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B-2016-2080CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2080 10201 TORRE AVE CUPERTINO, CA 95014-2131(369 41 005) SKYLINE COMMERCIAL INTERIORS INC SAN FRANCISCO, CA OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP DATE ISSUED: 08/10/2016 I OWNER'S PHONE: 408-982-8433 I PHONE NO: (415) 908-1020 LICENSED CONTRACTOR'S DECLARATION License Class B Lic, #727637 Contractor SKYLINE COMMERCIAL INTERIORS INCDate 09/30/2016 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. ,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. 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 regulati n p r he C ertino 0nicipa ode, Section 9.18. Signature Date 8/10/201 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 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 (See.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. s. 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. Signature Date 8/10/2016 BUILDING PERMIT INFO: BLDG _ ELECT _ PLUMB MECH _ RESIDENTIAL X COMMERCLAIL DESCRIPTION: FLOOR; T.I. - RECEPTION AREA (590 S.F.) -AMAZON Ft Floor Area: Naluation: $20000.00 "N Number: Occupancy Type: 369 41 005 1 B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Aygndc RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/10/2016 ALL ROOF COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous. material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Manageme District I will maintain compliance with the C ertin Muni 'pal Code, h3P r 9.12 and the Health & Safety Co e, Sec o s 255 5 25533, a d 2553 owner or authorized agent: Date: " 8/10/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CGP-ERTIN (408) 777-3228 a FAX (408) 777-3333 buildi up@rt na oral ' �- ❑ jilt' CC3NSTRCIC I"ION ❑ r!I)tai PION 0 ALTERATION / TT ❑ REVISION 1 DEFERRED ORWINAL PERMIT P Phi JF.CT AI?l�I{gg$ ' "0' �C� � �� . �ii OWNER GAhIr PHON['. ^ n t3 E-411TL L Chi C'3 , ! _4 ➢➢=ui` ��o MEET ADDRESS CtI"S', S`CI\'CE.2.iF �y CON ACT NAME s b Q PHOINE F -MAIL. *I . T 4<4 s nzFEr ADDRrss 01\ . sr crs . zip sees, lap.- u 7 L� FAX ® f71V:tiCti ❑ OtVSfEti-i3t%it(2iR I] aq'*,F:RAt;C\T ® CONFIXACTOR ❑cuNrRACTCIRAGENT' 41 4RCHfT7i('F ❑ E_tiGiivFFR ❑ DEVELOPER ❑ 't`('•;y\4T fiO\TR4CTORNAME I.� i�.. 3"u°',' tEl.5..$1•�U1'nLL'4 �.. tf` 'jI.''11 ,.�.+ ri.'Er �. T .3FAXLICFNSFtit;43ER$ C3T'LIrtiNSCi1PPCLS LIC= �1. �H a�� C?MPANNYNAMEYo STREET ADDRESS >�a`"`" t C'tiY. Crt�'E.7,tP _� �a 1 iIGT, F'i`g-r yI`l+ ees' ev ,-i. *mac w 4 Ff 10`�,i:"? }� G r1L Ti'Lr� j„� \itF. LFCFNSF NT`:\IBER CA2 6 0 3 5 L4jjj��}} VU ries tdt'=� �ntiIPANY NA`IF OQMS- i /MARVIN STEIN ASS CVIAIL EGOODELL@NELSONONLINE.com STRFF' ADDR FSS Ci rS'. S r 17F., 1500 WESTLAKE AVE NORTH, STE 1 7tP SEATTLE, WA 98109 "1R)N"206.441.144( DLSCRIPIt(,i;y:{)F1V"L7R.K.. aim INTERIOR TENANT IMPROVEMENT AT EXISTING BUILDING MA ..:� U+? o _ ...._ � ... �.., tj1rFACFC NXIS fl NG USE PROPOSED USE CONS7R TYPE stSFORIES Ll 'r I h��siLyy r i tst. TYI>I (lcc - - SQ F7` =Uli`LI.i_IjG iSNFIS tS:1SEGa:Vn LMT' QYFS iLCaiti ID 4'rat;Y �SFS� ❑.kfSTG NEWI'LOOR UI>',4a O`I'AI. ,iREA '.I.. t AKEA :1KF.a N't:t ARFA :3 D ' L;`Ai1IROt?tt �p-p� i�CFCHF'�� p C)Titc7t REMODFLARFA LTJ L RWODLL. RFA 5*F! '-4r RF-MODFL AREA wefO' - �. MA ..:� U+? o _ ...._ � ... �.., tj1rFACFC =Uli`LI.i_IjG iSNFIS tS:1SEGa:Vn LMT' QYFS iLCaiti ID 4'rat;Y �SFS� - �. RF.t+IG:iApF.[)? W\a ADDITION". �n F PRE -APPLICATION [l Yt`S IF YES, PROVIDE COPS OF PLANNING APPIl ONO PL\NNI`G APPROVAL Lf.fT'F`.R IS -1.110 flLDG kN, o Yt:S EICIFLER 110AIE? [3 N() titE=IVEDB-Y- -0 p.. � EC)'I�:%V dL�L'r�\Li,'A E7C71w I3y° Iitt' signature belotl_ I certify it) each of the following i am the prop ert} t,\tner or authanzed agent to act on the property annt r :s behalf' I have read this apphcatianand the mibrfnation I hate provided is correct. I have read the Dmription oI' Work ly is and ven It accurate. l agree to comply #with all applicable local ordinances and state t !tt$ relatingt0 bnlldiFtg pC{i,F7 i a)If ,ni1�E representatives CCI Cupertino 26 Cl'fer Cite above- identified property or inspection purposes, SigaattireofApphc int Agent M' _ Date • 7.16 SU I'Lf. WNT°AL INFORMATION REQUIRINI) New SFU or Multifamily dwellings: Apply fnr delnolitiort Nnnit Ior Pt.A. cIIE;cFc rYP' rtL1L�'t €�vs cele existutg building(s). Demolition permit is required prior to issuance of building ❑' t�vPR.'rtt� C(5UN"IFR ❑ RL=ttnll`G.I•tAvttEvtl�v permit for new building. ❑ I:,XPRESS ❑ YtA:'U;'vINGPLAN RI;F'Ik:Si' X _ Commercial Bldgs provide it completed I fa-r_ardous Materials Disclosure ElSTAtv'r4ARI) ❑ PuRt.1cwORtzs fol` i Warty Hazardous Materials are being used as part of this project. ❑ I ;1IiGl ' Q FM DErr Copy of Pianuing, Approval Letter or Meeting with Planning prior to sitbntittal (11713uilding Permit application. MAJOR ❑ SANI ARS S12WER Df, rtttCT 131* -4m) 011.doc evistd O6 21 11