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HomeMy WebLinkAbout131101275 CITY OF CUPERTINO BUILDING PERMIT = BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 13110127 - CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12!0912013 O ER'S PHONE: 5103316719 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTR�CTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class %4 cic, Lie. # �i9q �P APPLE- COMM. T.I TO FITNESS LAB 12,858 SQ FT TO INCLUDE M,E,P'S / Contractor�y_CG1 6144N[. Date 12 q 1 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 aWrn nirder 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 Sq. Ft Floor Area: Valuation: $4500000 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 pedbrmance of the work foi which this permit is issued. '. � APN Number: 35720020.00 Occupancy Type - APPLICANT APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK ISNOT STARTED correct. 1 agree tocomply with all city and county ordinances laws relating WIT PERMIT ISSUANCE OR tr ofthis.c-state to building construction, and ticreby authorize representatives of this.city to enter SOF upon the above mentioned property for_inspection purposes: (We) agree to save 1$4 DA S FROM LA T CALLED INSPECTION.: 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, the appli ant understands and will comply Issued by: Date: f with all non -point source re lations upertino Municipal Code, Section RE ­ROOFS: 9.I8. , _ Date �Z q 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt'from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I,.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:gffered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec,7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health& Safety Code, Sections 25505, 25533, and 25534. [will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 55 , 5 534. Section 3700 of the Labor Code, for the performance of the work for which this u ag Date• �= Q 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 ofCalifomia. It; after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subjeet to the Worker's Compensation provisions of the!Labor Code, I must I hereby affirm that there is a construction lending agency. for the performance of, forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above: information is correct. I'agree to comply with all city and cqunty 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per.the Cupertino Municipal Code, Section Licensed Professional 9,18: , Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupedino.org ❑ NEW CONSTRUCTION ❑ ADDITION 1� ALTI_RATION / T1 ❑ REVISION 1 DEFERRED ORIGINAL PERMIT # R�/}� • PROIECI ADDRESS DqCJ 00 lb 10 APN ;, 7 - gzD OWNa NAME 1 .O�/ �( PN • • F.MML yt4y � � I w . STRADDRFSS I ' ^� � � C S P FAX EET ` CONTACT NAME A /IA�� /1,��'1IA%J ' 1f , `jr it y j� lL/ jf � PHO 5 •� I �y(0 1 ��/ E tvfAtl, i _cim� V n re � STRM DRE i _ r • CIT ATE. P O FAX '� 0 OWNER ❑ OWNER•BUrIDER 17 OWNERAGENT CON-nUCTOR ❑ CONTRACTOR AGENT ❑ ARCHISECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME j�� YlAD t rCENSENUM B LICENSE�ft BUS. LIC COMPANY NAME C {AL K � EARAIL ID FAX STREET ADD S` LC J �%�y� CITY �T TE. � O -4142 -yY1 VLLJIJ ARCHITECTlENGINEERNAMEvi LIM'SENUMBER /��n Q v jJ BUS, LICE COMPANY NAME E-MAIL E-MAIL FAX wTf • STREET ADDRESS ., A �� ZI [ M/� C STATE ZIP ' V1�Y3 C -2, J PHONE / I r, 01 1 I^ T e e r rt � _s DESCRIPTION OF WORK I -T I M,14011 1�L r�[,�J r .► IWAGi AV" EXISTING USE PROPOSED USE CONSTR-1YPI: #STORIES USE TYPE OCC. SQFT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA:DETACH U ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY [:]YES BEING ADDED? El NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF iS THE BLDG AN ❑ YES RECENED BY: - "" "' -"''' - TJPTAVALUA'nDN- PLANNING ADPL 9 ❑ NO PLAN"G AFPROVAL LETTER EICHLER HOME? ❑ NO y/) /t 0 (/til 00 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's 6eha[E I have read this application and the information I have provided is correct, I have read t e D ' 'ption of Work and verify it is accurate. i agree to comply withal] applicable local ordinances and state laws reAatgbu'ld' construction. I a o 'z pr en tives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/,A. Date: SUPPLEMENT& INTFORMAT N REQUIRED r . vPLANCHEcxTYPE _ _ , _ RourINcsiTP p' ovEii-TIW COuN-rkR% ❑ BUIL15ING PL AN,iiEiZEw _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. �0 iiPRESS, kNNING PLAN'ItivifW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure's'STAR'DARn ❑ PUBLtC;�i'ORIZ&:;w ' form if any Hazardous Materials are being used as part of this project., acs 'FIHE Deer _ Copy of Planning Approval Letter or Meeting with Planning prior -to w SA1VIre1RY, submittal of Building Pcrmit application. ;iWOR E'❑: SEAVER,DISTRIC,T ' z❑_hNT%'IRONTI]ENTALHEAI.TII'' M CITY OF CUPERTINO IiI FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10300 bubb rd FLR AREA s.f. DATE: 11119/2013 REVIEWED BY: Mendez BP FEES APN: BP#: 11-B,111-B,IV,V-B *VALUATION: $4,500,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building IBTIINSP flee, Insp. Fee: PENTAMATION PERMIT TYPE: 113 TI WORK le- comm t:i to fitness lab 12,585 sq ft SCOPE fq Permit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) 11-B,111-B,IV,V-B 12,858 AM FAM—T,,9-41 1BTIPLNCK $7,426.94 IBTIINSP flee, Insp. Fee: PME Plan Check: $0.00 Permit Fee: $7,426.94 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee, $0.00 PME Permit Fee: $0.00 TOTALS: 12,858 $2,776.94 Construction Tax: $7,426.94 MECH� SOURLY- 0' -Yes O No 'PLUMB, HOURLY Q Yes d ,,No ELEC,,:HOURLY Q Yes, E) No Xfech, Plan Check Plumb. l'larf Check Flee. Plan Check F,L9ech, fermi! Fee.. Plumb. Permil Fee: Elec. Permit Fee., Other :11ech. Insp. Other Plumb Insp.Li Other lace. Insp. Ll A4ech, Insp, Fee: Plumb. Insp, Fee." flee, Insp. Fee: NOTE: This estimate does not include fees due to other Departments (ac Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). 77jese fees are based on'the nrelinunary information available and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,776.94 Select a Mise Bldg/Structure or Element of a Building Suppl, PC Fee: Q Reg. Q 07 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $7,426.94 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee, $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 4 Yes E) No $0.00 Advanced Planning Fee: $Q.00 Select a Non -Residential Building or Structure 0 0 Trcwel Documentation Fees: Strong Motion Fee: 1BSEISRfICO $945.00 Select an Administrative Item B1dp- Stds Commission Fee: IBCBSC $180.00 StJBTOTALS: 11,328.88 $0.00 TOTAL FEE: - AM. Revised: 10101/2013 MA. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 13110127 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/09/2013 OWNER'S PHONE: 5103316719 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL APPLE- COMM. TA TO FITNESS LAB 12,858 SQ FT TO License Class Laic(. #. INCLUDE M,E,P'S p y j f Contractor C?%U r ' ll 1' ��6� I .14 REV # 1 CHANGE LAYOUT, ADD MECHANICAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 EQUIPMENT WITH STRUCTURAL UPGRADES TO (commencing with Section 7000) of Division 3 of the Business & Professions SUPPORT. -ISSUED 119114 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 Sq. Ft Floor Arca: Valuation: $4500000 erformance of the work for which this permit is issued. I? ave 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 APN Number: 35720020.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above informal ion is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and stale laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F T C ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the �r/7 granting of this permit. Additionally, the applicant understands and will comply Is ate: I with all non -point saurc egulation er th ertino Municipal Code, Section 9.18. /)'} � RE -ROOFS: l Signature Date t/ l 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOU MATERIALS DISCLOSURE construct the project (See.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505,25S33, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino unicipapcvdc, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Seeti ns 5 , 2553 ad 55 :.: `p performance Owner or authorized age Da e: permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall (J 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(acuoertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI Irkr REVISION/ DEFERRED ORIGINAL PERMIT # I Citi PROIECTADDRESS I -7 ,^ Yjy I^` E/V lJl APN!! /L S -3-^7 r1 OWNER NAME � PHONEi{tea 5!_�. 2 EMAIL VCvv EC's � no� coy) J STREET ADDRESS )ffi nil wO f ` C� CITY, STATIE�ZVIA(f��{J,..� /I �� �{},�� FAX CONTACT NAME 1 n �yi I PHONEiI 0?) -5[ C}_ E -MAH., 1 rot t VR 1 1 u�N ' 1 O V e: V U Y' �O STREETADDRES5 C ,TATE ZIP QA C7 FAX i ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DUVELOPER ❑ TENANT CONTRACTORNAMEy hi� jvl 1 I LICENSENUMBER LICENSE TYYE BUS. LICA COMPANY NAMEmrA4it E-MAIL De—VIMX1(1 rn i ch elaY� @de �r�0[n �o>�} cum FAX STREETDRESS b CITY, ,ZIF S ^A TS� (� JjQIV� 2-. 5�0 Hr ARCTECFIENGINEERNAME DOM LICENSENUMBER BUS. LIC 4 COMPANY NAMEf yrs V " t' E- AIL, V I FAX STREET ADDRESS `b5 MQ [co CITY, STATE, ZIP � qsf PHO t�Z 2_5 ��50 DESCRIPTION OFWORKQVedPPh; M (2lir) I r i CAmayI{ -J aI�lllj I Y_�vi �`Y1e% 1GiV1i CQ I P -4 a e S'�Vu.G�"Lc�'UII �G�2s e EXISTINGUSE PROPOS SE CONSTR-TYPE #STORIES USE TYPE OCC. SQ.Fr. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH ATTACH I # DWELT INGUNITS: ISA SECOND UNIT []YES SECONDSTORY []YES BEING ADDED? [3NO ADDITION? ONO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES I TOTAL VALUATION: PLANNING ADPL H El NO PLANNING APPROVAL LETTER EIC- -- ---- -E- � N By my signature below, I certify to each of the following: I am the property Owner or authorize ent to act perry owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify I -Is accurate. I agree to comply with all applicable local ordinances and state laws relating Jo b ildi construction I au 'ze rep sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicandAgent;Date; N ' N - 14 SUPPLEMENTt INFORMAT ON REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PLMLIC WORKS form if any Hazardous Materials are being used as part of this project. [] LARGE ❑ FIRE DEPT _ Copy ofPlanning Approval.Lctter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH E1dgApp_2011.doc revised 06/21/11 t," m M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 13110127 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/09/2013 OWNER'S PHONE: 5103316719 MILPITAS, CA 95035 PHONE NO: (408)942-8200 I LICENSED CONTRACTOR'S DECLARATION Ox JOB DESCRIPTION: RESIDENTIAL COMMERCIAL : APPLE- COMM. T.I TQ - T 2 858_ SQ FT TO License Class Lie. 990.74_ _ .' 1 1 tY ! INCL. CvntractorNyyY L1' u"' `rh Date, ; REVISION # 2 - CHANGES TO PROPOSED ELECTRICAL I hereby affirm that I am licensed under the provisions of Chapter 9 RM & I.D.F. RM (SERVER RM) - 2/27/2014 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my hceuse is in full force and effect. I hereby affirm under penalty of perjnry one of the following two declarations: 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 Sq. Ft Floor Arca: Valuation: $4500000 performance of the work for which this permit is issued. � have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Cade, for the performance of the work for which this pennit is issued. APN Number: 35720020.00 OccupancyT Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITFIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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, the applicant understands and will comply Issued by: Date: with all non -point source regulations er a Cupertino Municipal Code, Section 9.18. 11 RE -ROOFS: Signature Date ' [� 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. O'YVNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt From the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sale compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air eontamivants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Guile, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Cade, for the performance of the work for which this the Health & Safety Code, Sect' ns 5 , 2 3z, d 2 3 Owner -or authorized agent: ate permit is issued. 1 certify that in the performanee, 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Leudcr's Name APPLICANT CERTIFICATION Lender's Address I certify that I 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 eity 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date `9 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 13110127 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/0912013 OWNER'S PHONE: 5103316719 MILPITAS, CA 95035 PHONE NO: (408)942-8200 IV LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] APPLE SCO AB 12,858 SQ FT TO p� rte, License Class Lie. tt I If/ DE M,E,P'S Contractor rDaTe r DEFERRED # 1 - INSTALLATION OF ENLARGED I hereby affirm that I am licensed under the provisions of Chapter 9EXERCISE ROOMS - ISSUED 2/27/2014 (commencing with Section 7000) of Division 3 of the Bnsincss & Professio c Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: — 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 ofthe Labor Code, for the Sq. Ft Floor Arca: Valuation: $4500000 performance of lite work for which this permit is issued. 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. APN Number: 35720020.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the derunstands and will comply granting of this permit. Additionally, the applicanrti Issued by: Date: with all non -point source regulations peri Cup icipal Code, Section M 9.18. r r ' �§dq"� RU -ROOFS - Signature alc All roofs shall be inspected prior to any rooting material being installed. Lf a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner ofthe 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations,. Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Arca Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupe InoRlunici 1 de, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se cti ns 05, 25533, al#3 . Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent:.. 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per tlrc Cupertino Municipal Code, Section Licensed Professional 9, l 8. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION - 10300 TORRE AVENUE • CUPERTINO, CA 950'14-3255 �CUPEFiTINO -t (4018-) 777-3228 • FAX ((408) 777-3333 • buildiiF ngacupertin_o.org 1 I NpCw n1N.RTRTTf'TTf1N I I AT71T)MnW I I AT .TF.R ATICSN I TT U R.VTSI0N / T)FFFRRFT) ORIOTNAL PPR .^} MTT # 4 / l I / PR078CT-ADDRESSI� Dr� JPJbb Rd, APN# • OWNER NAME. A-1- PHONE � >s �O Q �� • STREETADDRESS / �n 12 1 Loo CITY. ATE Z[P q6 FAX CONTACT NAME P6I� J M i`-,eLmoke i9c I PHS sem' �4� �M Ichelmnve�VCCO STREET ADDRESS r ! t V � C ATE, FAX � • 1❑/(OWNER M 1 13 OWNER ❑ OWNER-BUILDERr/ AGENT CONIRACTOR ❑ COMMACTOR AGENT 11ARCHITECT ❑ ENGINEER ElDEVFIOPER 11TENANT CONTRA RMUNA O LICENSE NUMH I+^ T�=SETYPE,X,10 HUS, LIC# 4 �!/ COMPANYNAME COQ) 01nm E-MAIL mow, d coh- FAX � STREET ADD SC STA +ZIP cf, ry () t PHO *94 ARCHTPECTlENGINEERNAMB' ' '' LICENSE NUMBER HUS. LIC# ZI�$p O Q COMPANYNAMEwPA1MAn FAX Ike STREET ADDRESS (�-(oa CITY, STATE ZIP 5du A04r/1CA 11I N4 �f�21-- ftp DESCRIPTION OF WORK r n JI I � � � D } ti {' � fl Q �f t ji} { r1�1 o m ' r ��C/U L3 �V �"Li`'I r 1lJ�IV -room �. yuV P �• EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES - ' - USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA , PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLBQG UNITS: 1S A SECOND UNIT ❑YES SECOND STORY YES BEINGADDED? []NO ADDITION? [:]NO FRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLD(; AN L] YES f'REGEIVET3 TOTAL VALIDATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO iow9ner's By my signature below, I certify to each of the following: I am the property owner o ed agent oact on the pro ehalf, I have read this application and the information [have provide is correct I have r d thf ription of Work and verify it is accurat . agree to comply with all applicable local ordinances and state laws relating to u'1 a myction. I auth rese tat' es of Cupertino to enter the above -identified properly for inspection purposes, Signature of Applicant/Agent: Date; V�'!/� L✓ SUPPLEMENTA&INFORMAT101A REQUIRED`" s+.--_ ,.e �..PLAId,CH7'(�CiT1TL.,•:sw� ��x:� 3�^"�a�OUTIIV"GS��+tS ,.�w_``��t: OVER TA1iCOU14TER ❑ BUILDiNGPLAN REYiEW 3 s 2 New SFD or Multifamily dwellings: Apply for demolition permit for existingbuildi s . Demolition permit is required ri6r to issuance of building �O p q P g n t v r r � k Ir k' � 4 r permit for new building. ❑ ExPiuss s $� � N .YLANNIt�'GREVIEW �^ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q s�AllnnxlD =1]rusLr�w fon rm if any HRzardous Materials are beig used as part of this project. .try 4 kh ry 5�: yp n, l7,� ,ri -Trc 9 :,` .E i {� yY T9"yt 3 P w '%'Wz" 7"V Copy of Planning Approval Letter or Meeting with:Planning prior to $ ♦ �s )'MA,JOR�>'`" �'.y s W. Q F-SAN7TARX.SER'ER D1STRI•'� submittal of Building Permit application. �'�a;""" �, R` e.LtI1VI�20I114IENTATtHRAL7=Htxw:l"�..,dGu S1dg,4pp 2011.doc revised 06111/11 1 CADYYI RJ CONSTRUCTION PERMIT APPLICATION 'COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION10f. 10300 TORRE'AVENUE • CUPERTINO, CA 95014-3255 GUts'ERTIN0 (408) 777-3228 • FAX (408) 777-3333 • building@cuper ino.org I7 NEW CONCTRT lr ..TION I I ADDTTION n AT.TP.R ATTON / TT 0 RFVTSI 1 I DEFERRED ORIGINAL PERMIT # f14 PROJECT -ADDRESS y 0/Lo o f�� j �7✓ jJ APN# PH NE Z-&MAII •OWNERNAME Hiote a e• STREET ADDRESS CITY, STATE, ZIP �r CA A FAX QoCONTACT NAME s n , PHO ��� E-MAIL f` 0 y^n STREET ADDRESS CITY s TE, ZI O 15 FAX r/A (J I ❑ OWNER ❑ OWNER•BUU.DER ❑ OWNERAGENT XCONTRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT 1:1 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N M i- LICENSE NUMHE_1,,�;1 I �✓ LICENSE BUS. LIC # EMAIL "V� FAX n 1 OW STREET S �� CITY STA ZIP Ch ,34 0 S P O 2 -.?2W0 ARCHITECT/ENGIIQEERN V�t� LICENSE NUMBER C� �J pL� ` BUS. LIC# COMPANY NAME ^i 111 E-MAIL y�� f�j dOld ► �C`I W hr Tht o� In .Ce+•• FAX ,1p���, STREET ADDRESS ZI +V s 1-ko-A C i1 AMO&. fKOD P1Y, STATE S613 d 4 S4 - C4 VS4 "'SAP PH 0 — DESCRIPTION OF WORK ^, _ �, jL ,NW A rd Lo EXISTINGUSE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN OTHER' REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLNGUNUS: ISASECOND UNrT ❑YES SECOND STORY []YES BEING ADDED? • ❑NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LEITER EICHLERHOMET []NOsi .,; �^'-m r �'-' By my signature below, I certify to each of the following: I am th roperty o er ora o ' on roperty owner's behalf. I have read this application and the information I have prov•de • correct I have e d the D c ption of Wor V it is curate. I agree to comply with all applicable local ordinances and state laws relatin to Mild g on (ruction. I au pre a tiv s of C rtino to enter the above -identified prop rty for inspection purposes. Signature of ApplicantlAgcnt: SUPPLEMENTAL&FORMATZK QUIREDc>cicE4s� .eu s w a -s �.. ROfITING_ IPZ= s ;!6-, t ,, i4� O�ER COUL INs"4+' +t'"� 3•%�''z74'-' - 4 1y 6ii DI PLAN pj • New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building THE TER 1 s � %�p "�N 'r 4"' x G ,,y W r � permit for new building. 1 1 ..Y � U Isr ANmIc rl �NAEVIEW, a '; g� p� l fl[IBL r+ Commercial Bldgs- Provide completed Hazardous Materials Disclosure sTnnxn �vUItTCS5' form if an Hazardous Materials are bei' used as art of this project. Y g P P] • �S.ARGP.�'ay_.� � r� i5'x%}v �a s kt ,, 0# � -t� � „„ Copy of Planning Approval Letter or. Meeting with Planning prior to `� Ott L z F Yif submittal of Building Permit application. •k'_5-iVt' 4 iAj F'3�' [��` (, �Y 'y _n§TaICzr• 'e"a* �.'Y' 1 r 9 T S, J'GT F4. . L"`^�'S"a�3K'w �ti :� x �a� x,�-dia�s�t�;,'�ls."�� �.�•, d• F _x©� EIWIROI+.IMENi'i�'.I-I�AliT�Iv4:ti.w B1dg,4pp 2011.doc revised 06/21/11 ;!10 . Ci7Yr CITY OF CUPERTINO FEE ESTIMATOR --- BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, e1a). These fees are based on the prelinunary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-05.3 Eff. 7/1/13) ADDRESS: 10300 BUBB RD Phimb. Plan Check DATE: 02/27/2014 REVIEWED BY: MELISSA Phimb, Permit Fec': APN: 357 20 020 BP#: 13110127 *VALUATION: Iso *PERMIT TYPE: Building Permit Alech. In.af . Fe. PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building hrs $0.00 PENTAMATION PERMIT TYPE: 1GENC0 i woffM R FV1%QN CHANGES TO PROPOSED ELECTRICAL RM & D.F.I,RM SERVER RM - 44" SCOPE 2/27 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, e1a). These fees are based on the prelinunary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-05.3 Eff. 7/1/13) Lterh. flan Check Phimb. Plan Check Elec. Plan Cherk f KI—.11. Pertuil Fe(,: Phimb, Permit Fec': Elea. Pcrmft Fee odwr Ahd uf'!. Insp. 0"Jvr Phimb Imp. 01her !;IGC_ Insp. Alech. In.af . Fe. 1'Irrrul�. lu•sp, Fee: Elec. Insp, _[""C: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, e1a). These fees are based on the prelinunary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-05.3 Eff. 7/1/13) FEE QTY/FEET MISC ITEMS Plan Check Fee: Hourly Only? ® Yes ) No $0.00 0 hours Plan Check, Hourly $139.001 ►STPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0,00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cons -notion Tax: Adininistrulive Fee: G Work Without Permit? ® Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A Tr(-.wel Documentation Ftres: Strom Motion Fee: $0.00 Select an Administrative Item BldgStds Commission Fee: $0.00 `SUBTOTALS: $0.00 '$139.001, TOTALFEE: $139.00 Revised: 01/15/2014 CITY OF CUPERTINO ID'/11 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the meliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution li-053 Eft: 711113) ADDRESS: 10300 BUBB RD DATE: 01/09/2014 REVIEWED BY: MELISSA 11fech. Permit Fee: APN: 357 20 020 BP#: 13110127 "VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 7 Plurnh. /rise. Fee: PENTAMATION 1 PERMIT TYPE: A WORK REV # 1 - 119114 -CHANGE LAYOUT ADD MECHANICAL EQUIPMENT WITH STRUCTURAL SCOPE UPGRADES TO SUPPORT. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the meliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution li-053 Eft: 711113) Afech. Plan Check Phuub. Platt Check Dec. Plan Check 11fech. Permit Fee: Fee: It -lee. Pennir Fee: Other Afech, Insp. Other Plumb Insp. Other Elec. Insp. �Wech. Insp. F't:e: Plurnh. /rise. Fee: Elec. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the meliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution li-053 Eft: 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. O OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp, Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consouction Tax: Adtnini slt'ative Fee: Work Without Permit? Yes E) No $0,00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 1 Tiarel Doewnentalion Fees: Strong Motion Fee: $0.00 F1 # $834.00 Revisions IREYCOMTI Tenant Improvement Bldg Stds Commission Fee: $0.00 11. SUBTOTALS: $0.00 $834.00 TOTAL FEE: 1 $834.00 Revised: 01/01/2014 FM__7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION igADDRESS: 10300 BUBB RD phenrb plow (:'bre.d DATE: 02/27/2014 REVIEWED BY: MELISSA 1'lnmh. permit Fee, APN: 357 20 020 BP#: 13110127 'VALUATION: Iso PERMIT TYPE: Building Permit ,41c°eb hasp F,.. I.. PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: hrs $0.00 PENTAMATION 1GENCOM PERMIT TYPE: WORIC�!`.EE3k SCOPE -'INSTALLATION OF ENLARGED EXERCISE ROOMS NOTE: This estimate aloes not include fees (lite to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School District, ela). These fees are based on the preliminary, information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resohrlion 11-053 Efl.' 7/1/13) itfc,h Man ('her k phenrb plow (:'bre.d Elec. flan (7,ck Vlerh Perrna Fee- 1'lnmh. permit Fee, ltlec ptrnrr Fre, 01-11t 0Ile r h. In -tipLi 01,1 r Plumb In %1;Lj other Elec Imp Lj ,41c°eb hasp F,.. I.. plumb My. Fee: Elec. Insp. heat" NOTE: This estimate aloes not include fees (lite to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School District, ela). These fees are based on the preliminary, information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resohrlion 11-053 Efl.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 t^! J # $278.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check. $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con+'1r uclion Tux: T -F Adminiatrutive Fee: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning- Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Ti• wel Dociementurion hies: Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE: $278.00 Revised: 01115/2014 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3224 Fax: 408-777-3333 JOB ADDRESS: 10,300 Bubb did. PERMIT # 13110127 Y OWNER'S NAN E:Apple PHONE #408-942-8200 GENERAL CONTRACTOR: Devcon Construction BUSfNESS LICENSE # 11068 ADDRESS. -690 Gibraltar Dr. CITY0PCODE:Milpitas 195035 *Otir municipal code requires all bllSinCSSC5 W01-1 lig in the oily to hnvc .r City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. °i°�""°"�°141" "a'°'°eB Ashley Michelmore °"° """°°° --0-04-03-14oti a�wLa�],oI�.�E..m�m�5mtita U9 I am not using any subcontractors-°"'?°'4oe.mw°aas mm Signature Please ebeelc applicable snbcontr:rctors nstd complete the following information: Date ✓ SUBCONTRACTOR BUSINESS NAN4E BUSINESS LICENSE 9 X Cabinets & Millwork Cement Finishing Mission Bell aS`j3 X Electrical Redwood Electric Group 21108 Excavation Fencing X Flooring / Carpeting DFS 28664 Linoleum 1 Wood X Glass / Glazing Walters & Wolf 25601 X Heating Insulation j �' AS` QL –45,js3 Landscaping Lathing Masonry X Painting/ Walipaper C&O —SG+26$--rs/ Paving Plastering X Plumbing Castro 25296 Roofing Septic Taal: Sheet Metal X Sheet Rock Magnum Drywall 25212 X Tile De Anza Tile 25127 Diguc9y signed by Ashley Micholmom Ashley Michelmore ON: cn=AsMeyMchalevccn-0 tcoCcnslruction,ou, 04-03-14 emalV.amirhelmoro�tlevcomoonsl,com, c.115 Dela: 2014.04.05 097249 -OT00' Owner / Contractor Signature Date