B-2016-1461 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1461
10815 N WOLFE RD CUPERTINO,CA 95014-0614(316 05 056) (LENZORA SIGN
SERVICE)
MANTECA,CA 95337
OWNER'S NAME: KIM CO REALTY DATE ISSUED:03/03/2016
OWNER'S PHONE:650-746-7503 PHONE NO:209425-6024
LICENSED CONTRACTOR'S-DECLARATION BUILDING FERMI '1 1 O'
License Class C-45 Lie.#665659
Contractor(LENZORA SIGN SERVICE)Date 03/03/2016 X BLDG —ELE IT!
P MB
MECH RES • , OMME' IAL
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 B DE' RIPTI 1: :
PANCHER S S-iN:TALL 2(N d LUMINATED WALL SIGNS
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 Worke 's
Compensation,as provided for by Section 3700 of the Labor'..e,for
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation nsuran',-,as. ovided f 0/
by Section 3700 of the Labor Code,for the perfo •,ce . the wo.. for w h i
this permit is issued. Sq.Ft Flo, Area: Valuation:$2600.00 i
APPLICANT CERTIFICATIO
I certify that I have read this application and state that t e abo e
information is correct.I agree to comply with all city an: coun ' Number. Occupancy Type:
ordinances and state laws relatin to building construe,on,and ereby '16 05 056 A(Tenant Improvements)
authorize representatives of this ci to enter upon the :bove m- tinned
property for inspection purposes. )agree to save i damnify-a : -ep
harmless the City-of Cupertino agains'liabilities,judgm-nts,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against sa' City in conse uence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the plicant undo .tands and -
comply with all non-point source regulatio per the Cu.ertino M icipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
Issued by:ALEX VALLEL[INGA
Signature a 03/03/2416 Date:03/03/2016
Il
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Con •.ctor'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. I,as owner of the property,or my ployees with wages as their sole inspection.
compensation,will do the work , d the structure is not intended or offered
for sale(Sec.7044,Business 'rofessions Code) Signature ofApplicant:
2. I,as owner of the property,.tri exclusively contracting with licensed Date:03/03/2016
contractors to construct t e project(Sec.7044.Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty i f perjury one of the following three declarations:
1. I have and will m.' Iain a Certificate of Consent to self-insure for Worker's
Compensation, provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance.f the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have an. 'ill maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Sec ,n 3700 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 emit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. slt fy that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
L11 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 25505,25533,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:
be deemed revoked. Date:03103/2016'
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
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 03/03/2016
Susan Winslow
From: Teos, Maria <MTeos@kimcorealty.com>
Sent: Tuesday,September 05,2017 9:49 AM
To: Building
Subject: 10815 N.Wolfe Road
Attachments: 0932_001.pdf
Hello,
Panchero's is no longer a tenant at Cupertino Village so the permit will not be reactivated.
Please let me know if you have any questions.
Maria
Maria Teos
Property Manager I NW Region
15 Southgate Avenue, Suite 2011 Daly City,CA 94015
(650) 746-7504 I cell: (650) 666-7038 I mteos@kimcorealty.com
Blog I Facebook I Twitter I Linkedln I YouTube
Original Message
From: canscan@kimcorealty.com [mailto:cancan@kimcorealty.com]
Sent: Tuesday, September 5, 2017 9:54 AM
To:Teos, Maria<MTeos@kimcorealty.com>
Subject: scanned letter
scanned letter
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