12090221 I ,
CITY OF CUPERTINO BUILDING PER
ADDRESS 1'0123 rl WOL E RD STE 2007
CONTRACTOR:CAL WESTERN PERMITNO:12090221
BUILDING p
CONSTRUCTION
OWNER'S NAME:I VALLCO SHOPPING MALL LLC 12121 BEATRICE ST DATE ISSUED:03/06/2013.
OWNER.'S PHONE 40889G660.I CULVER CITY,CA 90230 PHONE NO:(213)798-9565
❑ LICENSED'CONTRACTOR'SbECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License ClassLia# ' ' STE 2007-TATAMI RESTAURANT-COMMERCIAL
TENANT
Contractor!I Date A�,v IMPROVEMENT 4,060 SQ FT IN INCLUDE STORE FRONT
I hereby,affirm that.I am licensed under the provisions of Chapter 9 DINING AREA,STORAGE AREA,NEW PARTITION WALLS
(comniencing,withl Section,7000)of Division 3 of the Business&Professions
Code and that.my;license is in full force and effect.: REVISION#1-ADD(2)TON AIR HANDLER INSTEAD OF(1)20
Lhereby'Affirm under,penalty of perjury one of the following two declarations:
TON AIR HANDLER-ISSD OTC 5/22/2013
I have and IwiI l rnaiptatn a pertrfipate',of consent to self-insure for Worker's
Compepsa(ion,as pioyided for b�Section 3700 of the Labor Code,for the
performance ofthe'wofik r'or which this permit is issued. Sq.Ft Floor Area: Valuation:$250000
I have end will maintain Worker s'Compensation Insurance,as provided for by
Section 3700 of the ILOor Code Ifor the performance of the work for w 'ch_this N Number 31620097.00 Occupancy Type:
permit rs issued.
APPLICANT CERTIFICATION
I certify';that I brave'read this'application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct II agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
- to building construction,and bereby authorize representatives of this city to enter
upon diel above,ruentioned property,for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keeps Harmless the',City of Cupertino against liabilities,judgments,
costs,and,expenses which may accrue against said City in consequence of the Date:
.£ -
granting'of this,permit. Additionally,the applicant understands and will comply Issued by i°'
with all non point sourlce(,regulations per the Cupertino Municipal Code,Section
9 18' k
RE-ROOFS:
Signature
Date _a 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 matenals'for
inspection.
❑ OWNER BUILDEIR'DECLARATION
Signature of Applicant: Date:
lf,am exemRt from the Contractor's License Law for one of
the following two Treasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner,of the,property,or my employees with wages as their sole compensation,
will do the work,'and t)re'structnre',is not,intended or offered for sale(Sec.7044,
B�smess,'&IProfessioi}s ode)
I tis owner of the,p 111 roperttu,am exclusiveI It ly contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct-the projec (Sec.7044 us ss&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
I I I California Health&Safety Code,Sections 25505,25533,and 25534 I will
I hereby,affirm nnde'r pen�lty of perjury one of the following three maintain compliance with the Cupertino Municipal Code;Chapter 9.12 and'the'.,
declarations Health&Safety Code,Section 25532(a)should I store or handle bazardous
I have and willi in in a Certifilcate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,,las,plovlld d for by Section 3706 of the Labor Code;for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the rk for I is permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I bt �lf p rfo ion Insance raof the work for which this the Health&Safety Code,Sections 25505,25533,and 25534.
d will=e q on Insurance,as for which
for b Owner or authorized agent:I have an I ainl I orke s Com ens
Sectioq 700 of Code Qr the a . _... % Date:
ermILI VIII I i�I I I i
it,s issue�{. 4
p II I �il II1
I cern tiiat in' e, e orm c Io l tete work for which this permit is issued,I shall �'
I I II I I 1
not a 1,o�1an ; I in y erso as to become subject to the Worker's
r' �� ii CONSTRUCTION LENDING AGENCY
Compo sirtion(laws T IC�1I'�rnr . If after making this certificate of exemption,I
become sAect to, Tel;JVgzkeF s ompensa,tiom provisions of the Labor Code,I must I hereby affirm that there is a construction lending;agency for the performance of
forthwitli.pomply will such prov'srons or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C:)
Lender's Name
I I I II III I � i
I AYPLICIANT CERTIFICATION Lender's Address
I certify(that I have read this application and state that the above information is
correct!I,I agree to comply,with all city and,county ordinances and state laws relating
to building coz)struiihon,,�nd hereby authorize representatives of this city to enter
upon eI, ove, entl nedl property,for inspection purposes.(We)agree to save ,
d} n} oARCHITECTS DECLARATION
indemnify and'keep armless the City,of Cupertino against liabilities,judgments,
costs,,sanlaid expenses wi ich may IaFcrue against said City in consequence of the I understand my plans shall be used as public records.
granting of thi Ipe t.I itionaal1ly;the applicant understands and will comply
this,pe
Code,Section
with ali non'pouit so�rCe�egulat�ons';per the Cupertino Municipal Co Licensed Professional I
9 18
I; L,
I
Si a l'I}lel III I'II Date
it 11
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II'jI� �Illl i I
II,
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10123 N WOLFE RD DATE: 05/22/2013 REVIEWED BY:
APN: BP#: EVALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1 CMB4
USE: Commercial Building PERMIT TYPE: i
WORK
SCOPE
Meeh.Plan Check 0.0 hrs $0.00 Phirrb.Alun Check E'ec.Plan Check
Me-h-PermMIT it Fee: IMPERAlura:b.Pcmil Fee: Elec. Permit Fee:
Other Mech.Insp. L2J hrs $45.00 0/her"Alhimh hasp. Lj L- Other Elec.Insp.
Li
,Mech.Insp.Fee: Plumb. hrsp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prefimina information available and are onl an estimate. Contact the Dept for addn'1 info-
FEE
n o.FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
Suppl.PC Fee: Q Reg. OT 0.0 hrs $0.00 $100.00 IBBOILER(1) Boiler/Comp.<=3hp
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl..Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Constrziction.Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes (F) No $0.00 E
Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: I
$132.001 $100.00 TOTAL FEE: $232.00
Revised: 04/29/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10123 N WOLFE RD STE 2007 CONTRACTOR: B--T9-Br& / PERMIT NO:12090221
OWNER'S NAME: VALLCO SHOPPING MALL LLC �/" 7 DATE ISSUED:03/06/2013
OWNER'S PHONE: 4088966601 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class 13 - Lie.# .f 7D- ' STE 2007-TATAMI RESTAURANT-COMMERCIAL
TENANT
Contractor Date �-3 �/� IMPROVEMENT 4,060 SQ FT IN INCLUDE STORE FRONT
I hereby affirm at I am licensed under the provisions of Chapter 9 DINING AREA,STORAGE AREA,NEW PARTITION WALLS
(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:
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. Sq.Ft Floor Area: Valuation:$250000
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 APN Number:31620097.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 FR CALLED INSPECTION.
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 I Date: .
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatu Date 8 3a l3 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec" s 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this —� �3 w�
permit.is issued. Owner or authorized agen : Date:
I certify that in the performance of the work for which this permit is issued,I shall 3not 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 CONSTRUCTI N LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
W-PERMIT
DDRESS: 10123 N WOLFE RD#2007 DATE: 09/26/2012 REVIEWED BY: SYLVIA
PN: BP#: O2� �� "VALUATION: $250,000
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1A TI
USE: PERMIT TYPE:
WORK TATAMI RESTAURANT- COMM T.I 4,060 SQ FT IN INCLUDE STORE FRONT DINING AREA
SCOPE STORAGE AREA, NEW PARTITION WALLS
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
A(Tenant Improvements) II-B,111-B,IV,V-B 4,060 $2,485.08 IATIPLNCK $2,042.72 1ATHNSP
TOTALS: 4,060 $2,485.08 $2,042.72
MECH,HOURLY Yes (F) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ® Yes (j)No
A,rcch. Plan Check Phurrh.Plan Clieck T E7ec.Plan Check
1LtechP,e,-wit Fee: Plumb.Permit Fee: Elec. Permit Pee:
Other rl/ech.Insp. Other-Plumb lrssp. Other Elec.Insp.
A'k-ch,Insp,Fee: Plumb. hrsp. Fee: I-lee.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelinWdna information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,485.08 Select a Misc Bldg/Structure
Suppl.PC Fee: (F) Reg. 0 OT 0.0 firs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $2,042.72
Suppl. Insp.Fee.-(D Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consir action Tax:
Administrative Fee:
Work Without Permit? Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Trcn-el Doczunentaiion gees: Building or Structure 0
Strong Motion Fee: IBSEISMICO $52.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $10.00
SUBTOTALS: 1 $4,590.30 $0.00 TOTAL FEE: $4,590.30
Revised: 07/01/2012