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B-2016-2130 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2130 10351 N PORTAL AVE CUPERTINO,CA 95014-2324(316 31 020) ACCO ENGINEERED SYSTEMS INC GLENDALE,CA 91201 OWNER'S NAME: MCMANUS MARCELLA M TRUSTEE DATE ISSUED:06/14/2016 OWNER'S PHONE: PHONE NO:(818)244-6571 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL ENGINEERING CONTRACTOR Lie, #120696 BLDG _ELECT —PLUMB Contractor ACCO ENGINEERED SYSTEMS INC Date 12/31/2017 X— I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH— —RESIDENTIAL X_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: BUILDING#8;T.I.-IT SERVER ROOM;NEW ROOF TOP UNIT; I hereby affirm under penalty of perjury one of the following two declarations: WALL/CEILING MOUNTED UNIT-APPLE 1. I have and will maintain a certificate of consent to self-ins a for Worker's Compensation,as provided for by Section 3700 of the Lat or 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 Section 3700 of the Labor Code,for the performance of th e work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000.00 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 count ordinances 316 Number: Occupancy Type: and state laws relating to building construction,and hereby aut�orize 316 31 020 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 expehses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all hon-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature \ I Date 14/2016Issued by:Abby Ayende Date:06/14/2016 �'`�►�/y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is t. I,as owner of the property or my employees with wages I s their sole installed without first obtaining an inspection,I agree to remove all new materials for I inspection. compensation,will do the work,and the structure is not' tended or offered for sale(Sec.7044,Business&Professions Code) 2.. I,as owner of the property am exclusively contracting wiII licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 Lai ior Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 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 Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to beco a subject to the air contaminants as defined b the Ba Area Air Quality Management District I rid Y Y Q tY g Worker's Compensation laws of California. If,after in 'I g this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensati provisions of the the Health&Safety Code,Sections 25505,25533,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:6/14/2016 I certify that I have read this application and state that the abo Ie 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 construction 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 agEinst 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 ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/ 46 1� /2016 Professional I GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPME qT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CJPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcuaertino.ong misc fJ-ZOLCo -213D ❑PLUMBING MECHANIC L ELECTRICAL ❑MISCEELLANEOUS PROJECT ADDRESS 7 O-_Z-5 I f5v-oz /Zo APN# 1 P_ �t-O, II / 1 OWN ERNAME A071,1_= (NC, PHONE y�Q E-MAIL L r STREET ADDRESS y�35� 3u- 1Z-0WD CITY,STATE,ZIP���,Aj0/ (/C A g5L)I� FAX 1 `7 CONTACT NAMEPHONE E-MAIL jZfJ$6� 7o�,cNIG( STREET ADDRESS �y CITY,STATE, ZIP FAX 11 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT k`CO CTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEjZUT3ErZf LCCENSE NUMBER ;ZD LICENSE TYPE BUS.LIC# 1��•7 i70(u-F.,rv1G( o (� COMPANY NAME �J ,, ��u (t � �j�C(i�S E-MAIL ��©M�N 1G(���SS�I LE,c�r_l FAX AU0 La Co°l-Z5 STREET ADDRESS 'a 7 b t �� OlZ(UF CITY,STATE,ZIPI„P TUB' (-A q613( PHONE(a�q^Z57- &&Us ARCHITECT/ENGINEER NAME LII ENSE NUMBER BUS.LIC# COMPANY NAME E-MAH. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SID.,DUPLEX ❑ MULTI-FAMILY PROJECT IN*,ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTEFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK acv SYt_(i 4YST-�, 0 ?5k(--WM1r A,t, U, U/i, _ _TT SeNeV TO .— V1Q,c�t1 �p lAVtt� CUt R TOTAL VALUATION: zo r O D RECEIVED BY: Q?1tib� By my signature below,I certify to each of the following: I am the roperty owner or authorized agent to act on the property o er's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating tM struc ion. I auth ':e representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: Q SUPPLEMENTAL INFORMA ION RE UIRED OFFICE USE ONLY W ❑ OVER'-THE-COUNTER D EXPRESS ..."❑ STANDARD LARGE D.. MAJOR MEPMiscApp_2011.doc revised 06/21/11