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B-2018-1054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1054 10501 N TANTAUAVE CUPERTINO,CA 95014-0709(316 06 06 1) Mike Drake 2025 Gateway Place 320 ATLANTA,CA 30339 OWNER'S NAME:(Campus ) DATE ISSUED:06/21/2018 OWNER'S PHONE:408-996-6684 PHONE NO:708-204-3230 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie.#977963 Contractor Mike Drake Date 1 0131/2 0 1 8 X BLDG X ELECT_PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my Beene is In full force and effect. JOB DESCRIPTION: AC2 THEATER-INSTALL DEDICATED CIRCUITS ON LEVEL B2 I hereby affirm under penalty of perjury one of the following two declarations: AND THE CREW ROOM;INSTALL(N)PANEL(100 AMPS)TO r. I have and will maintain a certificate of consent to self-insure for Worker's SUPPLY PROPOSED DEDICATED CIRCUITS. Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. z. 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:$50000.00 APPf.i2 t:F.RTIFR:ATION 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 ON Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 31606061 A(Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 06/21/2018 Issued by:Kim Dunbar Date:06/21/2018 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as thein sole installed without fust obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(See.7044,Business&Professions Code) Z 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the.project(See.7044,Business&Professions Code). Date:06/21/2018 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER L I have and will maintain a Certificate of Consent to self-insom 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, HAZARDOUS MATERIALS DISCLOSURE Z I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Coders 255Q5 55. ,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:06/21/2018 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is issued(Sec.3097,Civ.C.) to enter upon the above mentioned property for Inspection purposes. (We)agree Lender's Name to save Indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City In Lender's Address consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal AR HiT. T'A D. . RATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 06/21/2018 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1054 10501 N TANTAU AVE CUPERTINO, CA 95014-0709 (316 06 06 1) HOLDER CONSTRUCTION 3000 RIVERWOOD PKWY STE 1200 ATLANTA, GA 30339 OWNER'S NAME: ( Campus Holdings Inc) OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #977963 Contractor HOLDER CONSTRUCTION Date 10/31/2020 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: 1. 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. 2 I have and will maintain Worker's Compensation Insurance, as provided for by 01 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, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. (Signature Date 10-3-2018 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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) 2. 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: 1. 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. 2, 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. 3. 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, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 10-3-2018 DATE ISSUED: 06/21/2018 PHONE NO: BUILDING PERMIT INFO: X BLDG X ELECT —PLUMB _ MECH _RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: AC2 THEATER - INSTALL DEDICATED CIRCUITS ON LEVEL B2 AND THE CREW ROOM; INSTALL (N) PANEL (100 AMPS) TO SUPPLY PROPOSED DEDICATED CIRCUITS. REVISION #1 - MISC ELECTRICAL UPGRADES, INCLUDING POWER FEEDS FOR OUTDOOR MEDIA STATION, COMPANY ' SWITCH ADDITIONS, ADDED OUTLETS AND DEDICATED CIRCUITS, AND TEMPORARY BACK-UP POWER MODIFICATIONS - ISSUED 10-3-20108 Sq. Ft Floor Area: I Valuation: $50000.00 APN Number: Occupancy Type: 316 06 061 1 A (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 06/21/2018 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: 10-3-2018 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, Sections 25505, 25533, and 25534. Owner or authorized agent: / Date: 10-3-2018 CONSTRUCTION LENDING AGENCY I hereby affirm that there is 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. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1054 10501 N TANTAU AVE CUPERTINO, CA 95014-0709 (316 06 061) Mike Drake 2025 Gateway Place 320 ATLANTA, GA 30339 OWNER'S NAME: ( ) DATE ISSUED: 06/21/2018 OWNER'S PHONE: 408-996-6684 PHONE NO: 708-204-3230 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #977963 Contractor Mike Drake Date 10/31/2020 X BLDG X ELECT — PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH ,_ RESIDENTIAL X COMMERCIAL -- with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: AC2 THEATER - INSTALL DEDICATED CIRCUITS ON.LEVEL B2 I hereby affirm under penalty of perjury one of the following two declarations: AND THE CREW ROOM; INSTALL (N) PANEL (100 AMPS) TO 1. I have and will maintain a certificate of consent to self-insure for Worker's SUPPLY PROPOSED DEDICATED CIRCUITS. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REVISION #3 - ADD POWER AND CIRCUIT PROVISIONS FOR 2. I have and will maintain Worker's Compensation Insurance, as provided for by OUTDOOR AUDIO SPEAKERS. - ISSUED 1/18/19 Section 3700 of the Labor Code, for the performance of the work for which this REVISION #2 - MISC ELECTRICAL UPGRADES, INCLUDING permit is issued. ADDED POWER FOR WORKSTATIONS, UPDATED CIRCUITRY, AND APPLICANT CERTIFICATION RECONCILIATION OF COMPANY SWITCH SCOPE FROM REVISION certify that I have read this application and state that the above #1. - ISSUED 1/18/19 information is correct. I agree to comply with all city and county ordinances REVISION#1 - MISC ELECTRICAL UPGRADES, INCLUDING and state laws relating to building construction, and hereby authorize POWER FEEDS FOR OUTDOOR MEDIA STATION, COMPANY representatives of this city to enter upon the above mentioned property for SWITCH ADDITIONS, ADDED OUTLETS AND DEDICATED inspection purposes. (We) agree to save indemnify and keep harmless the CIRCUITS, AND TEMPORARY BACK-UP POWER MODIFICATIONS - City of Cupertino against liabilities, judgments, costs, and expenses which ISSUED 10-3-2018 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Sq. Ft Floor Area: Valuation: $50000.00 Signatur Date 1/18/19 APN Number: Occupancy Type: 316 06 061 A (Tenant Improvements) OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: PE1ZMIT EXPIRES IF WORK IS NOT STARTED 1. I, as owner of the property, or my employees with wages as their sole . WITHIN 180 DAYS OF PERMIT ISSUANCE OR compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 180 DAYS FROM LAST CALLED INSPECTION. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Issued by: Kim Dunbar I hereby affirm under penalty of perjury one of the following three declarations: Date: 06/21/2018 1. 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 RE-ROOFS: performance of the work for which this permit is issued. All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. I have and will maintain Worker's Compensation Insurance, as provided for by installed without first obtaining an inspection, I agree to remove all new materials for Section 3700 of the Labor Code, for the performance of the work for which this inspection. permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I Signature of Applicant: shall not employ any person in any manner so as to become subject to the Date: 18/19 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. HAZARDOUS MATERIALS DISCLOSURE APPLICANT CERTIFICATION I have read the hazardous materials requirements under Chapter 6.95 of the I certify that I have read this application and state that the above information is California Health & Safety Code, Sections 25505, 25533, and 25534. I will correct. I agree to comply with all city and county ordinances and state laws maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the relating to building construction, and hereby authorize representatives of this city Health & Safety Code, Section 25532(a) should I store or handle hazardous to enter upon the above mentioned property for inspection purposes. (We) agree material. Additionally, should I use equipment or devices which emithazardous to save indemnify and keep harmless the City of Cupertino against liabilities, air contaminants as defined by the Bay Area Air Quality Management District I judgments, costs, and expenses which may accrue against said City in will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and consequence of the granting of this permit. Additionally, the applicant understands the Health & Safety Code, Sections 25505, 25533, and 25534. and will comply with all non-point source regulations per the Cupertino Municipal �- Code, Section 9.18. Owner or authorized agent._ Date: 1/18/19 Signature Date 1/18/19 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.)