B-2018-0062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2015-0062
10123 N WOLFE RD CUPERTINO,CA 95014(316 20 100) BLACH
CONSTRUCTION
COMPANY
SAN JOSE,CA 95131
OWNER'S NAME: DATE ISSUED:04105/2019
OWNER'S PHONE: PHONE NO:(408)244.7100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#290418
Contractor BLACH CONSTRUCTION COMPANY Date 06/30/2019 X BLDG_ELECT—PLUMB
MECH RESIDENTIAL X COMMERCIAL
1 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. JOB DESCRIPTION:
TENANT IMPROVEMENT OF FOOD COURT TO CREATE ADULT
I hereby affirm under penalty of perjury one of the following two declarations: EDUCATION FACILITY(24730 SQ FT).
n. 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
perfoemance of the work For which this permit is issued.
I have"',
av and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$3000000.00
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: Occupnncy'rype:
and state laws relating to building construction,and hereby authorize 316 20 100 A(Tenant Improvements),B(Tenant Improvements),B
representatives of this city to enter upon the above mentioned property for (Tenant lmproveonents),A(Tenant Improvements)
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. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18.
� .
/- Date 04!05!2018
' Issued by:Jasmine Archbold
OWNER-BUILDER DECLARATION Date:04/05/20I8
1 hereby affirm that I am exempt from the Contractor's License Law for ane of the
following two reasons: RE-ROOFS:
n. 1,as owner o£the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) - inspection.
4 I,as owner ofthe property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code), Signature ofApplicanh
Date:04/05/2018
1 hereby affirm under penalty of perjury one of the following three declarations:
L I have said will maintain a Certificate of C.t,e.t to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of(he Labor Code,for the
per of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of floe Labor Cade,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
a. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not em to any son in an awor so as to become permit
it to the Health&Safety Cade,Section 25532(a)should 1 store or handle hazardous
p y y per y m 1 material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California.If,afier making this certificate of air contaminants ns dented by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25550,55,25533,and 25534.
be deemed revoked. ��.
I certify that I have read this application and state that the above information is Date:0410 5/2 01 8
correct,I agree to comply With all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for Inspection purposes. (We)agree of work's for which this permit Is Issued(Sec.3097,Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit.Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 04/05/2018 Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0062
10123 N WOLFE RD CUPERTINO,CA 95014(316 20 100) BLACH
CONSTRUCTION
COMPANY
SAN JOSE,CA 95131
OWNER'S NAME:VALLCO PROPERTY OWNER LLC DATE ISSUED:0 4/0 572 0 1 8
OWNER'S PHONE: PHONE NO:(408)244.7100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO;
License Class B Up.#290418
Contractor BLACH CONSTRUCTION COMPANY Date 06/3012019 XBLDG—ELECT_PLUMB
I herebyform that I am licensed under the f Chapter 9 eactn —MECH_RESIDENTIAL X COMMERCIAL
a In o p (comm g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
TENANT IMPROVEMENT OF FOOD COURT TO CREATE ADULT
1 hereby affirm under penalty of perjury one of the following two declarations: EDUCATION FACILITY(24730 SQ FT).
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#3-(N)FIRE RATED WALL AT BRIDGE-ISSUE 5-31-2018
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#2 ADD RATED SOFFIT OVER EXISTING SOFFIT TOO
performance ofthe work for which this permit is issued PROVIDE OCCUPANCY SEPARATION BETWEEN A2 AND B AT THE
I have and will maintain Worker's Compensation Insurance,as provided for by CORRIDOR BETWEEN CLASSROOM 4 7 5;ADD EXPANSION JOINT
Section 3700 of the Labor Code,for the performance of the work for which this COVER AT FIRE RESISTIVE WALLS-ISSUED 5-31-2018
permit is issued REV#1-Replacing demountable walls with metal stud framing walls-See
APPLICANT CERTIFICATION A 1.2;Adding a wall and suspended ceiling at reception/waiting room
I certify that I have read this application and state that the above 33A/33B-See A2.2,E2.1,E6.1&M2.1;Adding power and data-See
.information is correct.I agree to comply with all city and county ordinances clouded areas on electrical drawings;Rerouting waste line in classrooms I
and state laws relating to building construction,and hereby authorize &2,9&10 and staff breakroom 34-See P2.1&P2.2;Adding overhead
representatives of this city to enter upon the above mentioned property for - braced partition detail-See dd I/AI.2;Adding wood curb aturchment detail
inspection purposes. (We)agree to save Indemnify and keep harmless the at roof cut out-Sec dtl 7/09.1;Revision to panel LB I(section 2)and panel
City of Cupertino against liabilities,Judgments,costs,and expenses which 2J2X-See E0.2.-ISSUED 04/18/20]8
.may accrue against said City In consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point REV 0-(N)FIRE RATED WALL AT BRIDGE
source regulations
per
7the
Cupertino Municipal Code,Section 9.18. Sq.Ft Flour Area: Valuation:$3000000.00
Signature "'�" \ Date 5-31-2018 APN Number: Occupancy Type:
31620 100 A(Tenant Improvements),B(Tenant Improvemiaind,B
OWNER-BUILDER DECLARATION (Tenant Improvements),A(Tenant Improvements)
1 hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 1,as owner ofthe property,or my employees with wages as their sole PERMIT EXPIRES IF WORK IS NOT STARTED
compensation,will do the work,and the structure is not intended or offered for WITHIN 180 DAYS OF PERMIT ISSUANCE OR
sale(Seo.7044,Business&Professions Cade) 180 DAYS FROM LAST CALLED INSPECTION.
z 1,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sce.7044,Business&Professions Code).
Issued by:Jasmine Archbold
1 hereby affirm under penalty of perjury one of the following three declarations: Date:04/05/2018
a. 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 fou which this permit is issued RE-ROOFS:
x. l have and will maintain Worker's Compensation Insurance,as provided for by All roofs shall be inspected prior to any roofing material being instal led Its roof is
Section 3700 of Nue Labor Code,hot the performance of the work for which this installed without first obtaining an inspection,I agree to remove all new materials for
permit is issued. inspection.
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 Signature of Applicant
Worker's Compensation laws of California.If,after making this certificate of Date:5-31-2018
exemption,I become subject to the Worker's Compensation in of the
Labor Code,1 must forthwith comply with such provisions or this permit shall ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
be deemed revoked.
APPLICANT CERTIFICATION HAZARDOUS MATERIALS DISCLOSURE
I certify that I have read this application and stale that the above information is I have read the hazardous materials requirements under Chapter 6.95 or the
correct.I agree to comply with all city and county ordinances and state laws California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
relating to building construction,and hereby authorize representatives of this city maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
to enter upon the above mentioned property for inspection purposes. (We)agree Health&Safety Code,Section 25532(.)should I store or handle hazardous
to save Indemnify and keep harmless the City of Cupertino against liabilities, material.Additionally,should 1 use equipment or devices which emit hazardous
judgments,costs,and expenses which may accrue against said City in air com andamits as defined by the Bay Area Air Quality Management District I
consequence of the granting of this permit.Additionally,the applicant understands will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
and will comply with all non-point source regulations per the Cupertino Municipal the Health&Safety Code,SecRo"
505,25533,and 25534.
Code,Section 9.18. /
Owner or authorized agent:
Signature Date 5-31-2018 Date:5-31-2018
CONSTRUCTION LENDING AGENCY
CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS:
10123 N WOLFE RD CUPERTINO, CA 95014 (316 20 100)
NAME: VALLCO PROPERTY OWNER LLC
PHONE:
Class A..@ Lic.#290418
or BLACH CONSTRUCTION COMPANY Date 06/3012019
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
ith Section 7000) of Division 3 of the Business & Professions Code and that my
cense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
t. 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
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
certify that I have read this application and state that the above
nformallon Is correct. I agree to comply with all city and county ordinances
tnd state laws relating to building construction, and hereby authorize
epresentatives of this city to enter upon the above' mentioned property for
nspection purposes. (We) agree to save indemnify and keep harmless the
;sty of Cupertino against liabilities, judgments, costs, and expenses which
nay accrue against said City in consequence of the granting of this permit.
\dditionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Date 04/181201
8
hereby affirm that 1 am exempt from the Contractor's License Law for one of the
flowing two reasons:
v 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 to]
sale (Sce.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),
hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-hrsare 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.
a 1 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 die 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 ofCali£ornia, 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 CER'PIFICA'fION
artily that I have read this application and state that the above Information Is
meet. I agree to comply with all city and county ordinances and state laws
sting to building construction, and hereby authorize representatives of this city
enter upon the above mentioned property for Inspection purposes. (We) agree
save indemnify and keep harmless the City of Cupertino against liabilities,
figments, costs, and expenses which may accrue against said Clty in
rsequence of the granting of this permit. Additionally, the applicant understands
d will comply with all non -point source regulations per the Cupertino Municipal
tde, Section 9.18.
Date 04118/2018
)NTRACTOR:
PERMIT NO: B-2018-0062
,ACH
)NSTRUCTION
)MPANY
,N JOSE, CA 95131
DATE ISSUED: 04/05/2018
PHONE NO: (408) 244-7100
JILDING PERMIT INFO:
BLDG ELECT —PLUMB
MECH _ RESIDENTIAL x COMMERCIAL
SOB DESCRIPTION:
TENANT IMPROVEMENT OF FOOD COURT TO CREATE ADULT
EDUCATION FACILITY (24730 SQ FT).
REV # I -Replacing demountable walls with metal stud framing walls - See
A 1.2; Adding a wall and suspended ceiling at reception/waiting room
33A/33B -See A2.2, E2.1, E6.1 & M2.1; Adding power and data - See
clouded areas on electrical drawings; Rerouting waste line in classrooms 1
&2, 9& 10 and stats breakroom 34 - See P2.1 & P2.2; Adding overhead
braced partition detail -See dtl I/A I .2; Adding wood curb attachment detail
at roof cut out -See dtl 7/09.1; Revision to panel LB I (section 2) and panel
2J2X - See 130.2. - ISSUED 04/18/2018
Ft Floor Area: Valuntion:$3000000,00
APN Namber: Occupancy Type:
31620 100 A (Tenant Improvenrents),B (Tenant hmprovenrents),B
(Tenant Improvements),A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
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: 04/18/2018
012 BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous insist lots requirements wider Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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
nit contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 slid
the Health & Safety Code, Sections 25505, 255 and and 25534.
Date: 04118/2018
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