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