B-2016-1893CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMI
NO: B-2016-1893
19319 STEVENS CREEK BI;VD CUPERTINO, CA 95014 (316 20 113)
S C BUILDERS INC
SUNNYVALE, CA
94085
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC
DATE ISSUED:
05/05/2016
OWNER'S PHONE: 408.777-3081
PHONE
O: (408) 328-0688
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 3 Lic. #Z 1"
Contractor S C BUILDERS !INC Date 08/31/2017
XBLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIDENTIAL X
COMMERCIAL
with Section 7000) of Division 3of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
INSTALLATION OF HIGH DESITY
FILING UNITS IN ROOM #1038.
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
l k
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation:
$5000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
"N Number:
Occupan
ry Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
316 20113
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
PERMIT EXPIRES
WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS
F PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST
CALLED INSPECTION.
Z
:Signature Date 05/05/2016
Issued by: SEAN HATCH
OWNER--BUILDERDECLARATION
Date: 05/0512016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
following two reasons:
All roofs shall be inspected prior to
any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an ir
spection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection..
sale!(Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 05/05/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERING
S TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS
DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials
requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Coc
e, Sections 25505, 25533; and 25534. I will
permit is issued.
maintain compliance with the CuF
ertino Municipal. Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section
5532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use
equipment or devices which emit hazardous
air contaminants as defined by the
Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the
Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code,
Sections 505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05/05/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION
LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a con
truction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued
(Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep' harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence'of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
ARC TECTIS
DECLARATIO
Code, Section 9.18.
1 understand my plans shall be used
as public records.
Licensed
Signature Date 05/05/2016
Professional
CUPERTINO
CONSTRUCTfON PERMIT APPLICATION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(448) 777-3228 • FAX (4,03) 777-3333 = building5cuperiino.gr
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