B-2016-1912CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1912
10881 S BLANEY AVE CUPERTINO, CA 95014 (369 34 052) L & Q
CONSTRUCTION INC
SAN FRANCISCO, CA
94132
OWNER'S NAME: PACIFIC RIM PARK LLC
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class $ Lic. #969273
Contractor L & Q CONSTRUCTION INC Date 01/31/2018
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:
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.
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.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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)
2. I, 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.
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.
DATE ISSUED: 10/27/2016
PHONE NO: (415) 533-2224
BUILDING PERMIT INFO:
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 06-21-2017
X BLDG —ELECT —PLUMB
MECH RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
T.I. (9,486 SQ FT) - FORBIDDEN CITY
(12/13/16) REVISION #1: REVISE ROOM LAYOUTS - ISSUED 1/24/17
DEF #1 - TRASH ENCLOSURE - ISSUED 06-21-2017
Sq. Ft Floor Area: Valuation: $100000.00
APN Number: Occupancy Type:
369 34 052 1 A (Tenant Improvements),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 Ayende
Date: 10/27/2016
RF -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: 06-21-2017
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. 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:
Date: 06-21-2017
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
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10881 S BLANEY AVE CUPERTINO, CA 95014-(369 34 052)
OWNER'S NAME: PACIFIC RIM PARK LLC
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class ]a Lie. #969273
Contractor LA Q CONSTRUCTION INC Date 01/31/2018
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:
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.
have and will maintain Worker's Compensation Insurance, as provided for by
on 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 Mu_2!�IpalCC.odse, Segcjion 9.18.
Date 1/24/2017
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
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (See.7044, Business & Professions Code).
CONTRACTOR: PERMIT NO: B-2016-1912
L&Q
CONSTRUCTION INC
SAN FRANCISCO, CA
94132
DATE ISSUED: 10/27/2016
NO: (415) 533-2224
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
OB DESCRIPTION:
J. (9,486 SQ FT) - FORBIDDEN CITY
(12/13/16) REVISION #1: REVISE ROOM LAYOUTS. T,�G 1Poi
(1/12/16) DEF #1 - TRASH ENCLOSURE
Sq. Ft Floor Area: l Valuation: $100000.00
APN Number: Occupancy Type:
369 34 052 1 A (Tenant Improvements),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 Ade
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: 1124/2017
I hereby affirm under penalty of perjury one of the following three declarations:( ALL ROOF COVERINGS TO BE CLASS "A"
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.
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
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 1/24/2017
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:
Date: 1/24/2017 —
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
Professional
11
CITY OF CUPERTINO BUILDING PERMIT
B
INGADDRESS:
10881-
CONTRACTOR: PERMIT NO: B-2016-1912
S BLANEYAVE CUPERTINO, CA 95014
(369 34 052) L & Q
CONSTRUCTION INC
SAN FRANCISCO, CA
94132
OWNER'S
NAME: PACIFIC RIM PARK LLC, DATE ISSUED: 10/27/2016
OWNER'S
PHONE:
PHONE NO: (415) 533-2224
CONTRACTOR'SLWMED
BUILDING PERMIT INFO:
Licer
se Class i3 Lie. #969273
Cont
actor L!1 O CONSTRUCTION INC Date 01/31/2018
X BLDG —ELECT _PLUMB
I hereby
affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH _ RESIDENTIAL X COMMERCIAL
with
3ection 7000) of Division 3 of the Business & Professions Code and that my
licen
a is in full force and effect.
JOB DESCRIPTION:
I her
by affirm under penalty of perjury one of the following two declarations:
T.I. (9,486 SQ FT) - FORBIDDEN CITY
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.
l 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: $100000.00
APPLICANT CERTIFICATION
I ceitify
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 ordinances
and state
laws relating to building construction, and hereby authorize
369 34 052
A (Tenant Improvements),B (Tenant Improvements)
representatives
of this city to enter upon the above mentioned property for
inspetion
purposes. (We) agree to save indemnify and keep harmless the
Cityf
Cupertino against liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may�ccruy
against said City in consequence the granting of this permit.
Additionally,
the applicant. understands and will comply with all:,non-point
l
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source
regulations per the Cupertino Municipal e, Sicion 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Sign
pure Date 10/27/2016
Issued : b A A en
y y e
affirm that I am exempt from the Contractor's License Law for one of the
Date: 10/27/2016
RE -ROOFS:
I hereby
following
two reasons:.
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole
installed without first 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)
1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/27/2016
I here
by affirm under penalty of perjury one of the following three declarations:AT
I have and will maintain a Certificate of Consent to self -insure for Worker's
"T •ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
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
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
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.['
`
-�
Owner or authorized agent: —
APPLICANT CERTIFICATION
Date: 10/27/2016
cerci
that I have read this application.and state that the above information is
CONSTRUCTION LENDING AGENCY
correct.
I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relatir
g to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.).
to ent
ar upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to sae
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
and
ill comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code,
Section 9.18.
1 understand my pians shall be used as public records.
Signature
Date 10/27/2016
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1912
10881 S BLANEY AVE CUPERTINO,CA 95014(369 34 052) L&Q
CONSTRUCTION INC
SAN FRANCISCO,CA
94132
OWNER'S NAME:PACIFIC RIM PARK LLC DATE ISSUED:10/2712016
OWNER'S PHONE: PRONE NO:(415)533-2224
LICENSED CONTRACTORS DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#989273
Contractor L&O CONSTRUCTION INC Date 01/3112018 X BLDG ELECT_PLUMB
I hereby affirm that 1 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:
T.I.(9,486 SQ FT)-FORBIDDEN CITY
I hereby affirm under penalty of perjury one of the following two declarations:
[01. 1 have and will maintain a certificate ofconsent to self-insure for Worker's (12/13/16)REVISION#l:REVISE ROOM LAYOUTS-ISSUED 1/24/17
Compensation,as provided for by Section 3700 ofthe Labor Code,for the DEF#I-TRASH ENCLOSURE-ISSUED 06-21-2017
performance oftic work for which this permit is issued. REV#I-REVISE SHEET A.0 TO SHOW ADA COMPLIANCE PER
. I have and will maintain Worker's Compensation Insurance,as provided for by INSPECTOR'S NOTICE-ISSUED 04/12/2018
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued, Sq.Ft Floor Area: Valentina:$100000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 34 052 A(Tenant Improvements),B(Tenant Improvements)
representatives of this city to enter upon the above mentioned properly 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.
Signature - Date 04/12/2018 Issued by:Abby Ayende
Date:10/27/2016
OWNF.R-BUH DER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Lav for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material Fixing installed.Its roof is
1. I,as owner of the property,or my employees withwages as their sole installed without first obtaining an inspection,1 agree to remove all new materials fur
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of ApplicanC
contractors to construct the project(See.7044,Business&Professions Code). Date:04/12/2018
1 hereby affirm miler penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"012 BETTER
1. 1 have and will maintain a Certificate of Consent to self-hnsnre for Worker's
Compensation,as provided for by Section 3700 of the Labur Cade,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,es provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe 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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the wank for which this permit is issued,I health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ u n in an manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y a y perso y J err coammal..is as dented by tiro Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,ancr making this certificate of will maintain compliance with the Cupertino Mnntcip 1 de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation In of the the Health&Safety Code,.Sections 25 5 5 3,n. ad 25534.
Lots Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:04/12/2018
I certify that I have read this application and state that the above Information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT S DECLARATION
Code,-Section 9.18. understand my plans shall be used as public records.
SignatureLicensed
Date 04/12/2018
Professional