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08070165- PUB
71 M LL- 0 L0 _ O 00rc v v cn al N Ql Ql � o ai �° a o o 0 > a o Li O m U w 0- Q = U U O LO �_ Q Dl V al � z a � a Q O z U a U O LOH 07 H V A a P4 U W O Q a w u w F � u O } o F zo w o o -4 0 w LO z N N O WO 0 CL P4 Z d) F V 10 J O N iiJ04 a F A 7 ~ N rU a) w � ava LO O r� o O a a 0 = M u = U a O N W H 3 U W W E -= x� z m D Lo o v co 0 U Q � eCD =1 Q u Idl LL. c O m m 6 15 t" a a _h A w ti Idl Idl Idl CD CL a a =1a , mvU O O O O ~ U a+ �dl LU o CD C=- I Z ~ w z mo CD O a 7 mz wLLI0 CL � 7 �� Q m w w O O p m M C �J LL) - CD O f F- O ice_ +0:�~ J O M M o Q LLJ °' _m '� ' z O 1 N Z 1 — ti � I-- a_ `�. m w — M J M O a a - _ � Q Q U -4. co o a o 07 43) 07 x 41 N xv n ? 3 > ar N 0 o a w �° a v fu w -0 x o a rti r= o z m a v w v o o -C ioCo d - m a� ar v O v w v v Q A, i� ar x� t Q < car v c .4' N 0 - 3 v as —' a� v a or To co a� m =j' w v ° o n a� `m 'a� CL 11 O Q co U O � O a_ a -� y a- Co a_ Q 0 U U U a_ 1* m % - a� .� CITE'OF CUPERTINO 777777777777 BUILDING DIVISION PERMIT C� I�AICTCII }RIIf31�tfi BUILDING ADDRESS: PERMIT NO. 20725 VALLEY GREEN DR TBD - TO BE DETERMINED 08070165 OWNER'S NAME: PERMrr ISSUE DATE MITCH KANE 07/23/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION u F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z w with Scctien 7000)of Division 3 of the Business and Professions Code,and my license is CO 'L TI NON—S TRUC TRL OFC BLDG I NC LDNG PLMBNG M y in full force and effect. 31g4 License Class Lic.N &ELECTRCL F mDate_ Contractor ,,,t ARCHITECTS DECLARATION cd< I understand my plans shall be used as public records �yU 4 WO CO Licensed Professional n y< OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the C p O following mason.(Section 7031.5,Business and Professions Code:Any city or county K m� which requires a permit to construct,alter,improve,demolish,or repair any structure u z a prior to its issuance,also requires the applicant for such permit to rile a signed statement E=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation a:t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $30000 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number QCCll not more than rive hundred dollars(s500). 32610026 . Occupancy Type ❑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 forsale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such wort himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 1,as owner of the property,am exclusively contracting with licensed contractors to . construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contrzctor(s)licensed pursuant to the Contractor's License Law. ❑1 am(e�yre�ptunr?Sec. .B&P Cfor this reason Owner ;(// 'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier._ Policy No.: CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any m ncr so asto be me lest to Workers' ompensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,after making this Cerificate of Exc ption,you should become subject to the Worker's Compensation provisions of the Labor Coda you must Oforthwith comply with such provisions or this pcmtil shall be deemed revoked. z CONSTRUCTION LENDING AGENCY [-+4I hereby affirm that there is a construction lending agency for the performance of p:' the work for which this permit is issued(Sec.3097,Civ.C.) Q Lender's Name z Lender's Address U O 1 cenify that 1 have read this application and state that the above information is / iz,F correct.1 agree to comply with all city and county ordinances and state laws relating to G 0 V building Conswction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. VNe)agree to save,indemnify and keep harmless the City of Cupertino against ice„t to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APP ANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date S Re-roofs natun;of App 'nuactor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,S Syr, 25532(a)? All roofs shall be inspected nor to an roofing material beim installed. [7 Yes No P P � Y g g If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or future building occupant use equipment or devises which P g emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 13 Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor• nia Health&Safety Cafe,Sections 25505,25533 and 25534.1 understand that if the building docs noqrrently have a tenant.Ural' y responsibility to notify the occupant of the rcyui n w' e r ssuancc of a Certificate o Occupancy. r Signature of Applicant Date + mer ar authoriz. age � Date' All roof coverings to be Class or or better OR7v CITY OF CUPERTINO a'-v TENANT IMPROVEMENT CUPEkTiNO PERMIT APPLICATION FORM APN# 04 ( , oo Date: _ O$ Building Address: ,z C9 11)q L-L f? 67 yQi�i^l D2I lrJ�- Mailing Address (if different from building address): Owner's Name: Phone #: ]��//`\/ �/� / /'It 4c,4L Contractor: Phone #: jFe 2 O?g V -105 i 04 �PA�I�S &1 S724,C7r ate/ Fax #: b S ZS -- 5-77-0 Contractor License #: .3�1 SOg Cupertino Business License#: Contact: -Jm e Sp,r�_5 Phone#: 4d g 1/3/ - 52-30 Fax#: Alternate Contact: Phone #: L A u,i-t e— Fax#: r— Valuation(cost of project):© x Job Description(be specific): Tenant Improvement Includes Re-Roof: Yes ❑ No X] If yes, number of squares Tenant Improvement Includes Structural . Yes ❑ No Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [ Project Size: Express Standard ❑ Large.❑ Major ❑ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved — *** For Office Use Only*** Over The Counter ❑ Revised 6/16/08 CITY OF CUPERTINO TENANT IMPROVEMENT FEE SCHEDULE Quantity Fee ID - Fee Description Fee Group Permit Type IATINSP Tenant Improvement B 1A TI Inspection IATIPLNCK Tenant Improvement Plan B Check 1BTIINSP Tenant improvement B 1B TI Inspection 1BTIPLNCK Tenant Improvement Plan B �OD Check' . IETIINSP Tenant Improvement B IE TI Inspection-Preschool IETIPLNCK Tenant Improvement Plan. B . Check_Preschool 1FTIINSP Tenant Improvement B 1F TI Inspection-Factory/Indust 1FTIPLN,CK Tenant Improvement Plan B Check-Factory/Indust 1HTIINSP Tenant Improvement B 1H TI Inspection-Hazardous 1HTIPLNCK Tenant Improvement Plan B Check-Hazardous I ITIINSP Tenant Improvement B R. 11 TI . Inspection-Institutional ` 1ITIPLNCK Tenant Improvement Plan B Check-Insfitutional 1MTIINSP Tenant Improvement ° B. 1M TI Inspection-Merchandise ` 1MTIPLNCK Tenant Improvement Plan B Check-Merchandise 1 STIINSP Tenant Improvement B 1S TI Inspection-Parking Garag 1 STIPLNCK Tenant Improvement Plan B Check-Parking Garage 1RER00FC0M Re-Roof Commercial B 1BSEISMICO Seismic Commercial B BUS LIC Business License B 2 of 2