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09090082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10212 N DE ANZA BLVD CONTRACTOR: BENCHMARK PERMIT NO:09090082 CONSTRUCTION OWNER'S NAME: 10212 N DE ANZA LLC 1045 LINDA VISTA AVE DATE ISSUED:09/11/2009 OWNER'S PHONE: 4086552326 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)938-1802 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL r Contractor Dale I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:2ND TEMPORARY PERMIT(FOR FOUNDATION& (commencing with Section 7000)of Division 3 of the Business&Professions PARTIAL Code and that my license is in full force and effect. FRAME),ORIG TEMP PERMIT EXPIRED(09070209)OR1G PERMIT#09060052;THIS PERMIT GOOD THRU 10/11/09 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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 Sq.FI Floor Area: Valuation:SI00 permit is issued. APPLICANT CERTIFICATION APN Number:31626088.00 Occupancy Type: 1 certify that 1 have read this application and stale 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date Issued b Date: OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is the following tiro reasons: installed without first obtaining an inspection,l agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material. permit is issued- Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall conlaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California- If,after making this certificate of exemption,) become subject to the Worker's Compensation provisions of the Labor Code,1 must 0ora thorized cqont: / � forthwith comply with such provisions or this permit shall be deemed revoked. IVF U6*?L Q.6-te: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec-3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 ARCHITECT'S DECLARATION 9.18. qq� �q��'A /� 1 understand my plans shall be used as public records. Signatur4 nj?- /V. D0 !/�L� IllyDate �� Licensed Professional CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:BENCHMARK PERMIT NO:09090082 BUILDING ADDRESS: 10212 N DE ANZA BLVD CONSTRUCTION O'- -''FR'S NAME: 10212 N DE ANZA LLC 1045 LINDA VISTA AVE DATE ISSUED:09/11/2009 O�. MOUNTAIN VIEW,CA 94043 PHONE NO:(650)938-1802 _ ER'S PHONE: 4086552326 p LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# MECH I— RESIDENTIAL I— COMMERCIAL Contractor Date JOB DESCRIPTION:2ND TEMPORARY PERMIT(FOR FOUNDATION& I hereby affirm that I am licensed under the provisions of Chapter 9 PARTIAL (commencing with Section 7000)of Division 3 of the Business&Professions FRAME),ORIG TEMP PERMIT EXPIRED(09070209)ORIG Code and that my license is in full force and effect. PERMIT#09060052;THIS PERMIT GOOD THRU 10/11/09 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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 Sq.Ft Floor Area: Valuation:$100 permit is issued. APPLICANT CERTIFICATION APN Number:31626088.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section _7 9.18. Issued b Date: Si---ure Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Business&Professions Code) Signature of Applicant: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: ' HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Workers Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 r aythora a nt: N2 L(16ate. forthwith comply with such provisions or this permit shall be deemed revoked. i I CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name u* 'ie above mentioned property for inspection purposes.(We)agree to save i:_ ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. p f np I understand my plans shall be used as public records. re/V Signatut/G l�?,�c Date �� © Licensed Professional RIPASIGN#_ 1 CITY OF CUPERTINO BUILDING PERMIT Z. 0 C1 BUILDING ADDRESS: 10212 N DE ANZA BLVD CONTRACTOR:BENCHMARK PERMIT NO:09060052 CONSTRUCTION OWNER'S NAME: 10212 N DE ANZA LLC 1045 LINDA VISTA AVE DATE ISSUED: 11/02/2009 C R'S PHONE: 4086552326 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)938-1802 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f- ELECT r PLUMB f— License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT NEW COMM BLDG FOR MERCANTILE (commencing with Section 7000)of Division 3 of the Business&Professions PURPOSE Code and that my license is in full force and effect. INCLUDES STRUCTURAL AND M/E/P'S 1,999'.ATTACHED TO T.I.STRUCTURE. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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:$300000 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:31626088.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: ���� Date: 2�/Y-LS- OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safe Code,Secti 25505,25533,and 25534. 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. Owner4*tg A Date: / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i; .ify and keep harmless the City of Cupertino against liabilities,judgments, C(1, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. pI understand my plans shall be used as public records. Signature 7 !ti �Grlir"�14 �-f`- Date /7J/5—/03 Licensed Professional