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02060160CITY PBRTNO f' CONTRACTOR INFORMATION: BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. ONE RESULTS WAY 02060160 OWNER'S NAME: RWC,LLC C/O GROSVENOR APPLICATION SUB DATE 06/25/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: a BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby ofErm that I am licensed under provisions of Chapter 9 (commencing with Senoms Section of Division 3 of dieB.Imess oaf PlefesslCode. and my license iin roll fik�eAnacR Z 22 PARKING LOT EXTENSION NO BUILDING License <.g FINALE® �Cl���—�� D, ate. -y! Com�ract) \✓l ARCHITECT'S DECyA0. H I understand my plana shall be cited as public recec ords 8 p p sy o 0qL OCT G L . Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I oro exempt from the Contractor's Limnu Law for the following reason. (Section 7031.5. Business and Professions Codc: Any city or county BUILDING which requires a permi....... ruct ober, improve, demolish, or repair any nrucam, --'---" - -.prion° its issuance, also require, the applicant fur..ch permit to File a signed.uatement Oaths ishanudpamuennoOnprovisions ofthe ConhanoesLicense Law (Chapter 9_ _� Ft. Floor Area;, Valuation ctjo000)of Division 3ofba B.M.c.pad Prifessiors Code) (comriericing with Sen,] .. ; : +Sq. -iJ�".S �`r..I iljR(:C\t t-oat\15 L9, r. sr orthai he is ese!dpt therefrom ami the basis far the alleged exemjiioh. Any violation -of Section 9031.5 by arty applicant for a permit subjects the applicam to o civil penalty APN Number ^ ,t: Occupancy Type I of not marc than five hundred dollars ($500) 01, as owner of Ne property, or my employees with wages as their sole compensation. 101 - _ - 1 O2 - PIERS Required Inspections " I •' q p -will do the work, and he suvaum B'dm intended or offered for sale (Sec. 7W. rBuei.a end-Pmfc,.ionv CodTin c Comctor's License law docs not apply to an owner of property Who builds or improves thereon. and who dues such work himself 103 - OF ER or through his own employees provided That such improvements t' tended or -uR ror r vale' If hdwevcr: the bairn ng or rmprovcmcnt'. cold ith n one year of offered _ - _.,__,. -- - "10 4- - REBAR '....._...--... _ 7:, _ _ .....- _ ------------ s.. r ` ( ) ' &impleton the owner bu lder will have the burden of proving that he did not build or improverorpurposeofatic.). 105 - ANCHOR BOLTS -cons ownerpfihepropcnynmexclusivelycumnatisionsCl-ice nudeControrsto 1'06 ---SEWER—&- WATER---------—:'...- �:•:l1 ••-- °omwcr the pejo (s«. Business and code:) The thereon. 2 02 - UNDERFLOOR PLUMBPNG ,:'.Lt'' :..i a m bre: n who improvo thereon. it) a property improves License Low docs not apply m an owner of property who builds se _andpho.,' nLiccmkl. such. pmjena wim.a cnmmnorfsl lieensed.pwsaant.m.lac_... .__........_2.0:3..... _....UNDERFLOOR ---MECHANICAL -.....__...___..__.._.___.__..____._. Col in..es pl,imle LSec B & P C far this masa ❑lam es<mpt undo s,-.`. ,., ..._.-...�_: ,,.. , ." '°' 204 - UNDERFLOORi'tFRAME;`•r. own2,� ^' "' li�t�.a "- "• 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION - 1' 301 - ROUGH PLUMBING -Iherenyafrrnnweyp7altyafpeiuty,naqur,mcfnnowingdeclarations: - 302 - TUB & OR SHOWER 0 l have and wRl'inrinmin%. Cemiecaie of Consent on -If imsum ror, Worker, 303 - ROUGH MECHANICAL Cu!npemimmi. us, provided for by Section 37W of the Labor Code, for the rfars!anunhestritforw•niehtm;pert:itisissued.,0 ,c « 304 - ROUGH ELECTRICAL 0l have and will maintain w kat: Ctim,,cii insurancrequired by Se6 on 305 - FRAME P00 of the Labor Code, for the performance of the'wbrk for which Nis permit is 306 - HOLDOWNS est ilMyWorkersC pc:'t Iniorne dPolcynumbe R:'„ .307' '- TNSUI;ATION.... _ 1 cWIFICnNON OFExEMtt10NFROMw0(KKEt�s,! 308 - SHEBTROCK W COMPENSATION INSURANCE ----- -- -- -- 309'-= EXTERIOR LATH )_ " (This secilon` need not be 6ompletfd if the permiis for one hu idmd dollars 310 INTBRIOR LATH -•311'—SCRATCH-MOAT h hth p, a,"hl'I many math so n to beeom : bh t to,the wok am"mpirn,t immhnifom "fth as s hag not empl y ani,' 3 13 - ROOF NAIL""' Cid, rn het ewe °rem'tnn Date _ a -! ENERGY._. _._. ....... .. _ . 50.1....-_FINAL...ELECTRICAL. - ..'Appb ant - NOT ICE TO APPLICkM' If, fit, makngN cr;f t i Ee-pttn, you should . _ _ 502 - FINAL PLUMBING ENERGY (- tittomesbjcrto the Worke Cmaptailumn p 'ons ofthe WbarCWe you must a with dmplywith suchp ,im,n,hipermit shall be, d ed revoked. 503,.x_._ FINAL._MECHANICAL_ ENERGY_._ c iCONSTRUCTION LENDING AGENCY � �. � 504 - FINAL BUILDING ENERGY,..,. �- isa Iorkfar nininasa � ', ane' 505 - FINAL ELECTRICAL' i..yere 6rm alse:ionimdi.cse)yfO1h' - _.. _. ........ ._.._. ..... ....... . . 506 - GAS TEST Led Add 1 < arty that I h red th application d t t N 'h boinformation is "a Iawtmining 50 FINAL PLUMBING 5 8 !NAL M CHANI CAL srect I g w e mply with all city and county ty d' n and state to huddmg iavm ucimn,and heriny audronze rtprtscmativcs of tau city tomo,upon - 5 9 - INAL DE the b c m mentionedproperty f pact p apo (W) g to a rMd perve, pct y 'the City fC penino ago mat 1 liabilities,j dg is c nil pane bah may in any y ace e agpi st emd 51 - INAL Cty nd9e ftM1 granting of th permit N UVDERSIA \D WILLCOSIPLYw'ITHALLNON�h�O7f-Yff 5 ISSUedby4 RKS Date R GI : .. t ... L/ Re -roofs of ApplicanJCmdmcI.r:.:..• "` •, .. ate" 7S, HAZARDOUS MATERIALS DISCLQSURE ill the ppl' t f w bmldi cccup nt mrc o h dla harardoiu mate .V asafr!cd by the Cupemm-M rcpteCnpi 913and he Health and Sony cadn'Siciinit 2553(al - oY _Type Of Roof .. -". •...• ' ,•' •^ `: ' .,,, ! -.i _( 1, i.�I \ .a. •. .. %.Irl 110` . . All shall be inspected to roofing material being installed..__ -which roofs poor -any -- "without wndm pei!vam rf i in but' goccupant-useequipment a vee t hazardous r cnmamm me ° oed by the Bay Area A r (QI tyManagement 'District? If a roof is installed first obtaining arvinspectton, I`agree'to remove inspection. Applicant and will comply with , all new materials for understands . ' _..... ❑Yes. 7.- .. ,❑Na. •.t .' - .. ,' _ all non-p6int'source ce Mations: g I have the' anamnals rcqu. under terun.6.95 of the HealthA Safety 15533 4. 1 that Calitomim Hwlth&Safety Code, Senionn 25505.'.,,, -. .. ._ .. yra,v3a.,undersmnd fifth hid n6Joe.nt eOYhuveamn tth Ilia my p bltytonaf the- � occ cant the regwrcm m �hich be m, t p br m r nuance j can if t of ° p e: St / 'L) �,L_ of Applicant Date °lN _Sign_ature _ _ . _ , ..-, -„ , All roof coverings to be Class "B" or better' D . D�tq ainprr:<d ., OFFICE- _.- ... - -.... ... .. . (I 11 GIF ((I" I I'l l I N G 1I����IOWNI 11) I�I���� APN # .3 2-41— Date: z—<,— /c, �- Fee Giroan Building Address: Other Appliances MECHANICAL ko Z f4SOL-r 0.4 Construction Tax BUILDING Owner's Name: Phone #: BUILDING R0C, LL. C, c a 6r�vC.� Con. Tax for BQ Zone ®a �l � Contractor: License #: BUILDING Contact: Phone #: BUILDING A vtvzs Elec 600V <= l OOOA ELECTRICAL Applicant/Contractor: Fax M ELECTRICAL c� b�-fle va �� �cr �s Gro ELECTRICAL din7nptlion: it Info: Energy BUILI<DENG Elect Plu t Mech BUILDING BINVESTIGA Investigation fee BUILDING Residential: Comm. Housing Mit. Fee BUILDING Sq.Ft. Floor Area: $/Sq.Ft.: BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL Architect/Engineer: Valuation: 0,77vv CR -4 BNUCOMME z Type of Construction: Occupancy G oup: New Comm Mechanical Quantity ]Fee ID Fee Description Fee Giroan BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BEN ERG Y Energy BUILI<DENG BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 O C F<uu f-'Zc rn a }LL}v Z `+ flylf 0Z—c F y F a C � C a o w Q. tXxt3tt� F c O . N tv p < a a c X c ur F Z ixc C F ` i3. CITYBUILDING DIVISIOi)1V® (CONTRACTOR IINIMR*, an BUILDING ADDRESS: PERMIT NO. ONE RESULTS WAY 02060160 OWNER'S NAME: RWC,LLC C/O GROSVENOR APPLICATION SUB DATE 06/25/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH U L_=I I-1 L J LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7 ) of Division 3 of the Bsi ess and Professions Code, and my license PARKING LOT EXTENSION ISin fi>end�,ff'e (�' 22 NO BUILDING Lcense # iCI DalContract r \J✓ ARCHITECT -S DR3"ATLON I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to conswct alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement - Sq. Ft. Foot Area, atlh! is licensed urs'u'ant to the provjsions of the Contractor's License law (Chapter 9 - .... p . (cemmenciag with Section 1A!I of Division 3 of the Business and Professions Code) 1 r, t (, .r , .` or that he is exempt therefrom aid the basis for the alleged,exernption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty pf.not more than eve hundred dollars (s500). APN Number Occupancy Type ❑ 1, as owner of the property, ormy employees with wages as their sole compensation, 1 01 - 10 2 - PIERS Required Inspections ' - will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself 10.3 — UFER or through his own employees. provided that such improvements are not intended or _ --: offeredfor'sale. If; however, the building or improvement is sold within one year of 1 4 — _ - - - - -' - • -- - , REBAR completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 105 — ANCHOR BOLTS I; az owner of. the property, am exclusively contracting with licensed contractors to _._.....- 106 — SEWER - construct the project (Sec. 7044, Business and Professions Code:) The Contractors 202 — UNDERFLOOR PLUMBING License law does not apply to an owner of property who builds or improves thereon, _.and..who contracts for such projects with a contractor(s) licensed pursuant to the. . -. . 2 03" — UNDERFLOOR- MECHANICAL Contractors License 1,-aw. ❑ I am, exempt under Sec, :B & P C for this reason 204 — UNDERFLOOR FRAME • own«• Dile 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING ' ' I hereby affirm uncle( penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑ 1 have and' will' inlintain a Certificate of Consent to self -insure for Worker's 303 — ROUGH MECHANICAL Compensation, as provided for by Section 3700 of the Labor Code, for the Performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ 1 haSc and will' maintain Worket:'s CompLnsition In'surdnce, as required by Section 305 — FRAME 3700 of the Labor'Code, for the performance oFthe work for which this permit is 306 — HOEDOWNS issued. My Worker's Compensation Insurance carrier and Policy' number are: pier:" �;'• P 'J t✓: P,,' 307 "=' INSULATION G" o:: r CERTIFICATION OFEX„[ON FROM WORKERS' 308 •= • SHEETROCK ' ' COMPENSATION INSURANCE: :. � .• :.. ' 3.0 9 :.—. EXTERI OR r '(This section need not be completed if the permit is for one hundred dollars _ 310 ' INTERIOR LATH ($100) or less.) ' 311 — SCRATCH ',COATI I cerify,that in the performance'ofthe work for which this permit is issued; l shat( nbt employ amy person in any manner so as to become subject to the Workers' 313 — ROOF NAIL •'' ` Compensation Laws of California- Date Applicant 5 O 1 - FINAL ELECTRICAL CAL ENERGY - NOTICE TO'APPLICANT:If. after making this Certificate of Exemption, you should 502 - F I NAL PLUMBING E14E RGY become subject to'the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 503 — F I NAL MECHAN I.CAL. ENERGY.. CONSTRUCCIONLENDINCACENcv' 504 - FINAL BUILDING ENERGY I hereby affirm that there is a construction lending aeency for the performance- of the work for which ihis permit is issued (Sec. 3097, Civ. C)5 0 5 - FINAL ELECTRICAL - [tender's Name 506 — GAS TEST Lender's Address' 5 0 F I NAL PLUMBING � I certify that I have read this application and state that the above information is r correct. I agree to comply with all. city and county ordinances and state laws relating 5 8 - I NAL M THAN I CAL 1 to building construction, and hereby'auth6riietepresentatives of this city to enter upon 5Ml— I NAL E the above-mentioned property for inspection purposes. (We) agree to save. indemnify and keep harmless the City of Cupertino against -INALliabilities, judgments, costs and expenses which may in any way accrue against saidCity in consequence of the granting of this permit., N -HR DERSTd `7D WILLCOMPLYWITH ALL N0 - 5 RKS- /Ol1NTT CE G Issued b Date C.[ Re -roofs S.i atu of Appiicant/Conirdctor ate'' HAZARDOUS MATERIALS DISCLQSURE • ' Will the applicant of future buildin occupant'store or handle hazardous materiel Type of Roof. as defined by, the Cupertino Municipal e, Chapter 9.12, and the Health and Safety Code; Section 25532(a)2 t ❑Yes "° All roofs shall be inspected, prior any. roofing material being installed. Will the applicant or future buil ' g occupant use equipment or devices which -to If a roof is installed without fust obtaining an -inspeetiori, I agree to remove emit hazardous air contdminants as fined by the Bay Area Air Quality Management District? all new materials for inspection. Applicant understands and will comply with ❑ Yes ❑ No all non -point source regulations. ' I have read the hazardous matei alk requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that iNhe building does not currently have; tenant, that it is my responsibility to notify the , oecu tro the regdirement's which use be met prior to issuance o a Certifire of Signature of Applicant Date All roof coverings to be Class rB” or better owner agept Date . pr authorized .. OFFICE