B-2016-1390 PERMITCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1390
10200 MILLERAVE CUPERTINO, CA 95014-3400 (375 03 005) LEON CONSTRUCTION
19400 SORENSON AVE
#114, CUPERTINO CA
950t4
OWNER'S NAME: FONTAINBLEU LLC I (DATE ISSUED: 02/24/2016
OWNER'S PHONE: I PHONE NO: 4082091272 I
LICENSED CONTRACTOR'S DECLARATION
Class B. CIO Lic. # 66002-72
or LEON CONSTRUCTION Date 2/23/2016
eby affirm that I am licensed under the provisions of Chapter 9 (commencing
Section 7000) of Division 3 of the Business & Professions Code and that my
se is in fall force and effect.
hereby affirm under penalty of perjury one of the following five declarations:
1. 1 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.
1 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 ag inst said City in consequence of the
granting of this permit. Additi ally, ffffffJJJ�JJ�����a applicant understands and will
comply with all non -points ce repfulation�ie} the Cupertino Municipal
Code, Section 9.18. �/ r I ��
2/23/2016
eby affirm that 1 am exempt from the Contractor's License Law for one of the
ving two reasons:
r. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and die structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
r. 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.
a. t certify that in the performance of the wm'k 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.
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.
PERMIT INFO:
BLDG _ ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
DESCRIPTION:
.00F BUILDING H WITH NEW PVC ROOFING (8,930 S.F.).
ALL SLEEPERS AND NEW SHEATHING TO RAISE ROOF PITCH
DRAINAGE.
Ft Floor Area: I Valuation: $50000.00
APN Number: Occupancy Type:
375 03 005
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST -CALLED INSPECTION.
I by: PAUL O'SULLIVAN I.�
M/lA I r.
RE -ROOFS:
All roofs shall be inspected prior to any rooting material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
2 23/2016
COVERINGS
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Califm'nin Health & Safety Cade, 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 are or handle hazardous
material. Additionally, should I use equipment o evict,it i h emit hazardous
air contaminants as defined by the Bay Area A' Qnal' y agmn t District 1
will maintain compliance with the Capes [iuo unit' . l , Chu ter 9.12 and
the Health & Safety Code, Se o 2550 , 5533 and 2, 34.
Owner or authorized agent:
Date: 2/23/2016
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
ARCIIITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date 2/23/2016