'' f7t t r# T d t,51. I TYPt: OCC(: j SQ F'1' VALUATION f5j '. t.l IS t4 \,,r ll OF llt�>i:li3 '_- 1011 Ar_ AREA amu,-�'.--•' iRF A f AREA.ta'¢`� NP.7 iFak;$1..— y. ,. e ,res.-.. 374 (Jr s 11E( {)OLI Kt 1 :11EN (!tilEx I#T tR ti'IF.i:�At°I st Ra %4OD6L AREA �kMODEL AREA 7 - hU[ ltI iRF.A FACE Att3 Y IIJt-a}'`r1)7 SaPt,IRC IE it.r:r�L C,ARttUt nRt:A DE” r ici{ - ❑Ak1AH {; I Iti i LI ICT 1=Ntksi=" � LS � Si a;tJ.^;I) i. Rlk`- lP� SLCOi155TE)Iti oYl;ti � - - NEING'ADDED? []NO—. ADDITK)N". ONO 1 A1ICA110IN ❑1;t IFYES, 1`RuVII)FtOPYUF ' Is THE,BE,DL-AN ❑ RECIIt `)By. - - lClA1iAllAllOi.RR- G AITI iaNO 'OVAtH171"'L1itir-'1 C ' t te.n Litt tlt)'4it,? "❑ 13y ii)t' tin, ntitute bCI013; I cCYtll'vtC) each of il)e folit)win, I a)n tile property oxkocr vii amhorized agent to act Oil the PTOPeTiyol"M is behalf. I nave rent this aptilii:at)on and the information 7 hat's; provided is correct, I have read ihc, Description of Work and verilt it is accurate_ I apiee to comply with all-applicabic local ordmanees and state Iasis relattim to building s:omstnkction. I authorize representatives of Cupertino to etiter the above -identified property for inspection purposes I Si�maturi:af'Apl.TlicantrA�cnt r�`yz`'� ..��'"'�`��';"�= Late: S JI'1'I.I;M::°Nl: fLl, INFOKMATION REQUIRED �I A�rat1ECr< tart a�cstl�t�r�,st it* Neu,k- SFD or Multifamily dwellings: Apply for demolition pen -nit for j existing building(s). Demolition hermit is required prior to issuance: of building permit for new building. ��KRI3ti�S. �! FLAt>tviNC)'Ln�[a>.�-u[OW . l _ Commercial Bldgs: Provide a completed hazardous Materials Disclosure ❑ ,x` �uy4R.1 ❑. IMMIL CNvolms i`arm ifany l laztardous Materials are being used as part of this project. CopY of Manning Approval better or Meeting with Planning prion to QTc Cl sT�rrIwtxl�tiittCT ; subtrultal of Building Permit application. flcft;3fr1) ?(tll.cfrTc'rertscdO(ii?11! CITY OF CUPERTI�IO FEE ESTIMATOR - RITTLDINt; nyvismN OCCUPANCY TYPE: ADDRESS: 19600 Vallco Parkway, #160 DATE: 05/�612016 APN: 316-20-108 --T—BP#. BY: REVIEWEDFlow *VALUATION: 1$300,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: BP FEE ID PENTAMATION PERMIT TYPE: 1A TI WORK INTERIOR T.I. WORK FOR 2,462 S.F. RESTAURANT, INCLUDES NEW NON-STRUCTURAL SCOPE WALLS, RESTROOMS AND KITCHEN, NEW KITCHEN HOODS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA !LS.L) I PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) I-A,I-B 2,462 $3,71166.00 IATIPLNCK $2,130.40 IATIINSP $0.00 PN/1E Plan Check: i Permit Fee: $2,130.40 Suppl. Insp. Feer Reg. 0 OTF0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 2,462 I 1 $3,�161 6,0VF $2,130.401 T -T MECH9.,,HOURLY - 0 -Yes G No J.PLUMB0110URLY ,0 Yes 'l--..(i),No:.I-.ELEC,HOURLY �O Yes -(),No NOTE: This estimate does not include fees due to other Departments (ie. Planning); Public Works, Fire, Sanitary Sewer District, School hicYriet ah- ) Thavo foot aro A"vod nn tho nrofimi""ry i"Mrmadan availahip and aro mik an Pvtimatp_ rantart the Dent for addn 'I info. FEE ITEMS (Fee Resolution II -(I53 3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,766.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: & Reg. OOT ��s $0.00 PN/1E Plan Check: $0.00 Permit Fee: $2,130.40 Suppl. Insp. Feer Reg. 0 OTF0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T -T 0 Work Without Permit? 0 Yes Q No $0.00 Advanced PlanqingLFee:$0.00 ISelect a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISAffCO $84.00 I Select an Administrative Item Bldg Stds Commission Fee IBCBSC $12.00 SU13TOTALS:- $5,992.40 $0.0 1 TOTAL FEE: $5,992.40 Revised: 05/07/2015 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19600 VALLCO PKWY CONTRACTOR: TSUKURU USA CORP PERMIT NO: 15060049 ' OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC 2401 W 208TH QST STE C5 DATE ISSUED: 10/26/2015 OWNER'S PHONE: 9497481796 TORRANCE, C�k 90501 PHONE NO: (310) 516-1945 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL ❑ COMMERCIAL SUITE 160-KULA .Z SUSHI,TENANT IMPROVEMENT (2462 SQ License Class Lie. 4 ( FT). Contractor IstAK(-1(ZLl WA cog? Datet61P—d V 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: Sq. Ft Floor Are Valuation: $300000 �. 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 APN Number: 3620108.19600 Occupancy Type: performance of the work for which this permit is issued. &4 M 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. N M PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is correct. I agree to 180 D S FROM LAST CALLED INSPECTION. 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 for ' property inspection purposes. (We) agree to save Issued by: I Date: 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. RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature - Date a W6 installed without first obtaining an inspection, I agree to remove all new materials for inspection. i Signature of Appl cant: Date: OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: t 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 i HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with he Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Sec Additionally, should 'on 25532(x) should I store or handle hazardous material. I use equipment or devices which emit hazardous air t. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain comphince with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health &Safety bode, Sections 25505, 25533, and 25534. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Owner or authorized agent: Section 3700 of the Labor Code, for the performance of the work for which this r ^ i t: Date: 10 C,y permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the of work's Compensation laws of California. If, after making this certificate of exemption, I for which this petrluit performance is issued;(Sec. 3097, Civ C.) -become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name I, must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION 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 I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter Licensed Professional 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. I Signature Date i i I CUPERTINO CONSTRUCTION PERMIT APPLICATION P COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildingacugertino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION /DEFERRED ORIGINAL PERMIT # 150"" PROJECT ADDRESS /_/,/ e) o VAL rno P K lit/ a/ 4160 APN # OWNERNAME CIS,, C3M?-,-+'7/O/aG` PHONE �� � e c�''��( E-MAIL STREET ADDRESS s�C✓3 y%a�%�g*L CITY, STATE, ZIPFAX %� I%/�i%� �,. 9G e l �`� rF CONTACT NAME�f �jcaa(E-MAILPHONE _ STREET ADDRESS ! / �� CITY, STATE, ZIP ( tC�EYt1/C I� �� % FAX d �U} s -1-d6 ZZ ❑ OWNER 13 OWNER -BUILDER. ❑ OWNERAGENT PeCONTRACTOR ❑ CONTR ACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER Q TENANT CONTRACTOR NAME , ,y LICENSE NUMBER LICENSE TYPE BUS. LIC # . ",' ' COMPANY NAME ` ,4j ec6e_( A .7 -MAIL FAX STREET ADDRESS 24 -*y e-71/ Ids CITY, STATE, ZIP of �J- PHONE ` S76—le f -f ARCHITECT/ENGINEER NAME ryli q &VC jA1,6 ! //Lt LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX f• STREET ADDRESS 102 &rc a v4fl?. j/ CITY, STATE, ZIP VI ,rVePHONE e DESCRIPTION OF WORK a G3.r_ ls,) G�t7r�� ani 2�e �`ivy c/,�ilt IA -1 — e e EXISTING USE PROPOSED USE _ CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL �> AREA AREA AREA NET AREA7t11(.m �v' y� `� �(� Z.'''�✓ " `•aa BATHROOM KITCHEN OTHER - - REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA _]�- TOTAL DECK/PORCH AREA GARAGE AREA;. DETACH ATTACH DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? [JNO "ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES Li1ATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: I am the property owner ora -zed agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons •uction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: m/-i/d / a/J SUPPLEMENTAL RMATION REQUIRED PLAN<CHECK T'7PE ROU'FIi\.GSLLP` .. ,... New SFD or Multifamily dwellings: Apply for demolition permit forDYER TAE coIIN EI; 3 � BUIL,Dilye PLAN vIEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS <PLtS\\iNGPLAIYREV3E�I r " Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C7 STANDARD z PVBLLC woRl�s form if any Hazardous Materials are being used as part of this project. �. BARGE ;: C3 . FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ©mASox" �4 _ © A Ir�iiYSEwER'D1s I CT submittal of Building Permit application.aNfAti 1FLAL rx BldgApp_2011.doc revised 06121111 — CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS; 18600 VALLCO PKWY # 160 DATE: 12/15/2015 REVIEWED BY: MELISSA APN: 316 20 108 BP#: 15060049 *VALUATION: $0 —� PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition /' Repair PRIMARY Commercial Building Civil / Religious activities PENTAMATION in BQ zone? Q Yes (F) No PERMIT TYPE: 1 GENCO WORK DEF # 1 - CHANGE KITCHEN EQUIP RICE COOKER &SHOW STRUCTURAL DETAILS FOR SCOPE ROOF TOP EQUIPMENT - ISSUED 12/15/15 $0.00 = # $286.00 Deferred Submittal IDEFSUBILI Suppl. PC Fee: (F) Reg. 0 OT 0.0 Lj ED PME Plan Check: f. F.`. sem.. 3.. ? 3 .f`s,'s, . p Permit Fee: $0.00 Suppl. Insp. Feer Reg. C OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBC'ONSTAVC $0.00 Work Without Permit? 0 Yes (E) No TE This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School utstrcct, etc.. 1 hese tees are based on the prelimina in ormation available and are o*nlv an estimate Contact the De t or addn'l in o FEE ITEMS (Fee IZevolutaon'II-053 Fff. 7,`1/13) FEE QTY/FEE Lf - MISC ITEMS Plan Check Fee: $0.00 = # $286.00 Deferred Submittal IDEFSUBILI Suppl. PC Fee: (F) Reg. 0 OT 0.0 Lj ED PME Plan Check: f. F.`. sem.. 3.. ? 3 .f`s,'s, . p TE This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School utstrcct, etc.. 1 hese tees are based on the prelimina in ormation available and are o*nlv an estimate Contact the De t or addn'l in o FEE ITEMS (Fee IZevolutaon'II-053 Fff. 7,`1/13) FEE QTY/FEE Lf - MISC ITEMS Plan Check Fee: $0.00 = # $286.00 Deferred Submittal IDEFSUBILI Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBC'ONSTAVC $0.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced. Planning -Eee: $0.00 Select a Non -Residential Building or Structure e £ Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SEBTQTALc,', $0.00 $286.00 TOTAL FEE _ $286.00 Revised: 10/01/2015 .r I CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-325544 (408) 777-3228 • FAX (408) 777-3333 • building(o-)-cupertino.or4 TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT Fire .�--[]APPROVEDPPROVED ............ G.G?�Date:........................ Signature:C-9�CZOW WITH CONDITIONS* u is Works Signature:......................................................... Date:...................... Signature: APPROVED ONDITIONS* APPROVED WITH CONDITIONS- Other: Signature:......................................................... Date:...................... Signature: APPROVED ONDITIONS* APPROVED WITH CONDITIONS- r.ru�n n�oAMTAACAIT / At_CAI!`V A0130MIA1 R• tanning Signature: ..... ................................................... Date:........................ ❑ APPROVED ❑ APPROVED WITH CONDITIONS` Fire .�--[]APPROVEDPPROVED ............ G.G?�Date:........................ Signature:C-9�CZOW WITH CONDITIONS* u is Works Signature:......................................................... Date:...................... Signature: APPROVED ONDITIONS* APPROVED WITH CONDITIONS- Other: Signature:......................................................... Date:...................... Signature: APPROVED ONDITIONS* APPROVED WITH CONDITIONS- *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance may result in an enforcement action. Owner Contractor Signature: ......................................................... Date:........................ Signature: .......................................................... Date:...................... This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and similar emergencies. 1 7 Buildin Officia� � T��� Print:.. ........ ��` .-... �.G �. '!............... Date:..4_..7 DEPARTMEN CTION: After determination, copies to: 1) applicant, 2) permit file TempOccForm_2013.doc revised 717114 CUE'E FZTINOO UIcroR (7i�J,5ol-azZS CONTRACTOR / SUBCONTRACTOR LM Buunllflnng Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /G PERMIT # 154060049 OWNER'S NAME: PHONE # X16 —15;' GENERAL CONTRACTOR: TBUSINESS LICENSE # z ADDRESS: S f CITY/ZiPCODE: 7 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING ]FINAL OR ]FINAL, OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UN'T'IL THE GENERAL CONTRACTOR ANIS ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CI,TP ERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date ?lease check appllneablle subcontractors and complete the ffolilowv ng lnfformnaden: V SUBCONTRACTOR BUSINESS NAME BUSI[N ESS LICENSE # Cabinets & Millwork Cement Finishing Electrical C SEck z 4 Excavation Fencing Flooring / Carpeting V1G � 4`7 6 Linoleum / Wood Glass / Glazing Heating j" " s lzleG 14 C 6,"7 Insulation Landscaping Lathing Masonry Painting /Wallpaper ? Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock �G� �- C Tile /� .,!� 17 Owner / Contractor Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PER€&1T NO;B-2016-1224 - 7ALLCO PKWY ERTINO,CA 95014(316 20 108) OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED:01/20/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Llc, 8 gy•5 dl 1(3X BLDG __ELECT _PLUMB Contractor Date(fWK�E4` ;a°�}>_,�©/�' MECH_RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: REV#3,Revised roof top platform detail(Parent permit#15060049) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 9 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:$0,00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number. Occupancy Type: information is correct.i agree to comply with all city and county 316 20108 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City In consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit, Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.18, //��,� it, Issued by' 1979 Signature /.. int. .1"1.(-21-2 Date /"`gyp` Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. 1,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant 2. I,as owner of the property,am exclusively contracting with licensed Date: 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. 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 read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Ilealth&Safety Code,Sections 25505,25533,and 25534. I will by Section 3701)of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous a. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 2550,,5,,and 25534. 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 Owner or authorized agent:.02-13e--- ala be deemed revoked. Date: /-a"--O -• ! APPLICANT CERTIFICATIONCONSTRU ION 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 correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is Issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional • Signature Date 1 CONSTRUCTION PERMIT APPLICATION '- . ..._ -.t - .. CONMUNIT'D`VELOPdENTDEPARTMENT BUILDING DIVISION ' . fr.-/ l= is • 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3226 i FAX(408)777-33333'buildinD(ouDerir o.ora CUPERTINO• c?/C\I +) O NEW CONST.RUCTIO T 0 ADDiTiON . 0 ALTERATION I TI ILEI REVISION I DEE ED ORIGINAL?' A]�T LI t+I A rioZcrAa � :s //D Ydttlt0 cwY • .F r� i . >`4 31L .1 OFrdEItNA Sft1 .) Q kr I ?EOM AIr 7i)----j� I `.,r�� , • STRUT PMIS. CITY, SIAic,ZIP • CONTACT NAUB PFIOh: =-?fA sT. res is 'D— — f « 169.-1-31-,404.,-,6,54. STRITS ADDP,SSS CITY,STATE,ZIP s PAX n .2a, rs.,ru -cam ':, Ae3- 'l6.� . ❑MEP. ❑.OWR:P.•at.M.DE ' 0 OWIN AaNT IC,CONTRACTOR ❑CONTRACTOR AEPN0 ARCI CT 0 FENIC -?i 0 D1?•10p. ❑ ali,,,,zr ` CONi?J CTORNh1 LICE E?'`UId ER LICENSE T r?E BUS.LIC 4 COIJ,PANY NAag 1 -NWL PA.X rd a- J.4. 1 'd -. '''�[� ,y f�'� )w. (• -..4 r 4..,1 - /r• Z'�ro., !2 ST,t`teT A LDR=55 _ _ 6 .G 5L `Tr,} 1 CITY,STA a s Z,? D As )'t 1 Piia1g 0—I1t^ [r A_RCircc•CU>OD.F.E RNAME. R i!n C LICENS�t\U'?.BBZR BUS. IC 7' 714 Ct rs er C.OIJ,PA).`Y NAME. E-MAIL e`A.X STREET ADDPMS d Cid,„ATE,ZI? P--I ". / Pi`.sC4l74 4 kyr ' e 1)-2 .— `-: DECF TION OP WORK =ONO USE PROPOSED USE I CORNS TR TM I r'STORIES USE TYPE I OCC, I SQ.PT. VALUATION(S) "SIO f N Ot ILOOR DF.I.40 iI TOTAL Regal/444#- ��,s - — 5T2- 1I ,-'C` f-.7.51 A.EAA. AREA • J N=TIR.EA G egal�Ylid++ 8 1 !.l 11 - BAT5ROOI4 KIT CI o KER 1 . BIN ODM AREA PaMODEL AMA F I .MODELA A PORCiB/RA ` DECK/`cE.A Tor.:1 DECK'.?OR CH 117,A j GARAGE ARE A: ❑DETACH 1 1 { !J I` ❑ATTACH. If {I 4DWPLLD4G:UNITS: i ISASECOND UNIT ❑YES I SECOND STORY OYES DEING ADDED? ©I NO ADDITION? ONO ( 1 ?XT-/.PP •CATION alas .2E^,PROVIDECOPY oP ISIII EBLD GA.N OYES ISD r =-$.'-- --'i.:'- "V-, .TOTA.I.YALU Iv: PLAe41N'Gs7PLt 0NO ?LANNINGAPPROVAL.LETL' EICHLER?Nohm! DNO '4_7,- - r By my signature below,I certify to each of the follow in : I am the property owner or sutbori ad agent to ac • the pr"opary owner's behalf. I hay read this application and the information I have provided is collect. I have read the Description of Work and verify it is accurate I agree to comply with all_pplicable local ordinances and state laws relating•to buil "ng co.st,e - z,,representatives of Cupertino to enter the above identified property for inspection purposes, Stanature or Apples nt/Agentl Date: .t - ' '. 0/l�_ SUPPLEM9TkL FOMATI01REQUIRED . . . v =� 1�a4 _ << —;irAF03f-ia nWrX New'S�or]M}Ll i ext i,r d,:%. llings: Apply f07 demolition 4 mit for 016-'''Wk--- r� # ` w 1- e . existing b .ldir a()• Demolition p.-r tIt isrequiredprior to iSSLa_T?ce of building - ,-74 .---,- roc -"` - - m permit for DC b-.-Iwrg. ° ras; CigP 41h 1tiEL� t Commercial Bides: Provide a completed Hazardous Materials Dt elo'..?r 4 is*$14,0 �__bs-E �`T� 'G - rom if any Hazardous Materials c, being' ed as part of this project. /1: C -,ag Ems, Iit-,--:::,_,---",_!..L. 5: Copy of Planning Approval Tetter or Meeting with Planning prior to 1 ig eip, a a r i r- submttal of Building Pe-=it application. '� — ?lea��p_2011.doc revised 06/21/71