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11080055I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10080 N WOLFE RD k ER'S NAME: CUPERTINO FINANCIAL CTR PARTS LLC CONTRACTOR: APPLIED CONSTRUCTION TECH 1230 OAKMEAD PKWY PERMIT NO: 11080055 DATE ISSUED: 10/04/2011 OWNER'S PHONE: 4085679900 1 SUNNYVALE, CA 94085 1 PHONE NO: (408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION License Class,3• Lie. # "S0 U (4 ) Con tracto Y' P Date 6 l I herb, 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. BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r MECH r— RESIDENTIAL I— COMMERCIAL r— JOB DESCRIPTION: NEC-STE 350 - COMM TI REPLACE NEW UPS & SUPPORTING SERVICES IN COMPUTER ROOM & ENERGY LAB 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 Sq. Ft Floor Area: 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-poin ource regulations per the Cupertino Municipal Code, Section 9.18. ature G� " — Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 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: 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. 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 ,nrrect. I agree to comply with all city and county ordinances and state laws relating uilding construction, and hereby authorize representatives of this city to enter ,on 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 Valuation: $30000 APN Number: 31620086.10080 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date77G°"- 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: 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. 1 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,4Safety Code, Sections 25505, 25533, and 25534. Owper/. f tjjp "gent: �/ Y �� �� __ Date: 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT IIIIILDING ADDRESS: 10080 N WOI.FI3 RU OW]ER'S NAME: CUPER'I'IN01'INANCIAL. CTR PAR'I'S I.LC — 'S PHONE; 4085679900 I LICENSED CONTRACTOR'S DI?CLAIIA ION License Class 13 Lic a '73 0 City Contractor APPlydn Lem- TCNI Dnle I hereby affirm Ila( I ant licensed under fire provisions Of Chapter 9 (commencing ",fill Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the lolh),viag two declarations: I have and will nwinmin it ecrlilicade of consort to self -insure fur Worker's Compensation, as provided for by Suction 3700 of the Labor Cock. for the performance Of the work for which this permit is issued. I have and will maintain Worker's Cmnpcnsation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which Elis pcnnil is issued. A PPLIC\N'r CF:R'I'IFI(:A'I'ION I certify that I have read this application and state flat the above infOrtnation is correct. I agree to comply with all city and county ordinances turd state laws relining to building constmctirnh, 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, judgincros, costs, and expenses v#ch may, accrue against said City in consequence of the granting of this pen d. Addluo ally, the applicant understands and will comply with all ;1011 -point nice reg bons per the Cupertino Municipal Code, Section 9.1x. ! 7 C[ONIRAC1014; APPLIYU CONS' I'ltUC'1 ION 'I'f:Cl I 123(1 OAK5IEAD PK\\'Y S(NNYVALE, CA 94085 PERMIT NO: 11080055 DATE ISSUED: 10/04/2011 1'110\E NO: (40x)252 99911 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB I MF.CH r RESIDENTIAL I COMMERCIAL .JOB DESCRIPTION'. NIiC-S'I'1i 350-COMM'I t REI'LACE NIIW EJVS SUPPOR PING SFRVICFS IN COMI'U'I'GR ROOM & IINI:RGY ].All I Iq'_/1I RIAIISION 0I ADI) ONE MORI: COMPUTER RACK IN'1'lit. F.XIS PING COMI'll'II:R KOONI-ISSIJIiD 12/7/11 Sq. Ft Flour .Area: Vahmliont $300011 AI'N' Number. 31620086.100x0 Occupancy Type: I hereby affirm that I ,in exempt from the Contractor's License Imo, for one of the following two reasons: I, as owner ol'Ihe progeny, or my employees with wages as their sole compensminn, will do the work, and the structure is not intended or cohered for sale (Sec.7044, Business & Professions Code) L as owner of the property, am exclusively contracting with licensed coil m construct the project(Sec.7044, Business & professions Code). I hereby affirm under pemdty tilperjury One Of the following ""'cc declarations: 1 have and will maintain a Cenificnle of COasenl to self -insure for Worker's Compensation, is provided for by Section 3700 at tile Labor Code, for the performance of the work for which this pcnnil is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the labor Code, for the perfornanec of Ila work for which this 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, alter making this certificate of excngmion, I become subject to the Worker's Co;nIle 11 sat ion provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be dccnhcd revoked. A I'I'I.ICAN'I' CISR'I'I FIG\'I'10N' I certify that I have rend Ellis application and slate that the arrive information is correct. I agree to comply with all coq' and county ordinances and slate laws totaling to building coil s'tructi011, and hereby authorize representatives of this city In enter upon the above mentioned property for inspection purposes. (We) agree to save iemnit'y and keep harmless tic City of Cupertino against liabilities, ludgnlenls. ts, and expenses which may accrue ngainst said City in consequence or the granting orthts permil. Additionally, the applicant undersumAs and will conhp1Y with till non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMITISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. //�� Date: � 2— !---1 Issued byf� RE -ROOFS: All roofs shall be inspected prior to any nutfulg "I'll l being insadled, II'a roof is installed without first obtaining an inspection. I agree to remove till new materials for inspection. Signature of Uma: ALL ROOF COVERINGS'I.0 BE CLASS "A" Oli B1:1-I'EIt I1:\IA1(1)01;S \I,\9E121ALS DISCI.OSIi11111 I have read the hazardous materials requiremenls under Chapter 6.95 of tile California I lenith & Safety Code, Sections 25505, 25533, and 25534. 1 will mulatto" compliance with the Cupertino Municipal Cod,, Chapter 9.12 and the Ile lith & Safety Code, Section 25532(11) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air ennmml anti as deli tie by the [lay Arca Air Quality Management District I will maintain ntpliance'ith the Cupertino>Iunicipal Cndc, Chapter 9.12 and the I leldth SafetyCt c, Scrtimrls 25505, 25533, and 25534. ��sS'I'RUC'1'ION' hIiNDING AGp;NCI' I hereby affirm that Ihcre is it construction lending agency for the performance Of l%ork's for which this permit is issued (Sec. 3097. Civ C.) Lender's Name Lender's A RCI11'fFCT'S DECLARATION I understand my plans shell be used as public records. Licensed