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BLD-2021-2546 CofOCertificate of Occupancy This Certificate is issued pursuant to the requirements of Section 111.2 of the 2019 California Building Code certifying that at the time of issuance, the portion of this structure described below has been inspected for compliance with the requirements of this code and with the various ordinances of the City regulating building construction for the occupancy and division of occupancy and the use for which the proposed occupancy is classified. Building Permit Number(s): BLD-2021-2546 Application Date(s): 12/22/2021 Issuance Date(s): 05/04/2022 Address of Building: 20395 Pacifica Dr., Suite 110 Scope of Work: KENNY WU, DDS - TENANT IMPROVEMENT - DENTAL OFFICE - (837 SF) Use: Dental Office Occ Class: B Occ Load: 11 occ Constr Type: V-B Floor Area (Tenant): 837 sq.ft. Fire Sprinklers System: Throughout Current Property Owner: KANA PACIFICA LLC Current Owner Address: 2268 Hendy Lane, San Jose, CA 95124 Final Inspection By: Bob Sabich, Building Inspector Final Inspection Date: 11-02-2022 *SPECIAL STIPULATIONS OR CONDITIONS: None ____________________________________ 11/15/2022 Albert Salvador, P.E., C.B.O., Building Official Date Issued NOTICE/POSTING: No changes shall be made in the character of occupancy. This certificate shall be posted in a conspicuous place on the premises, and shall not be removed except by the authority of the Building Official. CofO Application.doc revised 06/01/20 COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING: PROJECT ADDRESS CUPERTINO, CA APN # DATE OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP CONTRACTOR NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery): CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP LIST ALL BUILDING PERMITS ISSUED FOR PROJECT: PERMIT NUMBER DATE FINALED INSPECTOR SCOPE 1 2 3 4 - OFFICE USE ONLY - SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST: Permit signed off in system? ________ No other permits open or expired in system? ________ Verification of payment for certification? ________ APPLICATION FOR CERTIFICATE OF OCCUPANCY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org 20395 Pacifica Dr, Ste 101 369 40 022 11/02/2022 4083646202 drkennywu@gmail.com 20395 Pacifica Dr, Ste 101 CUPERTINO, CA 95014 KENNY WU 4083646202 drkennywu@gmail.com 20395 Pacifica Dr, Ste 101 CUPERTINO, CA 95014 BLD-2021-2546 11/02/2022 BOB SABICH Tenant Improvement 1286 Alma Ct SAN JOSE, CA 95112 PHUC DO 4089750797 phuc@norcalconstructiongroup.com Kana Pacifica, LLC �—' *"This document was electronlcally submitted to Santa Clara County for recording** 25198374 Regina Alcomendras Santa Clara County-Clerk-Recorder RECORDING REQUESTED BY: 12/17/2021 11:15 AM First American Title Company Titles: 1 Pages: 4 Fees: $24.00 MAIL TAX STATEMENT Tax: $907.50 AND WHEN RECORDED MAIL DOCUMENTTO: Total: $931.50 Kana Pacifica LLC 2268 Hendy Lane San Jose, CA 95124 Space Above This Line for Recorder's Use Only A.P.N.: 369-40-031 Flle No.: 4322-6599911 (SM) GRANT DEED The Undersigned G2ntor(s)Declare(s):DOCUMEfJTARY 1RANSFER TAX$907.50;CTiY TRANSFER TAX$;'Q SURVEY MONUMENT FEE$ � x � computed on the conslde2tlon or full value of property rnnveyed,OR � J computed on the consideraUon or fuil value less value of Ilens and/or encumbrances remaining at tlme of sale, � � unincorporated area; [x] Gty of Cupertino,and EXEMPT FROM BUILDING HOMES AND JOBS ACTS FEE PER GOVERNMENT CODE 27388 1(d)(21 � x � SI a ure of Declarant FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ]eanne R.Thomas,Trustee of the Jeanne R.Thomas Separate Property Trust dated 11/12/10, as to an undivided 50% interest; Nella Helen Tait also known as Helen Tait and �ayne S.Tait, or their successor(s), as Co-Trustees of the Helen Tait Survivor's Trust, as to an �n�0aaa�dea� 10% interest; and Nella Helen Tait also known as Helen Tait and Layne S.Tait, or their su��:��:�€rs�(:�),as �Co-Trustees of the Family Trust Pursuant to the 7ait Living Trust dated 6/15/79,as az��:�a�� as�s� restated, as to an undivided 40% interest hereby GRANTS to Kana Pacifica LLC,a Cali��rn�� 3's�ited liability company the following descrlbed property in the City of Cupertino, County of Santa Clara,State of California: A CONDOMINIUM COMPRISED O�: PARCEL 1: AN UNDIVIDED 1/12 INTEREST IN AND TO LOT 1, "TRACT NO. 6299 PACIFICA SUITES",IN THE CITY OF CUPERTINO, COUNTY OF SANTA CLARA, STATE OF CALIFORNIA,AS PER MAP AND PLAN RECORDED IN BOOK 449 OF MAPS, AT PAGES 40, 41 AND 42, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY,AND AS CORRECTED BY CERTIFICATE OF CORRECTION RECORCED NOVEMBER 30, 1979 IN BOOK E984 OF OFFICYAL RECORDS,AT PAGE 471, SANTA CLARA COUNTY RECORDS. EXCEPTING THEREFROM,ALL UNITS 1 TO 12 INCLUSIVE AS SHOWN UPON THE MAP AND PLAN ABOVE REFERRED T0. PARCEL 2: UNIT 11 AS SHOWN UPON THE MAP AND PLAN REFERRED TO IN PARCEL 1 ABOVE. Mall Tax Statements To: SAME AS ABOVE ------------------------------------------------------------------------------------------------------------------------------ � � � � RECORDING REQUESTED BY: First American Title Company MAIL TAX STATEMENT AND WHEN RECORDED MAIL DOCUMENT TO: I Kana Pacifica LLC 2268 Hendy Lane San Jose, CA 95124 Space Above This Line for Recorder's Use Only A.P.N.: 369-40-031 File No.: 4322-6599911 (SM) GRANT DEED The Undersigned Grantor(s)Declare(s):DOCUMENTARY TRANSFER TAX$907.50;CITY TRANSFER TAX$;'� SURVEY MONUMENT FEE$ � x � computed on the consideration or full value of property conveyed,OR � � computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, � � unincorporated area; [x] City of Cupertino,and EXEMPT FROM BUILDING HOMES AND JOBS ACTS FEE PER GOVERNMENT CODE 27388.1(a)(2) � X � Si ature of Declarant FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Jeanne R.Thomas,Trustee of the Jeanne R.Thomas Separate Property Trust dated li/12/10, as to an undivided 50% interest; Nella Helen Tait also known as Helen Tait and Layn�S.Tait, or their successor(s), as Co-Trustees of the Helen Tait Survivor's Trust, as to an undividecl 10% interest; and Nella Helen Tait also known as Helen Tait and Layne S.Tait, or their successor(s), as Co-Trustees of the Family Trust Pursuant to the Tait Living Trust dated 6/15/79, as amended anc� restated, as to an undivided 40% interest hereby GRANTS to Kana Pacifica LLC, a California limited liability company the following described property in the Ciry of Cupertino, Counry of Santa Clara, State of California: � A CONDOMINIUM COMPRISED OF: PARCEL 1: AN UNDIVIDED 1/12 INTEREST IN AND TO LOT 1, "TRACT NO. 6299 PACIFICA SUITES", IN THE CITY OF CUPERTINO, COUNTY OF SANTA CLARA, STATE OF CALIFORIVIA, AS PER MAP AND PLAN RECORDED IN BOOK 449 OF MAPS, AT PAGES 40, 41 AND 42, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY, AND AS CORRECTED BY CERTIFICATE OF CORRECTION RECORDED NOVEMBER 30, 1979 IN BOOK E984 OF OFFICIAL RECORDS, AT PAGE 471, SANTA CLARA COUNTY RECORDS. EXCEPTING THEREFROM, ALL UNITS 1 TO 12 INCLUSIVE AS SHOWN UPON THE MAP AND PLAN ABOVE REFERRED TO. PARCEL 2: UNIT 11 AS SHOWN UPON THE MAP AND PLAN REFERRED TO IN PARCEL 1 ABOVE. Mail Tax Statements To: SAME AS ABOVE ------------------------------------------------------------------------------------------------------------------------------------- � � , � Grant Deed - continued Date: 11/01/2021 A.P.N.: 369-40-031 File No.: 4322-6599911 (SM) Dated: November 01, 2021 Jeanne R. Thomas, Trustee of the]eanne R. Nella Helen Tait also known as Helen Tait and Tho as Separate Properly Trust dated 11/12/10 Layne S. Tait, or their successor(s), as Co- . Trustees of the Helen Tait Survivor's Trust ��'�`� �" Signed in ]e nne R. Thomas, Trustee Counterpart Nzlla Helen Tait, Co-Trustee Signed in Nella Helen Tait also known as Helen Tait and Counterpart Layne S. Tait, or their successor(s), as Co- Layne S. Tait, Co-Trustee Trustees of the Family Trust Pursuant to the Tait Living Trust dated 6/15/79, as amended and restated Signed in Counterpart Nella Helen Tait, Co-Trustee Signed in Counterpart Layne S. Tait, Co-Trustee A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the ' �I truthfulness, accuracy, or validity of that document. ! ` STATE OF �l �� (J�NI' � � )SS I � COUNTY OF �� L,�� ) On �E'CC'Vl'),-�'j��'� �� '2�before me, 7J� � ( I�i��, Notary Public, personally appeared �� i�v1� � , —'�•1�4�1'1�� who proved to me on the basis of satisfactory evidence to be the person(� whose namef1s) is/� subscribed to the within i instrument and acknowledged to me that J�/she/t�ej� executed the same in�/her/�ir authorized capacity(ies), and that by � �/her/tl�¢ti� signature(�j on the instrument the person(,a), or the entity upon behalf of which the person(�� acted, executed the instrument. I I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. II WITNESS my hand and official seal. Thisarea forofficialnotaria/seal. i, �� ---= - --- � - -� ,t•�.�•,., SAM Y.MAKHOUL ' ""�� Notary Public•Californla Notary Signature � `��.� Sanca Clara Counry � ` Commisslon q 2334620 �^ _ � My Comm.Explres Oct 1, 202a r Page 2 _ __ _---... _ — --� � � Grant Deed - continued Date: li/01/2021 � q,p,N.: 369-40-031 File No.: 4322-6599911 (SM) i Dated: November O1, 2021 )eanne R. Thomas,Trustee of the Jeanne R. Nella Helen Tait also known as Helen Tait and Thomas Separate Property Trust dated 11/12/10 Layne 5. Tait, or their successor(s), as Co- Trustees of the Helen Tait Survivor's Trust Signed in Signed in ]eanne R.Thomas,Trustee ounterpart Counterpart Nella Helen Tait, Co- ustee ! G�-%✓ s/�-- Nella Helen Tait also known as Helen Tait and La S. Tait, Co-Trustee Layne S. Tait, or their successor(s), as Co- Trustees of the Family Trust Pursuant to the Tait Living Trust dated 6/15/79, as amended L��1(lY� S� �� and restated Signed in Counterpart Nella Helen Tait, Co- stee � � /�, id— ,� yn . Tait, o-Trustee � �.�Ac�n� S. ��1 e�' A notary public or other officer completing this certificate ' verifies only the identity of the individual who signed the I document to which this certificate is attached, and not the truthfulness,accuracy, or validity of that document. c�— STATE OF � VL�l G� �/( G� )SS COUNTY OF ��(11�� On �� I (,�� Z � before me, ��"�� Cj� I—i�l � , Notary Public, personally appeared ) � I �hl^� who proved to me on the basis f sa isfactory evitlence to be the person(s) whose name(s) is/are subscribed to the within ' instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf ��ich the person(s) acted, executed the instrument �y«(�� I certify under PENAL7Y OF PERJURY under the laws of the State ornia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. This area for o�cia/nota�ial seal. ; 1 / , �� , I✓��/�J�V�� LY CANDACE HALL � (,�av v� (� l 6 Notary Public-Seal i Mo�rce County-State of Indiana I Notary Signature Commission Number N70732�46 My Commlzzion Expires Mar},�025 I, Page 2 � % Grant Deed - continued Date: 11/01/2021 q,p,N.: 369-40-031 File No.: 4322-6599911 (SM) Dated: November O1, 2021 Jeanne R. Thomas, Trustee of the Jeanne R. Nella Helen Tait also known as Helen Tait and Thomas Separate Property Trust dated il/12/10 Layne S. Tait, or their successor(s), as Co- Trustees of the Helen Tait Survivor's T� Signed in Counter art 'e ' v ]eanne R.Thomas,Trustee P N a Helen Tait, Co-Trustee Signed in Nella Helen Tait also known as Helen Tait and Layne S. Tait, or their successor(s), as Co- Layne S. Tait, Co-Trustee Counterpart Trustees of the Family Trust Pursuant to the Tait Living Trust dated 6/15/79, as amended and restated �-� f � N a Helen Tait, Co-Trustee Signed in Layne S, Tait, Co-Trustee Counterpart A notary public or other officer completing this certi�icate verifies only the identity of the individual who signed nc� document to which this certificate is attached,and not che truthfulness,accuracy, or validiry of that document. STATE OF �.� N�/1� )SS COUNIY OF ��,/� � � ' a� before me, (�t �'l.� .�erhd�, Notary Public, personally appeared on -�-�- � -�-��; who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entiry upon behalf of which the person(s) acted, executed the instrument. � I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. I WITNESS m hand an fi al seal. This area for o�cial notarial seal. ' `\\��iiiiiriii I .,• y µE�Np•,., � �� :�' �� +►+�� ': � �'o�� ees•. ; Notary Signature = '��pTAR y ' Q_ =u>�o�°UBl-�G,��-,�2� � � /'•, y .• . ' � ;,ti��.�.M"�� .�,� �, ''�.�N COU�.�`� Page 2 ��//�11111►��` � �— � , eoE 502_p(Pl)REV.15(02-21) PRELIMINARY CHANGE OF OWNERSHIP REPORT 10 be completed by the transferee(buyer)prior to a transfer of subject � prope�Y�in accordance wifh section 480.3 of the Revenue and Taxation � Code.A Pie�imi��'Change of O�a�ne�shrp Repo�t must be filed with � each conveyance in the County Recorder's office for the county � where the property is located. � NAME AND MAILING ADDRESS OF E3UYER/TRANSFEREE ASSESSOR'S PARCEL NUMBER K� (hfake necessary crorrections fo the pr/nfed name and ma!ling addressJ 369-40-031 � �� r � SELLER/TRANSFEROR i � ]eanne R.Thomas Separate Property Trust dated 11/12/10 and ( Kana Pacifica LLC elen Tait Survivor's Trust and Family Trust Pursuant to the Tait vin Trust dated 6/15/79 BUYEf;'cS�A��ETEL,EP�HO�N�NUMBER ¢ �i BUYER'S EMAIL ADDRESS � � drkennywu@gmail.com STREET ADDRESS OR PHYSICAL LOCATIOM OF REAL PROPERTY 20395 Pacifica Drive#101,Cupertino,CA 95014 Mp DAY YEAR �YES� NO This property is intended as my principal residence.If YES,please indicate the date of occupancy orintended occupancy. �YES� NO AomPensa eldaat 00%ebynthe Departmendt of Veterans Affairs?a disabled veteran who was MAIL PROPERTY TAX INFORMATION TO(NAME) �m STATE ZInP C�ODE MAIL PROPE_R_TY T�X INFORMATION 0(ADDRESS) ��p�j'�'(�� G 7`., �'� , "U��> �rci�lc�t �v�IG'�. ; D / PART 1.TRANSFER INFORMATION Please complete allstatements. This section contains possible exclusions from reassessment for certain types of transfers. YES NO � q, This transfer is solely between spouses(addition orremoual ofa spouse,death ofa spouse,divorce settlement,etc, . � g, This transfer is solely between domestic parfiers currently registered with the California Secretary of State (addition o�removal ofa partner,death ofa partner,terminatron sett/ement, etc.). between grandparent(s)and grandchild(ren). � *�, This is a transfer: � between parent(s)and child(ren) � Was this the transferor/grantor's principal residencel � YES � NO � � *p, This transfer is the result of a cotenanYs death. Date of death � *E, This transaction is to replace a principal residence owned by a person 55 years of age or older. Within the same county? � YES � NO ` � *F, This transaction is to replace a principal residence by a person who is severely disabled. Within the same county? � YES � NO I ❑ ! *G, This transaction is to replace a principal residence substantially damaged or destroyed by a wildfire or natural disaster for whic the Governor proclaimed a state of emergency.Within the same county? � YES � NO � � H, This transaction is only a correction of the name(s)of the person(s)holding title to the property(e.g.,a name change upon maiiiageJ. If YES,please explain; � I. The recorded document creates,terminates,or reconveys a lender's interest in the property. � ), This transaction is recorded only as a requirement for financing purposes or to create,terminate,or reconvey a security interest (e.g.,cosigner).If YES,please explain: I � {(. The recorded document substitutes a trustee of a trust,mort9age,or other similar document. � �, This is a transfer of property: I � 1.to/from a revocable trust that may be revoked by the transferor and is for the benefit of �] the transferor,and/or ❑ the transferor's spouse ❑ registered domestic partner, i � 2.to/from an irrevocable trust for the benefit of the � � creator/grantor/trustor and/or � 9rantor's/trustor's spouse � granto�'s/trustor's registered domestic partner. i � M. This property is subject to a lease with a remaining lease term of 35 years or more including written options. I � N, This is a transfer between parties in which proportional interests of the transferor(s)and transferee(s)in each and every parcel � being transferred remain exactly the same after the transfer. � p, This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions,or restrictions I imposed by specified nonprofit corporations, � *P, This transfer is to the first purchaser of a new building containing an active solar energy system. � � Q. Other.This transfer is to *Please refer to the instructions for Part 1. Please rovide an other information that will hel the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION � • A(P2)R�'15�02-21) 2 v�RT Z,pTNER TRANSFER INFORMATION Check and complete as applicab e. ��¢of Uansfer,if other than recording date: p aans�er: & T�e �Foreciosure ❑Gift ❑Trade or exchange ❑Merger,stock,or partnership acqu(sition(Form BOE-100-B) purchase �Inheritance, Date of death: �Contract of sale. Date of contract: � � �Sale/leaseback ❑Creation of a lease �Assignment of a lease �Termination of a lease.Date lease began: Original term in years(induding written options): Remaining term in years(includ/ng written options): �Other.Please explain; % �, Only a partial interest in the property was trensferred, ❑YES ❑NO If YES,indicate the percentage transferred: pART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable. � 8z5,000.00 q. Total purchase price qmount$ g, Cash down payment or value of trade or exchange excluding closing costs p,�nount$ C. First deed of trust @ %interest for years. Monthly payment$ Dlscount Polnts) ❑Cal-Vet ❑�A(—Discount Points) ❑ Fixed rate ❑Variable rate � FHA(_. �Bank/Savings&Loan/Credit Union �Loan carried by seller � Balloon payment$ Due date:�_ qmount$ D. Second deed of trust @ %interest for years.Monthly payment$ �Fixed rate ❑Variable rate � Bank/Savings&Loan/Credit Union ❑ Loan carried by seller �Balloon payment$___ Due date:__ Outstanding balance$ E, Was an Improvement Bond or other public financing assumed by the buyer? ❑YES ❑NO � F. Amount,if any,of real estate commission fees paid by the buyer which are not included in the purchase pr�Ce Phone number:( ) G. The property was purchased: �Through real estate broker.Broker name:Guadalu e M.Silva Broker i [�Direct from seller ❑From a family member-Relationship I �Other.Please explain: H. Please explain any Sass st the Asseslsor In the valuation�of yo urproperty.aived,flnancing,and any other information(e.g.,buyer assumed the existing oan balance)that would PART 4. PROPERTY INFORMATION Check and complete as applicable. A. Type of property transferred �Co-op/Own-your-own �Manufactured home �Single-family residence Condominium �Unimproved lot �Multiple-family residence.Number of units: ❑Tlmeshare Commercial/Industrial �Other.Description:(i.e.,timber,minerai,water rights,etc.) ❑ g, []YES N� are furnitbre,l farmPeqP p t Imachinery,etc.IExampleslof in�ntives are club membershipsc etce ttach Est f alvailab eersonal property If YES,enter the value of the personal/business property; � Incentives$ �, �YES �O A manufactured home ts included in the purchase price. If YES,en the value attributed to the m,�nufactured home: $ �YES NO The manufactured home is subject to local property tax.If N0,enter decal number: D. ES ❑NO The property pro s rental or other income. IIf YES,the income is from: Lease/rent �Contract ❑Mineral rights ❑Other: , E. The condition of the property at the time of sale was; ❑Good ❑Average ❑Fair ❑Poor Please describe: CERTIFICATION I ce�ti�y(or dedare)that the foregoing and all informaUon he�eon,induding any accompanying statements or documents,is true and coirect to the best of my knowledge and b�f, SIGNATU OFBUYER/TRANSFEREE OR CORPORATE OFFICER DATE TELEPHONE � - � Z �< 2�` ( �,��')j G�G - ,z�'�� NAME F_BUYER(TRANSFEREE/PERSONAL REPRESENTATIVE/CORPORATE OFPICER(PLEASE PRIN� TITLE EMAIL ADDRESS The Assessor's office may contact you for additional information regarding this transaction.