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11070116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR:APPLIED CONSTRUCTION PERMIT NO: 11070116 TECH OWNER'S NAME: CUPERTINO CROSSING LLC 1230 OAKMEAD PKWY DATE ISSUED:08/09/2011 OWNER'S PHONE: 4159898846 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION T� F I� :30��� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.N MECH RESIDENTIAL COMMERCIAL Contractor Date o I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:PANASONIC-SUITE 200-COMM.T.I(1040SQFT)CREAE (commencing with Section 7000)of Division 3 of the Business&Professions AN OPEN OFFICE AREA FROM THREE EXISTING ROOMS 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. 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:31609029.00 Occupancy Type: I certify that 1 have read this application and state that the above information is correct.1 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 expense which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this'p A. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-posource regula'ons per the Cupertino Municipal Code,Section 9.18. Signa Date r Issued by: Date: " ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 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: I,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 I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I 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. I 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(x)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintai ompliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health SafetyACo ,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I must Owh ! forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I 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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR:APPLIED CONSTRUCTION PERMIT NO: 1 10701 16 TECH OWNER'S NAME: CUPERTINO CROSSING LLC 1230 OAKMEAD PKWY DATE ISSUED:08/09/2011 OWNER'S PHONE: 4159898846 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990 LICENSED CONTRACTOR'S DECLARATIONF F LA BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.47 �(/+a LA � F T�yylne)r�, MECH RESIDENTIAL COMMERCIAL Contractor Date W-ACA 1 hereby affir tat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: PANASONIC-SUITE 200-COMM.11(1040SQFT)CREATE (commencing with Section 7000)of Division 3 of the Business&Professions AN OPEN OFFICE AREA FROM THREE EXISTING ROOMS Code and that my license is in full force and effect. Geea�e 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. 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:31609029.00 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 against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulation er the Cupertino Municipal Code,Section 9.18. Issued Datc:2 '-2i'f Signature Date�/��,/1�--► �- ❑ O -BUILDER DF,CLARATION RE-ROOFS: I 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 1,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: I,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 I 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 I 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 I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as dc(incJ by the Bay Arca Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,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 or a ent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is /,oreb/aFfirm 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 2 SoN CITY OF CUPERTINO BUILDING PERM BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR:APPLIED CONSTRUCTION PERMIT NO: 11070116 TECH OWNER'S NAME: CUPERTINO CROSSING LLC 1230 OAKMEAD PKWY DATE ISSUED:08/09/2011 OWNER'S PHONE: 4159898846 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATIONr ` ���� BUILDING PERMIT 11�IF0: BLDG ELECT PLUMB License Class S Lie. 1 --`` CAP —A, MECH RESIDENTIAL COMMERCIAL Contractor 4 eta � - • Date l 1"hereby aflirat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:PANASONIC-SUITE 200-COMM.T.1(1040SQFT)CREATE (commencing Ath Section 7000)of Division 3 of the Business&Professions AN OPEN OFFICE AREA FROM THREE EXISTING ROOMS Code and that my license is in full force and effect. 4/3/12-REV#2-REMOVE THREE(3)DOORS AND RELOCATE TWO(2)OF THE 1 hereby affirm under penalty of perjury one of the following two declarations: DOORS4/3/12-REV#2 ISS'D 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. Sq.Ft Floor Area: Valuation:$22500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31609029.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regul " pe he e ' o Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: S���1� .� l Gs�,l Date: ❑ OWN ILDER DECLARATION I hereby affirm th am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should 1 store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Co e,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,l must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or ge / ' Date' H1 3 ,l APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 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 hereVi.rrnhere is a construction lending agency for the performance of%ork's to building construction,and hereby authorize representatives of this city to enter for whith this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional