B-2019-0998 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0998
1 APPLE PARK WAY CUPERTINO,CA 95014(316 07 049) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:06/07/2019
OWNER'S PHONE: PHONE NO:408.942.8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2021 X BLDG —ELECT —PLUMB
X MECH RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: APPLE-LAB H09 T.I.-BUILDING A4 2 POD 11 -INSTALL(2)(N)FANCOIL UNITS IN LAB WITH NEW WALL(8 LF).
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 perfonnance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$150000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 07 049 A(Tenant Improvements),A(Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A
inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A
City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A
Additionally,the applicant understands and will comply with all non-point (Tenant Improvements)
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 6/7/19
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Haley McKee
1. I,as owner of the property,or my employees with wages as their sole Date:06/07/2019
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) RE-ROOFS:
2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is
contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
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 Signature of Applicant:
performance of the work for which this permit is issued. Date:6/7/19
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfonnance of the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
_
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:6/7/19
judgments,costs,and expenses which may accrue against said City in CONSTR
consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 6/7/19