11040141 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N WOLFE RD STE 100 CONTRACTOR:SAN JOSE CONSTRUCTION PERMIT NO: 11040141
OWNER'S NAME: SEARS ROEBUCK AND CO 1210 COLEMAN AVE DATE ISSUED:09/19/2011
OWNER'S PHONE: 8472867538 SANTA CLARA,CA 95050 PHONE NO:(408)986-5711
LICENSED CONTRACTOR'S DECLARATIONr [—
,�,rw ��� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class__ Lic.# T_ r
MECH RESIDENTIAL COMMERCIAL
Contractooc� �.f`�'F Date
I hereby affirm that 1 am licensed under the provisions of Ch pier 9 JOB DESCRIPTION:BAY CLUB ATHLETIC CLUB-TENANT IMPROVEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions COMMERCIAL RETAIL BUILDING(69,300SQFT)CONVERT TO
Code and that my license is in full force and effect. ATHLETIC CLUB,NEW CAFE,STRUCTURAL,INCLUDES
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.
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 Sq.Ft Floor Area: Valuation:$10500000
permit is issued.
APPLICANT CERTIFICATION APN Number:31620080.100 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue a st sa City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally a applie t understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point so cc regulation per the C pertino Municipal Code,Section
9.18.
Signature Dat1e Issued b Date:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
1 certify that in the performance of the work for which this permit is issued,l shall maintain compliance with the pertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health:or
Saf,ty Code,Secti ns 5505,25533,and 25534.
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 Owner thorized agen {
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N WOLFE RD STE 100 CONTRACTOR:SAN JOSE PERMIT NO: 11040141
CONSTRUCTION
OWNER'S NAME: SEARS ROEBUCK AND CO 1210 COLEMAN AVE DATE ISSUED:09/19/2011
OWNER'S PHONE: 8472867538 SANTA CLARA,CA 95050 PHONE NO:(408)986-8711
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
EI
License Class Lie.# 4/6/12-REVISION#1-LAYOUT/CONFIGURATION REVISIONS TO
BASEMENT LEVEL,GROUND,AND UPPER LEVELS ISSD-1/10/12
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 8/28112-DEFERRED 03 FOR EQUIPMENT ANCHORAGE,CURTAIN
(commencing with Section 7000)of Division 3 of the Business&Professions WALL,LOBBY SKYLIGHT,HEALTH DEPARTMENT APPROVAL
Code and that my license is in full force and effect. FOR STARBUCKS,ELEVATOR SPECIFICATIONS-ISSD 1/10/12
1 hereby affirm under penalty of perjury one of the following two declarations: 4/6/12-DEFERRED#2 FOR STAIR#2_SHOP DRAWINGS ISSD
I have and will maintain a certificate of consent to self-insure for Worker's 1/10/2012
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 2/7/12-DEFERRED#1-INTERIOR METAL STAIRS-ISSD 1/10/2012
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 Sq.Ft Floor Area: Valuation:$10500000
permit is issued.
APPLICANT CERTIFICATION APN Number:31620080.100 Occupancy Type:
I certify that 1 have read this application and state that the above information is
correct.,)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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN IAO DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAY F M LAST CALLED INSPECTION.
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 Issued by: fi Date://0 '/.3
9.18.
Signature Date
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
1,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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Seetion 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by air contaminants as defined by the Bay Area Air Quality Management District
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Section 3700 of the Labor Code,for the performance of the work for which this the Health&Safety Code,Sections 25 , 533 nd 25534.
permit is issued.
1 eertify.that in the performance of the work for which this permit is issued,1 shall Owner or authorized agent: Date: ( (�
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,l
become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued(See.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
I certify that l 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 Lender's Address
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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
j i (-) 40
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10101 n. wolfe rd. DATE: 02/06/2012 REVIEWED BY: la"s
APN: BP#: 0 0 "VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1DS
USE: PERMIT TYPE:
WORK deferred submital stairs interior.
SCO PE
OCCUPANCY TYPE: TYPE OF FUR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. sX
Deferred Submittal (Not R-3) II-B'111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH, HOURLY 0 Yes (D No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes Q No
r 1 ir>r. (`!mf"'e-,cY,
�i7NLi
Uli!;•C.,rrr'!,. i!J<�1
r'u�,rh. Ar r: ;IC'i Tr cll r'rre
NOTE: This estimate does not include fees due to other Departme►rts(i.e.Planning,Public Works,Fire,Sanitary,Sewer District,School
District,etc:). These ees are based on the relin ina information available and are only an esti»rate. Contact the De t or addn Y info.
FEE ITEMS (I,ee Resolution 11-053 Eff 7/1111) FEE QTY/FEE MISC ITEMS !
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes G No $0.00
SuppL Insp. FeeQ Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
_T71
0
Work Without Permit? 0 Yes G No $0.00 G
Adwinced Plannine Fee: $0.00 ® hours Plan Check,Hourly 0
$520.00 ISTPLNCK 0
Stroi,iu Motion Fee: 1BSEISA41CO 20 4.0 hrs Inspections
Bldg Stds Commission Fee: 1BCBSC 0 () $520.00 1STINSP Inspection, Hourly
SUBTOTALS: $5.20 $1,040.00 TOTAL FEE: 1 $1,045.20
Revised: 111912012
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10101 North Wolfe Road DATE: 08/28/2012 REVIEWED BY: Sean
APN: BP#: 11040141 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
woRK Deferred submittal #3: Roof top equipment anchors a curtain wall lobby skylight, starbucks approval
SCOPE from health, and elevator specifications.
;Uec:n. Pkr;.Cher..% Plzrnrb.Pk:n Ci,eca' t>'!ec:.pian
Flfech Pc'nwi(i•'e•e: Elec,penndr Fec.
01he:r:Ltecn.fns;?;. 0,1her 1 hrmh hrs'p. Ulhe r Eicc'lnsp.
11ec.rr, Inst:. hte: Phnrb.Insp. Pee: Elec. 1;1ip. Fea
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Server District,School
District,etc.). Thesefees are based on the prelinjinary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 11-053 Eft 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? O Yes (D No $0.00 6 hours Plan Check,Hourly
Suppl. PC Fee: O Reg. ® OT kmo hrs $0.00 $798.00 ISTPLNCK
PME Plan Check: $0.00
Pen-nit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(Anstrliction 711x:
,f1c/ntirtisiruri�,t rc:f�:
Work Without Permit? ® Yes (F) No $0.00 O
Advanced Planning Fee. $0.00 Select a Non-Residential
T'reivel Dricrnnc;runlicin 1<es: Building or Structure O
t
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.001 1
SUBTOTALS: $0.001 $798.001 TOTAL.FEE: 1 $798.00
Revised: 10/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10101 north wolfe rd. DATE: 04/19/2011 REVIEWED BY: bob s.
APN: BP#.. 19 ( "VALUATION: 1$10,500,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1A TI
USE: PERMIT TYPE:
WORK T.I commercial retaii bidg, convert to athletic club new cafe structural include M E Ps exterior
SCOPE improvements include parking lot.
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 69,300 $4,859.93 IATIPLNCK $14,959.87 ]ATIINSP
TOTALS: 69,300 $4,859.93 $14,959.87
MECH, HOURLY ® Yes Q No PLUMB, HOURLY ® Yes Q No ELEC,HOURLY ® Yes Q No
4c•Ir_ Ph'n Check l'luml). flan Check cslec.Plan(.'k.ck'
Aplech. Per,;:ii e: Prurn?,/ ar:
c:Tti�er:11,ci�.ls.tiy:. ;71irrr f luurr'ir.;p. ET Ll
AYech. Insla. Fz.,, Plwid".Imp.Fe"' Is1er.IRsp, Few
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 L' . 7/l/Mi FEE QTY/FEE MISC ITEMS
Plan Check Fee: $4,859.93 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. ® OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $14,959.87
Suppl. Insp. Fee.e Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(."oustru tion 7ir.,
Acoustical Fee: 0 Yes G No $0.00
Work Without Permit? 0 Yes E) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential
lr'-�Jiwl Doctuneniatiort_I'et Building or Structure Q
i
Strong Motion Fee: IBSEISMICo $2,205.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $420.00
SUBTOTALS: $22,444.801 $0,001 TOTAL FEF-7.7F$22,444.801
Revised: 01/15/2011