10070174CITY'OF..CUPERTINO,BLTILDING PERMIT
BUILDING ADDRESS:, 11INFINITE,IOOP'.
CONTRACTORaDPRCONSTRUCTION.tNC, .
PERMIT.NO: 10070134
OWNER:S.NANIE': ,AP.PLEINIC
1450 VETERANS BLVD
DATE ISSUED': 08/04/2010
OWNER',S,PHONEs 4087997346
REDWQOD',,GITY;;CA, 94063
P,HONE'NO:,(650)174-1450.
❑. ` LICENSEDiCONTRACTOR'S DECLARATION
ri
`
BUILDING PERMIT INFO':' BLDG ELECV PLUMB
License Class `7.. Lic. # S't%/ �
�� —
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MECH` RESIDENTIA�`" L
'" COMMERCIAL
Contractor.r �/Q C o.JS� ��G` r �t iDate, �-Y 6
hherehy affirm.that `I am licensed finder the peovisions?" f Ch" pter 9
JOB DESCRIPTION. FLOOR 4 - COMNI'L TI 10 NEW OFFICES`BUILT V/GRID
(commencing with Section'7000) of Division'3,:of:the Business;&.Professions
HIGH,.IVON BEARING,PARTITIONED`1268SQFT
Cod'e?and that.my license ivin full forceland effect.
l Hereby, affirm under penalty ofperjuryone of the followmgitwo declarations:
1,:}ia`ve:and.will:maintatn a,ceftificate o'f consent10 self-insure'for W. ,orker's
"
Compensation, as providedfor-byiSeciion;3700?of the Labor Code, for the
peifoririance,ofthe work"for which,thislpchnivis issued.
Sq. Ft Floor Area:
Valuations $7200
l;hayc and;will'maintain Workers Compensation.Insurance„as,provided for by
Section.3700 of the Labor Code for the peifoii5iance of the;woi& for Whicfi this
permit is;issued.
APN.Ninnber: 31'6021.05:.00
Occupancy Type:
APPLICANTCERTIFICATION.
1,'certify-that l have read,tl is'application and siate'thatthe above infonnatiog;is,
correct`. I agreeto°comply.with,All city and cpggty ordinances and',state4aws relating,
to.buddmg[construction and hereby authorize representatives of thiscity to enter
PERMIT EXPIRES IV WORK IS NOT STARTED:
upon the,above4mentioned property for,inspectionrpurposes. (We) agree to,save
_ -
'iifdemnrfy'and keep harmless the City of Cupeitinoragainst;lrabdities,iudgments;,
WITHIN 180. DA .&OF 'PERMIT ISSUANCE OR
costs and expenses whrch'may accrrie against sai&City'inconsequenceiof'the
FROM '
1'80 DAYS FR. - LAST' CALLED. INSPECTION.,
ranUn of,dus' erriiit , Additionally; the applicant understands and,wilLcom 1
granting P Y ,- PP P y
with all°non-point source, regulations' the Cupertino MumcipabCode`Sec-ply
ion,
Issued b �— Date: Z-
Signature Date t�
❑ OWNER -BU DER DECLARATION
RE -ROOFS:
lli ool's shall be i
Alltany rooSng<matenal being installed Ifzroofis
I herebyaffirm tha`t`I'am exempt from the 'Contractor'sLicense La_ w for onecof
_
lcal without inspected'prior'to
rst•obtaining;an>inspectron, t_agree to remove all new materials'for
"the following two reasons:
inspection,,
1, as owner:ofthe.propeity; or my employees with wages as;their"sole compensation,
will',do the work,iandthe sfniciure is notiniended or.offered'for sale (S',ect7044',
SignStCne,ofApplicant: Date:
Business &.Profession:Co
sde)
Lias owner„ofthe p-roperty,-am,exc-lusiyely;contracting'w`iih licensedcontractors to
construe - tj4t prcj&t,(Sec.7044; Business &.Professions Code).
ALL ROOF COVERINGS TO'BE CLASS "A” ORBETTER
-l' hereby, affirm_i nder penalty of perjury one ofthe following"three
HAZARDOUS°MATERIALS DISCLOSURE
'declarations:-
..-
l;hadej,and'will maintain a'Certs$Cate'ofConsenCto self'insuretfor'Worker's
l have=read the hazardousE,material s requirements under Chapter 6.95 of the.
f
Compensation, asprovided fof by Secti6n�3700 of--.the>UborCod'e; for the
California=Healthi & Safety Code,;Sections.,25505, 45533, and 25534 Lwill`maintai'n
perfonnance$of the•work�for.w}iichthispermrt is;issued.
_ - —
compliance with ,the Cupertino Mgni_cipal'Code; Chapter,9:,12'anif tire,=Hea1t.hr&,
•° ,
]have+and'will;matntam Worker s':Compensation.Insurance, as,
Suet Code, Section 25532 (6) should hstore or' handlehazardous material. .
-- y. � -- -, -(� -- '
Section 3700 _of the Labor Code; for the performance of the�wotk for which thi's
Additrriiially pshorild:I use equipment or devices`whrch erirrt Gazar'dous air
contanriiiantVas de`fined,by°the Bay Area Arc' Quahty.Managemegt Districtl,wi11'
pernirt is, issued:
maurtain,compliance+wit-h the Cupertino Municipal Code, Chapter,9.12 and the
Lcertify-that in the perfbrmAfice.of the'work,,forwhichthis:p rmit.rsF slued, lshall
.Health & Safety Codei- Sections 25505;.25533, aiid 25534.
not emto an e
p y y p rson in,any;manner so as to`become subject to the Worker's
Comperisatiomlaws ifCalrfomra If,afternrakingthiscertifrcate`ofexeniption, I
0H�i6r'.autlio izcd a' it:
become 'sub3ect io.the Worker;'s Compensation proyisions,of the,Labor Code; tmust
Date.:
f5rthwit4;comply with such pr'ovrsions orthis'pmnit'sliall.be'deemed revoked -
CONSTRUCT -ION LENDING„AGENCY
APPLICANT CERTIFICATION
Lherebyaf intt . at there is aconstruction lending agency for the: performance of work's
Lcertifythal h errea&thisapplicationand satethatheaboveinfomation.is
,
'for 309,, C1VC)
correct. 1 _agree,to;comply-.with all city dnd,county,.ordinancesuand state laws relating
Lchdcr''s Name.
to building; 6tisfi{rction,and hereby.autlionze representafivesofthis::city to enter
uporfthe above`.inentioned,property=.for;inspection puiposes'.,,(We) agree to save
Lend'er:'s -Address'
indemnify:and'keep hannlessithp,'6iy of.Cupertino; against" hibilities,.judgmems,
costs ;and expenses which may accrue against said City inconsequence of the
granting pfthis°permit Additionally, the applicant understands and will comply
ARCIIITEGT'S DECLARATION
with all nqk7poiiit,source regnlMions`,per the.Cupeitino`Municipal Code, Section,
l understand my plans§hall,be u--sed'as?public records.
9:18:
Licen_se_d Professional_
,Signature) Date
q!TT OF.
C.UPER-TINO
CITY OF CUPERTINO
TENANT -IMPROVEMENT
PERMIT APPLICATION FORM
APN #
ZD
Date:
Building, Address:
Mailing-Addr6ss (if different frpm building address)-.
Y 5/o
Tetaht F-1 (If tenant please provide rn 61etteffiothe buiWng owner 'approving the tenant impimprovement:)Buil,aing,
�
Owner
Are Hazardous Materials; being, Used as Part of this project? Yes F[ No
Tenant/Building, Owner's, Name
Phone: #-.,
7P7
'Contractor:
Phone, #:
Fax
Cupertino -,Business License:. State Contractor ,License #:
Contact:
> e A�
Phone:,: Y/S-
Fax 4--
71/)�
Landscape Ordinance Compliance:
Landscape area in„sq,ft. (includes all irrigated areas):,
,If 1,$904'sq. ft. or..less, compliance with_ the Landscape Water -Efficiency
If 'more than,2',500 sq. ft., a complete Landscape Pr.*ect,Submittaljrequired.
01
Comptiamce Method: E] 'Plant Type E], Water Budget
Job Description (be specific):
12-6 k
Tenant. Iffptov enient Includes' Re -Roof: Yes D No L3 yes;number-of squares..
Tenant lingtovdrffcntIncludes, Structural YesF_1 No
Type of Cbrisfruction (Usage Class),
'Occupancy Type:
oca,
;V-A , Fj ILL11H. B,, IV -,B ❑
I -A, 1-B U -HT; V
Valuation:
Project Size: Express.H_ Standard'E]' Large,, ❑ MaJbr'E1
Green Building: Please complete L6ed forcom-mercial interiors checklist, &,atta:c-h it to the application
orif applicable, include in plans &sheet:indei
LEED'f6ints Achieved
For Office Use Only*** Over The Counter ❑ Revised 05718/10
t.
CITY' OF
CITY OF CUPERTINO
TENANT IMPROVEMENT
CUPERTINO PERMIT APPLICATION* FORM'
Quantity
Fee ID:
Fee Description
Fee Group
PermitType
1ATINSP
Tenant Improvement
B
1A TI-
Inspection
1ATIPLNCK
Tenant Improvement. Plan
B
Check
1BTIINSP
Tenant improvement
B
19TI
Inspection
1-,BTIP,LNCK
Tenant Improvement, Plan
B
Check
IETIINSP
Tenant Improvement
B ".
IE TI
Ins ection=Preschool
I. .ETIPLNCK
Tenant Improvement Plan
B
Check -Preschool
1FTIINSP
Tenant Improvement
B
IF TI
Ins ection-FactoryLIndust
1FTIPLNCK,
Tenant Improvement Plan
B
Check-Factorydn4ust
1HTIINSP
Tenant Improvement
B ,
1H T -I
Inspection -Hazardous
1HTIPLNCK
Tenant Improvement Plan
B
Check -Hazardous
lITIINSP
Tenant Improvement
B
lI TI
Inspection -Institutional
11 TIPLNCK
Tenant Improvement Plan
B
Check -Institutional
1MTM4SP
Tenant Improvement
B
11VI'TI
Ins ection-Merchandise> .
17MTIPLNCK
Tenarnt.Iinprovement Plan
B
Check -Merchandise
iST1IlVSP
TenantImpr-ovement
B°
1`S TI
Inspection=Parking= Garag
fSTIPLNM
Tenant ImprovementT an,
_ B
v
Check -Parking Garage
1RERO.OFCOM
ke-Roof Commercial
B
1BCBSC-
Cal'Bldg Standards
B'
ALL PERMIT7YPES-
Cornrnission Fee
-
1BSEISMICO '
Seismic Commercial
B
1BUS LIC
Business License
B
2of2
CITY OF'CUPERIINO
.EM7w
9, '_F�KE 1E5TJM'AT(),R — BUILDING DIVISION
ADDRESS:
TYPE— OF
CONSTR.
DATE:: 07/261,2010
REVIEWED BY:
PC FEE ID,
APIC,::
AP
P 7V
I X7
'VALUATION:
0.0
*.PERMIT.`TYPE: Building Permit
$2,854:00:
j'pLoCH.E.CKTYP9;, Tenaht.1'rnprovement
$1,688.60
,PRIM
USE: ARY Commercial Building
Permit Fee:,
$1,688..60
PLIC TION
TV P E:
1.13 T1'
RE,, Up", 011 IN ffe;As
PM.E U.- 1.
Unit Fee.
$0.00
P'NAE.'Permit,F'6e:
$0,.00
:6.
CP Tux
Cn
Acoustical Fee: Oves (E) No,
$0.00
G
OCCUPANCY TYPE:
TYPE— OF
CONSTR.
FLR,XREA
sq.ft.
()
'TC'"FEES
PC FEE ID,
BP FEES
BP FEE' ID
R (Tehant,lfnprovements)
0.0
'hrs
$2,854:00:
MRPOCK
$1,688.60
TBITHINISP
Permit Fee:,
$1,688..60
Suppl. 1nsp. Feer Reg. 00T
$,0.00
PM.E U.- 1.
Unit Fee.
$0.00
P'NAE.'Permit,F'6e:
$0,.00
CP Tux
Acoustical Fee: Oves (E) No,
$0.00
G
Work Without:Pdrmit? 0 Yes 0 No
$0.00
TOTALS!
1,268
$21854.008;
$!,68 60
Strong Motion; d6 IPSEISMICO
�Veqh. Plot?
-T-1-1
11herviech, hap. T
Phimb.
FT
FT7
N,6T,E,.- These fees are based on thepreliminary, information. ayailableaiutarevnlytanestimate. Contort the Dept addn 'finfo.
FEE ITEM$ (Fee Re,s61i`?ti6et,0)-0 I Lk.` 7&0)
FEE,
QTY/FEE
MISC ITEMS
Plan Check. Fee,
$2,854.00
'Select a Niisc'Bldg/Structure
or Element of a Building
$uppl.. PC Fee: (F) Reg. 0' OT
0.0
'hrs
$0.00
PME,Plan Check:
$0.00
Permit Fee:,
$1,688..60
Suppl. 1nsp. Feer Reg. 00T
$,0.00
PM.E U.- 1.
Unit Fee.
$0.00
P'NAE.'Permit,F'6e:
$0,.00
CP Tux
Acoustical Fee: Oves (E) No,
$0.00
G
Work Without:Pdrmit? 0 Yes 0 No
$0.00
Planning Fee:.
$0.00,
Select a Non -Residential
Bui Idiriv or, Structure 0
Strong Motion; d6 IPSEISMICO
$28'77
Select anAdministrative Item
Bldg Stds CorninissionFee: .1)?CBSC
$6;00
SUBTOTALS
MRML
K$4,57.3.7so.;00 Ct1
1 "
1 $45,77371
Revised: 7/22/201:0
Building, Department'. _
Ci 'OfEupertin`a
-1.03.0.0 Torre:.Avenue;
_ iGupoti'no, CA95.014-32-5'5
Telephone 4.08 ZZ7-3228
CUP ERT M OFax. 408.:77.7 333
=3
ATO 5UBON
�TCT®R.LIST*
-JOB ADDRESS:
PERMIT;# , , , 'Q !�. •".
OWNER'`S NAME:`: ;* -:
_ °: PHONE -4.
GENERAL CONTRACTOR:..=
BUSINESS°LICENSE#
ADDRESS:
:. CITY%ZIPCODE-
*Our municipal ¢ode requires+all,,businesses working,in,the city to have a City of Cupertino busine_ss.Iicense.
NO._.BUILDINGY-INAL OR FINAL OCCUPANCY IN -ION( WILL BE SCI�EDULED UNT1I, TM
_. '
'GENE -;GENE -"CONTRACTOR AN® ALL ' S, GON.TRACTQ_RS �'HAVT OBTAINED ,A CITY` OF' C.UPERTINO
-BUSINES;S LICENSE.
1 anf not'.using.any.'subcontractors:..:
Signature Date
Please�;clieck appli-caWe, su'licontracto.rs:arid complete the -following information;
SU�BCONT A, TOR. � BUSIMSS NAIVI:E BUS'INESS'.LICENSE #
Cabl:nets &millwork --
Cement Finishing
Electrical`
Excauatiori
Fencing
- `Flo'oring.'/ Carpeting _ _ - - ._. • • _ _ i - ,
Linoleum / Wood .
- . Glass J Glazing
Heating.
- Insulation=- _ • '`_ „- _ - - 4" _
- Landscaping
-
_ . Masonry. _
Painting %Wallpaper
- Paving
Plastering -
_ Plumbing.
•Roofing •. - - - - r.- - _
:O_ wner / Conwactor Signature = Date