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B-2016-1951CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1951 10373 TORRE AVE CUPERTINO, CA 95014-3203 (369 40 020) COBE CONSTRUCTION INC CAMPBELL, CA 95008 OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP DATE ISSUED: 09/08/2016 OWNER'S PHONE: 408-257-3031 PHONE NO: (408) 371-3400 LICENISED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #835122 Contractor COBE CONSTRUCTION INC Date 03/31/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH _ RESIDENTIAL X COMMERCLAL _ with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADD 50 S.F. TO CREATE (I) MECH ROOM; T.I. DENTAL OFFICE I hereby affirm under penalty of perjury one of the following two declarations: FOR (E) 1,251 S.F. 1. 1 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 REV #1 - ADD CONCRETE WORK AND STRUCTURAL SLAB - -' performance of the work for which this permit is issued. ISSUED 10/3/2016 2. I have and will maintain Worker's Compensation Insurance, as provided for by REV #2 - CHANGE 2-EXTERIOR DOORS; CHANGE ADA RAMP - Section 3700 of the Labor Code, for the performance of the work for which this ISSUED 10/17/2016 permit is issued. APPLICANT CERIMCATION I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $1750000.00 information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the 369 40 020 A (Tenant Improvements),B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED source regulations per the Cupertino Mu Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/17/2016 OWNER-BUILDER D •ARATION Issued by: Abby Ayende Date: 09/08/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole RE-ROOFS: compensation, will do the work and the structure is not intended or offered for . All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for 2. I, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project(Sec.7044, Business & Professions Code). Signature ofApplicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 10/17/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. z. 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 3. 1 certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the .Cupertino Municipal Code, Chapter 9.12 and be deemed revoked. the Health & Safety Code, Sections 25505,25533, an 534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is �i�tl.6' Owner or authorized agent: 10/17/2016 correct. I agree to comply with all city and county ordinances and state laws - ,Date: relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 10/17/2016 Licensed ArA CUPl_RTINO- NFt>J (-`f1t�sS'i'RTiC CONSTRUCTION PERMIT APPS ICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408)) 777-3228 FAX (4108) 777-3333 buI1dinO a�DUDertinO.Org 1 Tl()W I 1 AnT)TTT(-)N 11 - AT T PP ATTnV 1 TT IIX 4 P1111QTnnT r nrrrDvcn nDTr TM AT nr I -r 17-Wf-I4ht PROIECTADDRESS 0373 Ton -6, f}v�y ,r1fit? I APVTW OVriI RNAIAF �'+ 1 r� / i{ PTSONE E-144IL �P�r'1'�h'Q 4-1.NfA� Vfop I 't"'�.7�"' �G"7iI STREETADDRESS 1;13 (rllfre. AV& I CITY, 1TA117�i� C4dlq FAX CONTACT TAKEN, �CA tlNt i � 5 PHO?�CE L[}�'" ��77 • �j(jj 7j� E'IvL4FL . c�l�.Xpoguavtg��pF.cel}.c'or� STREET ADDRESS n �1I fi ff� v U b 1 f} CITY, STATE, ZIP I FAX eryr.Ps,d, 01A'14ER ❑ OWNER -BUILDER ONN`NERAGEA'T CONTRACTOR ❑ CONTrRACTORAGENTf ❑ APCHrFECT ❑ ENOWEER DEvELOpER TENANT CONTR4CTORNANM;Imwp,, WAI _ AGQ, u '( T NTS LICENSE1vRIWER P1 1 - LICENSE TYPE f1 �b [ l7 BUS. LIC w4- � r % CONVANY1\&ME 3,1-6 COU rya�s�-y�L}`iu�, E-NWL56,& ,;, co@ t / tilb�.�M FAX 4UJ-V17�q01 STREET ADDRESS l l p lj �jn,M Nr PrV�. - CITY, STATE, ZIP � d� � �}' � Fy dI U �i} PHOlt'E �.1�+ 7 JUo0 ACI RITECTIM4GIIN RNAMF, 1 �LICE 7 -SE NU%fB£R '�es4icu� Presl� _`BUS, LIC;;' _ COMPANY NAME N'1eI5oN/ gV(I('165 E-MAIL �LWiCIA �Ni�154Nt�Yc�j}at�S,GUM FAX STREETA.DDRESS ?ak([„15 •�jZ`N �r� o V l CITY, STATE, 71F C1JZ CFs �w[d PHONE � — - �'<w6a►-qa C "P, a Waat�ivo e� - r�VSfotl C6 -2,!, F }? "r, 4-tl sroN ir-aI1,tn-aY l+ri'l-{1 I -e55 510re, EXISTING USB PROPOSED L'SE CONSTR. I'YPE R ST_ OMS - + i i1 USE TYPE OCC. SQ.FT. VALUATION (5) E>aSTG NEW FLDDR DLN40 TOTAL AREA AP.EA AREA NET AREA BATHROOM IOTCHEN OTHER M4ODELARrA RET40DELAREA RE140DELAREA PORCH AREA DECK AREA I TOT.AI.DECKIPORCHAREA GARAGEAREA; DETACH A-4 /V I Ij, IV4 Q ATTACH MATULkG U -NRS: IS A SECOND ITiIT © YES SECOND STORY El YES - - - BEING ADDED? wqo ADDITION? 23 NO YR£:RPPLIC.0.TION OYES IF TTS, PROVIDE COPY OF PL.ANN1NG APPL p []NO PLAN' TNO APPROVALLErTER I IS THE BLDG AN! ❑ YESfRECENED EICHLER HOME? � NO B � -s �_ ; � � 5 ffli � s TOTAL VALUATION` By my signature below, I certify to each of the foilovring: I alit the property owner or authorized agentlo act ol the property owner's behalf. I have rend this application and the information I have provided is correct. I have read the Description of Worl;'and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uilding��cc�orns ction. I uthorize representatives of Cupertino to enter the above -identified properly for inspection purposes. Signature v� Date: 10-416 ofAppfica.ntiAgent: SUPPLa4ENTAL INFORMATION REQUIRED -'1 - �,,.�.RflTTfT�GBLTP $UII.DT New 5FD or Multifamily dtarellines: Apply for demolition permit for existing building(s), Demolition pen -nit is required prior to issuance of building k P TornetvUuilding. _1 EREss FIfi`'PL��Lnc2rRE�ii» Commercial Bldgs: Provide a completed Hazardous 3+4aterials Disclosure :L $TA CD RD „4 ��PLBLICii0RI form if any Hazardous Materials are being used as pact of this project. 4M s s L•4RG£ FIRE-T)EPT - _ Copy of Planning Approval Letter or h'Ieetina with Planning prior to fl * L4JOA c SivITARl SE«ERDISTRICT submittal of Building Permit application. k -R. •.. y�:' ET\'i`IR0hT4E'r`'TAL H:E_4LTET...= ,--.+=: B1dgApp_2011.doc revised 06/?1/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1951 10373 TORRE AVE CUPERTINO, CA 95014-3203 (369 40 020) COBE CONSTRUCTION INC CAMPBELL, CA 95008 OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP DATE ISSUED: 09/08/2016 OWNER'S PHONE: 408-257-3031 PHONE NO: (408) 371-3400 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNHT INFO: License Class B Lie. #835122 Contractor COBE CONSTRUCTION INC Date 03/31/2018 X BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect_. JOB DESCRIPTION: ADD 50 S.F. TO CREATE (N) MECH ROOM; T.I. DENTAL OFFICE I hereby affirm under penalty of perjury one of the following two declarations: FOR (E) 1,251 S.F. 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 REV #1 - ADD CONCRETE WORK AND STRUCTURAL SLAB - f performance of the work for which this permit is issued. ISSUED 10/3/2016 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 Sq. Ft Floor Area: Valuation: $1750000.00 permit is issued. APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 40 020 A (Tenant Improvements),B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. A^e—1 Signature Date 10/3/2016 Issued by: Abby A ey Ode OWNER M DER DECLARATION Date: 09/08/2016 -B I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: i. I, as owner of the property, or my employees with wages as their sole installed without fust obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:` contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/3/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 255005, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall L be deemed revoked. Owner or authorized agent: APPLICANT CE ATION Date: 10/3/2016 d state that the above information is certify that I have read this application and state CONSTRUCTION LENDING AGENCY 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 to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 10/3/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 j } ��fns �(g,� (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org 0 NEW CONSTRUCTION ❑ ..ADDITION EIALTERATION / TI ® REVISION /DEFERRED ORIGINAL PFRMTT /# I APNT f PROJECT ADDRESS Jr0373 ONVNER TAMEPHONE E-MAIL �.J�'2r �If� �pr a( have � �� STREET ADDRESS I 3C6? CITY; STATE; ZIP C C A C4 S Q I L( I FAX VF 3r ,1-1 i CONTACT NAME AIt 4 1 CA (j J (¢I �l � PHONE E-AtiAIL S is�gN+cl �.CWA STREET ADDRESS w313 Torre, A-ve, CITY; STATE; ZIP F,+I�t fi `ra',�ti FAX El OANER , El owNER-BTaDFR ElOVJNERAGENT - K .CON -TRACTOR 13 CONTRACTOR . AGENT ❑ ARCHITECT El ENGLN-E ER ❑ DEVELOPER ❑ TENANT COS NAIME�If�c� LICENSENUmBER gl351'r�k LICENSE TYPE i3 BUS. LIC 4 -4 6�,C SNL �l COMPANY N.A,ME E-MAIL FAX STREET ADDRESS t{4 SAI-t� 1%Z CITY; STATE; ZIP C�c�pla2l� ,L/}� �tsp►' PHONE 0 371-3�tOfl ARCHITECT/ENGLNEERNAME ,1 LICE !SE NUMBER BUS. LIC- COMPANYN.ANIE f+T i��Son/ , �-�t�iu5 E-MAIL • j�SSI�-�. �'/ Ni2�5v;✓�C'G�IF`f`tci�'j.��a FAX STREET ADDRESSti as crr✓ 5+ CITY, STATE, ZIP �r 5a,,ijq Crv� ,Cl X150 � I PHONE f � �- 1m361 � DESCRIPTION OF WORK D r.AWI�y i° 2V 65 iacJ (P'fUi 15 f6d' � h Crry f Or Cr2,�Q/ �rrDT �s EXISTING USE PROPOSED USE - CONSTR TYPE ,`.-' STORIES. •(j USE TYRE OCC. SQ.FT. VALUATION (S) � EXISTG NEw FLOOR DaIO TOTAL — AREA _ AREA AREA NET AREA BATHROOM. KITCHEN OTHER REMODEL AREA RE11,40DELAREA REMODELAREA -.. PORCH AREA DECK AREA TOTAL DECK.TORCH AREA GARAGE AREA: DETACH - - 1v.A NA AfA ffA ❑ ATTACH DWELLING UNITS: - IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES - N BEINGADDED? ''ZNO ADDITION? R'NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPT" OF PLA WINGAPPL= ❑.NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLERHOAIE? NOUWE REC ED BY � x ��� � �._. - TOTAL VALUATION:. By my signature below, I certify to each of the following: I am the property owner or authorized 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 build- a Constructlo authorize representatives of Cupertino to enter the above -identified property for inspection purposes. j 101j3/i16 Date: Signature of Applicant/Agent: SUPPLEMENTAL IINIFORMATION REQUIRED .PLAN ciiEc%TYPE � -w ❑ RE\TEC1 New SFD or Multifamily dwellings: Apply for demolition permit for existing building s). Demolition permit is required prior to issuance of building OV ER THE COLTER k BUiLDIiG PLAN permit for new building.EIPRESS a PLS\iNGPL�n I2E\ IE\i Commercial Bldgs: Provide a Completed Hazardous Materials Disclosure X `E1 ST4lDARD ' ❑ PLBLIC �\ ORIS fornl if any Hazardous Materials are being used as part of this project. ;❑ � FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior t0 LARGE � � „„' � _ submittal of Building Permit application.' LAJOR � r SA�iTARl SEii ERDISTRICT �z - "� '`, . �n•��� .�.� .x 3 .�. E;�'\IROA'TiE?\TAlHEALT33�- z B1dgpp_2011.doC remised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUIL DING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1951 10373 TORRE AVE CUPERTINO, CA 95014-3203 (369 40 020) COBE CONSTRUCTION INC CAMPBELL, CA 95008 OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP OWNER'S PHONE: 408-257-3031 LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #835122 Contractor COBE CONSTRUCTION INC Date 03/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing pith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. 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 performance of the work for which this permit is issued. z.',) 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 t 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 regulatio s per the Cupertino Municipal Code, Section 9.18. k WAOV Signature Date 9/8/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the' following two reasons: i. 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 sale (See.7044, Business & Professions Code) 2. 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: 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 performance of the work for which this permit is issued. 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 permit is issued. a. 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 9/8/2016 DATE ISSUED: 09/08/2016 PHONE NO: (408) 371=3400 PERMIT INFO: BLDG —ELECT _ PLUMB MECH RESIDENTIAL X COMMERCIAL DESCRIPTION: 50 S.F. TO CREATE (N) MECH ROOM; T.I. FOR (E) 1,251 S.F. Sq. Ft Floor Area; I Valuation: $1750000.00 APN Number: Occupancy Type: 369 40 020 1 B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Aypnde 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: 9/8/2016 "A" OR 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: -44 Date: 9/8/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed 05/16/2016 08.23 FAX 4082575842 190001/0001 CONSTRUCTION PERMIT APPLICATION EWh COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA $5014.3255 CUPfiRTEI�ii i (408) 777-3228 • FAX (408) 777-3333 • buildincj cuoertino.®ra , r ry r f El NEW CONSTRUCTION Li ADDmoN Q ALTnATION I TI REVISION I DEFERRED OMOINAL. PER=# PROiECTADDRESS 10373T*=Ave APN# 36940.020 0WNERNAME PHONE �� . ?J�J E MAII - ` •1cr rte+ vi �� � ,( . STItE61'AADItF,SS / � Cl'lY, STA,TE,Z[P sem' ar r2 �ii*P/� 1 CONTACT NA1Y3E `may-, j ay .l ! (� G PROM g'h� SWIM J&DDIMS5 ► • f`t ATX. STATE. ZIP PAX Z�owm ❑ 4WNIIt5 l7lEAEa CQ OWNERAC:ENTr © CONTRACTOR ❑CONTRACTORAOENT © ARCEwra I m;emm ©-rsbVELOPFii ❑TENANT CONTRACKM NAME Shaw Olson LICBNSEN[IMB13R e".YLdry t Z LICENSE TYPE BUS. LSC # � COMPANYNAMB I� u.-, coir �-.c, C01-- F` r $TFtE£T ADDRbSS C1TY, STATE, I cc �s i 4 ARC1M=/F QWfi'ERNAMii ChdstiMW01sen LICENSENUMBEL C31888 BUS.LIC# B1,96210 831 b21.3926 COMPANYNMS NAcU=Anfiitacts &MAI% Ymielsan�nis4setlaschitecis.com FAX STREET ADDRESS 228 R. FemSr. CTTYY STATE, ZIP Santa Cruz Ca 95060 PHONES31-621-3926 DESCRIPnwo,,woRK -M�trs�t �1' 1S ��U," -Y 4�tiziT�1� �TPY to "�+ t c-" Vl4- C-4 r 6 EX[Sr1NGUSE PROPSA77USE CONSTYPB #STORES t USE TYPE flCC. VALUATION (S) EXLSTMO G LOQR DARRtt TOTAL NET ARISA , i� +r}SQr,FT- F 6 ✓ I i ! AREA i Z� I ARTA i2S, L l% _ l BATFLROOM RSMOUSLAREA K1TC13EN - _- RkTtgUIiLARisA OTEM REND➢EiLARFA - PRPrAPPLiCAT10N i3YES WyE3,PROVIDF,—[7x ` .. ",; rY : r V PUM MOAPPL# 13KO PLANNING APPROVALA.TT1OM LT—k 1(CHT O } �...t: By my signature below, I certify to cads Of the following: I am the property owner or authorized agent t _ eproperty o vner'a behalf. I have Tea s application and the i➢fvro ation I have provided is correct I bavp read the D wiption of Work and verify it is accurate. I agree to comply with all applicable 10eal ovditlances and state laws relating to b01#9 otion. I duce ofCupertino to enter the above -identified prop" for inspection purposes. Signatutc of Applicant/Agent Date.—, 9Y < F New SFD Or Multifamily dwellings. Apply for demolition permit for ®: �9 ? l': •' ? 1NO PDB�1x.64iE1V w to fing building(s). Demolition permit is required prior to issuance of building �.'G�•�,Tac v i S y pernnt for new building. Commercial BIdgs: Provide a completed Hazardous Materials Disclosure fo3 siaivti u ', ° any Hazardous Materia) are being used as pant of ts projec hit s , _rm i£ or Meeting with Planning prior to �. #' "ti: _Copy of Planning Approval Letter g iIt r > f ?F;DIs1R submittal ofWldmgPCCTi]It S Iucatl0n. pp B1d&4pp2011.d0e revised 06121111 0-r .5'o'Er Buildini Department City OF Cupertino 10300 Torry Avzmue Cupertino, CA 95014-3255 Telephone: 408-71717 CUPERTINO 22S Fax: 408-777-3333 coNTRAcm SUBCONTRACTOR LIST 3J1B ADDRESS: 10-77,*-�73 -b)! 11ERN11T # . ........ . . ..... . ... O1A1XLVSNA{4E- iGLNE'.RALC0NTRACT0.R- COar:i PHONE #-- - -- — - ---------- BUSIME'SS 1-10. '�s # — LADDRESS: T "!—V . A -t -L 7-11--l- 1---'r . . . ....... . ... . ...... CITY/ZIPCODE: C�-S�n'-o —=j 'Uur municipal code requires at! businesses working in the dq, to fir iaCii; y.ofCupertiiiol.)usi.ne'Ij Die ss ce NO BUILDING FINAL OR FINA1. OCCI]PANCY INSPIE-CTION{ S-) WILL BE SCIIEDULED UNTIL THE GENERAI., CONTRACTOR AND ALL SUBCONTRACTORS ILWE OBTiUNED A C]TV OF CUPERTINO BLISPNESS LICENSE. I am not usling any subcontractors: Signature Date Please check applicable subcontractors and complete the folio -wing information. V I SUBCONTRACTOR 5-"-1 N -E S--",— 1 S N A1W E -BUSIS NESLICENSE # . ............... . . . Cabinets & Miflwark i— ........... . Ceinent Finishing i e Electrical ... . ......... . ........ . ...... . .................. ........... . . . ...... Excavation Fencing . . . . ...... . . ....... Flooring Carpeting -7'f—i.in­oieuny1/ Wood v f ,Glass Glazing pn 1AIrk&-hill eW 7 Insulation Landscaping 1-athing masonry.— Painting I Wallpaper Paving Plastering Plunib'ing Ll' Roofing Septic Tank Sheet Metal, ... . . ..... ........... . . .... . ... Sheet Rock - - - ------ ------- Tile .......... .. . . . ....... .. . .. ..... . .... .. ........... . . ...... . ...... . . . .......... . . z�d'- .,;ContradorSignature 9 51 v I —le. ir i zo-;,