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08070236Ir �a Uz CITY OF CUPERTINOra4fl%tirY U rn 3 f O p $ - Oforthwith z Q BUILDING DIVISION PERMIT -�CO�L�xTRACITOWIN.EUI.tMA`�I BUILDING ADDRESS: PERMIT NO. 20400 STEVENS CREEK BLVD STE TBD — TO BE DETERMINED 08070236 E; PERMIT ISSUE DATE PROMETHEUS REAL ESTATE GROUP 09/12/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECffENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION 9 Job Description 1 hereby affirm Nat I am Ilanud under provisions of Cnapur (commencing wlmsmuonTa(ler)oroiwdon3oruxBnunesa,naerorucomcode.wmyncenQu COMM' L TI INTERIOR RMDL PREV BLT—OUT TI in full fora and cU O Liana CI Lk. g Dsu GamDECL Y ARCNIIELTS DEC TIO Ise Hund my plans BIW l W used u public records , Lmerued Professional UR.DER DECLARATION Oat . I No Lew far We I Mcby aRrm that 1 sun exempt Iron tier Canuaerots :Any ].mal Business sod.,donuv Code: Any NayOr gmase..($ciao. .county which q.t. , Permit re cmestho alley. W ri repair sunetum which forsu h permiN, its ed poor Wj, its to ON du apprisiomant for Cormacmit m rile a cense Law (uumem Sq. F[. Floor Area Valuation that IN ecuanee. man,so that cavcdpurm,nttolhepmnsioosofou cStaleoraticeoulniw(C Code) Semon 7006 of Division, ofthe Cade) or xeNdon. 285000 . edlexemption.Any wPlaum of Oat V dumpy any.p li and de bur for exempo My Scat 13 exempt Number Occupancy Type bi ots On to o fears permit mbjccu ttc appl¢Nt m ,civil penalty of Semon 70313 by airy red doll Hat mom dN nK hundred doles, ($cam. 36901028 .qA ❑ 1, u awe of de property, a mY moployeu wIN wgn u du'vule compntsaSlon, Required Inspections will do the wert and d�e nwctum In nut intended aroRcmd for sale (Sec. 7004, Business and Professions Cade The Contrumrs License Law don WE apply to an owner or prrpsrty who Wilda arimpmwesdvreo, and wmdoessuce work himeulrortnmugn his own employers, pmwded Shatsuch impmsemenes ser not intended aro@red forme. If. however, de Wilding or impmwemmt u sold within mu yes o(compledon. the owner. Wider MB hate ON bundm of prownb But Ise did ON bonds or impmwe for purpose of ale.). 0 1. u.. of the pmpeny. w adusively cowering with licensed convect. m construct the project (Sec. ]OU, Business and Porusiov Code:) M Conuumh U. ave Law does not apply to an owner of property who Wilds or impmvv demon, sed, who crntracts for such projects with a eontrano (s) licensed punwnt m IN Contractors u Aw. vm eacmpt undo Stt , B & P c for Nis aero. Dao WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury arc of de fallowing declantionc ❑ I ham and will mainuin • Ccnifiuu of Covent m self-ivuu far Worker,Compen- sere, for by ass 7700 of the ichor Code. for the performa a of six rprovided were for whim out permit is isnhcl is 0 1 nave and will maimam Workers Compensation Insurance, u required by Section 3]00of On leWr Cade. for the performance of ons work for which this permit u issued. ' My Workeh omN don Na acmer Nd Policyn�umberer�e:.��yd�- Grtvr. Policy No: S ERTIFICA OFEXEMPf10NFROMWORKERS COMPENSATION INSURANCE munmim mend rot W completed flood permit is farone Wnded dollar ($IW) or leu) I cerhifv ON in due perfare. of the work for which dis Permit is bond, l shall rot employ any person in as, manner so u d become subject m de Wmksti Compensadon Laws of California. Dau Appnau NOTICE TO APPUCANT. If, afar making this Ccnifinm of Exemption, you should become subject m the Worked Compensation provision of the Iehm Crdc, you most comply with such provisions m this permit shall W doomed mmked. _-- CONSTRUCTION LENDING AGENCY I hereby affirm ON dem H a construction lending agency for She perfomnce of the work for which this permit is issued (Sec 3097, Civ, C.) . Lenders Name Lenders Address 1 amity du 1 have rad thin application W sou du the aWu information is coma 1 ague ut comply with all city and county ordinances Nd stile la%nladng in Wilding eonunedo.., sed Wmbyauttrriu mpmNmwJe of this city in marupon the aWwm-mmtimmd property for hOpecoom Purposes (Woo) agree to am, indemnify and keep harmkv the City of Cupertino against cuts N. whim mey M NY way aevue abaiwseid City incoioeAjudgmenu, in consequence of the granting of Nu permit. ng of Ois APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON -POINT SOURCEREG Issued by: Date Re -roofs Type of Roof uConucSar Dau AZARDOUS MATERIALS DISCLOSII ant or fume Wilding accupantrom or WShce incautious material JR7-Zbjy�t ertino Municipal Code. Chapter 9.12, ad tW Hath Nd Safety,)] OYen r All roofs shall be inspected nor to an roofing material bei. P P Y g g installed. Will ON applicant or mtum Ndldin occupant weed m JMana whim PP t W If a roof is installed without first obtainingan inspection, I agree to remove P cooll ldnw air contamination u/defined by the Bay Area Air Quality Management a it Qu all new materials for inspection. DiNnet? 0Yu [(NO 1 nevecowlded'-s wmoan,.requimmenuunder Chaptera.93oftte Califon undvvuhd dmifde Wilding dosYutCereallhsde 2Nit IS3yonsp023534.1 thou nest currently ler none du it u my nespomihility m notify site ocupNt of the mquim metpnormmmanaofacemiRea fOcapamg Signature of Applicant Date All roof coverings to be Class 'a" or better r aadoriud.genr Doth J FJJ IF _ r . =ile Edit Actions Details Links Favorites Help �'.=rrni� Infer;:ralio� Permit Plumber " 08070236 Status " C - Closed Master Number Project Apply Date' 07/31/2008 Permit Issue Date 0911212008 Certificate Issued 01/06/2009 Certificate Type Certificate Number Permit x Property Zoning Permit Details 131 Nates 2 $P Operator patg Operator patg Operator PALM of Applicant Contractor " Defined Fields Permit Type ` 1B TI ISI TENANT IMPROVEMENT Usage Class " 1-A,1-13 ISI 1 -A,1 -B NEW Applied Value " 285000 SQUARE FT. 3644 Calculated Value 0 jl US C-404 Type 437 E ALT: NON -RES, NON-HSKPG Permit Form AUTOPERM - PERMIT Ownership 1 - Private Project Size STANDARD -STANDARD 'ermit issued 0911212008 anter the purpose or any special conditions for this permit Address x 20400 STEVENS CREEK BLVD STE #300 City/State/Zip CUPERTINO APN 36901028.300 U nit Owner Name xl PROMETHEUS Use Default E Address Home -1900 S NORFOLK ST STE 150 City/State/Zip SAN MATEO CA 95014 CA 94403 Purpose/Special Conditions COMM'L TI 3,644 SQ FT INTERIOR RMDL PREV BLT -OUT FILMED 5/20111 I[OAdd Default T /'OK I4c., Back Contractors Fees d, Plan Reviews ", Inspections r Print Permit 'Adjustments Holds II• d Copy Permit IClose Permit Overrides �- Supplemental Fields j Notes i Attachments I M Lu ZLL) oars -�N �f-to d 3yU %µF- in in CC em� -Za 0 zC + V. W? �z UC L �CA U F10110, CITY OF CUPERTINO DIVISION PERMIT CC.NTRRACTOR INFORMATION; BUILDING .. BUILDING ADDRESS: PERMIT NO. 20400 STEVENS CREEK BLVD STE TBD — TO BE DETERMINED 08070236 OWWLM E: PERhIIT ISSUE DATE PROMETHEUS REAL ESTATE GROUP 09/12/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis COMM h L TI INTERIOR RMDL PREV BLT—OUT TI in full force and effec License CI Lic. # - Date Contractor '!` ARCHiTECPS DECLARATION 1 un erstand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Contractur's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Section 7000) of Division 3 of the Business and Professions Code) or $285000 (commencing with that he is exempt therefrom and the basis for the alleged exemption. Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 3 6 9 01 0 2 8 , .J [ ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's Limn Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employers, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. cense law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, 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 required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Workers Compen Gan IXns; t 'er and Polity, number are: Carrier. Polity No.: tERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompleLed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to Ire Workers' Compensation ' Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) - Lenders Name , Lenders Address 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-medGoned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expense which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCEREG Re -roofs Type of Roof A can"Contractor Date HAZARDOUS MATERIALS DISCLOSU Si�dcf�ined he applicant or future building occupantstore or handle hazardous material the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)?All roofs shall be inspected prior to any roofing material being installed. [:]Yeso If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which croft ha;,-dous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑ Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &SafetyCodc, Se ' ns 25505, 25533 and 25534.1understand that irthcbuilding does not curenty ha ant that it is my responsibility to notify the occupant of the require i met prior to issuance of a Certfica�c f Occupancy. Signature of Applicant Date All roof coverings to be Classor better Date r or author'vtd agent 'MCI CITY OF CUPERTINO TENANT IMPROVEMENT CUPEkTINO PERMIT APPLICATION FORM APN # 3 ('09 o i o Date: 7 - Building Building Address: c-1 zeta Mailing Address (if different from building address): FOAM K " , 0GAW 0 P"Z�A- 5- ► -L. - 04[Q -ANS GA 91e')2— Owner/'s Name: FODN ETHG-(\� CIA6 , Mpo#,31 Phone #: 4o13 . 5-7-3, D1 ) Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #:(j& ®'l _ Fax #: 5;-11 o gop -5 9 Alternate Contact: Phone 4: g f © (04 5- . _g� 0 0 iQ 64,r> Fax #: -991��;- Valuation (cost of project): +Zf Jam' n,yry, y l�� Job Description (be specific): [N�orZ- 2�n�o�c-c�N� �, `P�rpvsL� J�5uILT-ori' �'�.�r � �t P2ou�►�c �tl'. Tenant Improvement Includes Re -Roof: Yes ❑ No If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No Type of Construction (Usage Class): Occupancy Type: 1-A, I -B � IUIII/V-A ❑ WM B, IV -HT, V -B ❑ — 61 Ifiroject Size: Express Z 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 6/16/08 :u MOP CUPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 2 �` ISG 3 PERMIT # So ? 0 27 OWNER'S NAME: -W ` 14i e PHONE # 9 D � (o& GENERAL CONTRACTOR: -' Ef.> ) FAX #z3(Z) 6¢�39q i;;- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date