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10010056 (2)PERMIT # ! l S DATE l -12 PROJECT' �(9n b��r-1�E, _ wo_Ll -Jt� ADDRESS / ? D12— A `g c,_ t� w d SPA Le APPLICANT OWNER m1�1�� ®©mmmmmmmmmm ,.. Imo]®►.I' �� I�VS��S��S■ APN# SS% //f S RES. (LVNG) (GARAGE) COMM. SQ. FT. (NEW) T.I. SQ.FT. RES. REMODEL CONTACT PHONE# l 2 L FAX l� ` -7 J'0 r cz VALUATION (Cost of Project) "2 i REQD. PAID NOTES: 4 lit %ff d Cb mftp�'J CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED Y - - DATE 2 U'�� TOTAL FEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10555 S DE ANZA BLVD STE 125 1 CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 10010056 OWNER'S NAME: MENG'S ACADEMY I I DATE ISSUED: 0 1/20/20 10 1 OWNER'S PHONE: 4082579228 1 1PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Contractor Lic. k Date I 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. 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. MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REMOVE (E) NON -BEARING WALL ABOUT 30SQ & PATCH CEILING AS NEEDED; NO RE -ROOF & NO STRUCTURAL I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, te applicant understands and will comply with al I non -point sourcgzagulatipns-or the Cupertino Municipal Code, Section 9.18, n` i .J Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, wil I 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit is issued. 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 Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally plicant understands and will comply with all non -point sour Qee re 9.I8. per the Cupertino Municipal Code, Section .�i%�i Valuation: $2500 APN Number: 359I8058.STE125 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b yDate./— z Gib y_ RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Se ,$igas 2 , 25533, and 25534. Owner or Date: I hereby affirm tHat thesis 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 I understand my plans shall be used as public records. Date Licensed Professional l 0C)1 0c� CITY Of CUPERTINO CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM :�5q I ?-oE5?, 12-!-:-:> APN # Date: Building Address: SS� S I)Q_ -La, 2,:5 Mailing Address (if different from building address): Tenant (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? Yes El No Tenant/Building Owner's Name: Phone #: f �'( ` 5 �`,q `D� �'1 � ��8 � Z — 2Z-9 Contractor: T5 � Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: ( -4-68�> q `t 6 ?qi 16 Fax #: of q(S-78o q Alternate Contact: Phone #: Fax #: Valuation (cost of project): Job Description (be specific): lev�..ov-e Cam) /Ja h o J�' Tenant Improvement Includes Re -Roof. Yes ❑ No If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No;j� Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IIIIII/V-A ❑ II/III B, IV -HT, V-B Project Size: Express Standard Large Major Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Over The Counter ❑ Revised 07/06/09 CITY OF CUPERTINO TENANT IMPROVEMENT FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type IATINSP Tenant Improvement B IA TI Ins ection 1ATIPLNCK Tenant Improvement Plan B Check 1BTIINSP Tenant improvement B 1B TI Inspection 1BTIPLNCK Tenant Improvement Plan B Check IETIINSP Tenant Improvement B IE TI Inspection -Preschool IETIPLNCK Tenant Improvement Plan B Check -Preschool IFTIINSP Tenant Improvement B IF TI Ins ection-Factory/Indust 1 FTIPLNCK Tenant Improvement Plan B Check-Factory/Indust 1HTIINSP Tenant Improvement B 1H TI Inspection -Hazardous 1 HTIPLNCK Tenant Improvement Plan B Check -Hazardous I ITIINSP Tenant Improvement . B 11 TI Inspection -Institutional I ITIPLNCK Tenant Improvement Plan B Check -Institutional 1 MTIINSP Tenant Improvement B 1M TI Inspection -Merchandise 1 MTIPLNCK Tenant Improvement Plan B Check -Merchandise 1 STIINSP Tenant Improvement B 1S TI Inspection -Parking Garag 1 STIPLNCK Tenant Improvement Plan B Check -Parking Garage 1REROOFCOM Re -Roof Commercial B 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic Commercial B 1 BUS LIC Business License B 3 / / 6 2 of2