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B-2016-1308CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR:: PERMIT NO: B-2016-1308 19725 STEVENS CREEK BLVD CUPERTINO, CA 95014-2405 (316 20 083) SAGARCHI ENTERPRISES INC 495 E BROKAW RID #F SANJOS 95112 OWNER'S NAME: PORTAL PLAZA LP DATE ISSUED: 08/11/2016 OWNER'S PHONE: 650-919-3459 PHONE N0: 408458-6670 LICENSED ONT A TOR' DECLARATION License Class 5 Lie. #8394 99 fUILDING PE>G2NIIT INFO: ContractorSAGARCHI ENTERPRISES INC Date 08/31/2018 XBLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapte (c mmencin g — MECH _ RE$IDENTrar, X CO RCIAL with Section 7000) of Division 3 of the Business & Professions Code n that my license is in _ ll force and effect. JOB DESCRIPTION: CUPERTINO Mt1RKET - PLACE (E) PRODUCE CASES, (E) GLASS enalty of perjury one of the following two declarations: I hereby affirmXa.nd DOORS, (E) SINKS, (E ATER HEATER; INSTALL 160 S.F. OF T BAR 1. I hall maintaina certificate of consent to self-insure for Worker's CEIL G WITH(N) SHES IN OFFICES AND BACKROOM Compensation, provided for by Section 3700 of the Labor Code, for the #1-DE T FOR STRUCTURAL & ELECTRICAL CALCS FOR T performance of the ork for which this permit is issued. N ROOF T A/C UNITS= SSUED 1/18/207 -'� 2. 1 have and will main ' Worker's Compensation Insurance, as provided for � Section 3700 of the Lab0 ode, for the performance of the work for whit this v permit is issued. Sq. Ft oor Area:' Valuation: $10000.00 P certify that I have read this application an tate that the above N Number: Occupancy Type: information is correct. I agree to comply with city and county ordinances and state laws relating to building construction, a d hereby authorize /31620083 A (Tenant Improvements) representatives of this city to enter upon theabove entioned property for inspection purposes. (We) agree to save indemnify a keep harmless the City of Cupertino against liabilities, judgments, costs, an expenses whic PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City consequence the of this pe it. Additionally, the applicant understands and willl complyly with a on- int WITHIN � 80 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9. 180 DAYS I ROM LAST CALLED INSPECTION. Signature,-', Dat i Issued by: KIM DUNBAR Date: 08/11/2016 I hereby affirm that I am exempt from the Contra or'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 a oyees with wages as their sole talled without fist obtaining an inspection, I agree to remove all new materials for compensation, will do the work, d the structure is not intended or offered for inspection. sale (Sec.7044, Business & Pr essions Code) 2. I, as owner of the property exclusively contracting with licensed Signature Applicant: nstruct a project (Sec.7044, Business Sc Professions Code). contra/penal Date: I hereby affirm al of perjury one of the following three declarations: i. I havefain a Certificate of Consent toself-insure for Worker'sCompprovided ALLRO COVERINGS TO BE CLASS "A" OR BETTER for by Section 3700 of the Labor Code, for the perforhe work for which this permit is issued. HAZA MATERIAL DISCLOSURE 2. I haveaintain Worker's Compensation Insurance, as provided for by I have read the hazardous aterials requirements under Chapter 6.95 of the Sectiohe Labor Code, for the performance of the work for which this California Health & Safety ode, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cu rtino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25 2(a) I handle hazardous a. 1 certify that in the performance of the work for which this permit is issued, I should store or shall not employ any person in any manner so as to become subject to the material. Additimi, ally, should I use eq ' ment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Air Quality Management District I `vim maintain compliance with the Cupertino . unicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cade, 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: 1/18/2017 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 I hereby affirm that there is a construction gency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is is c. 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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 1/18/2017 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 19725 STEVENS CREEK BLVD CUPERTINO, CA 95014-2405 (316 20 083) CONTRACTOR:! SAGARCHI PERMIT NO: B-2016-1308 ENTERPRISES INC SAN JOSE, CA 9512 OWNER'S NAME: PORTAL PLAZA LP DATE ISSUED: 08/11/2016 OWNER'S PHONE: 650-919-3459 PHONE NO: (408) 458-6670 LICENSED CONTRACTOR'S DECLARATION BUILDING PEMT INFO: License Class. GENERAL BUILDING ONTRACTOR Lic. #839499 Contractor SAGARCHI ENTERPRISES INCDate 05/31/2018 X_ BLDG —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 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: CUPERTINO MARKET - REPLACE (E) PRODUCE CASES, (E) GLASS 1. I have and will maintain a certificate of consent to self-insure for Worker's DOORS, (E) SINS, (E) WATER HEATER; INSTALL 160 S.F. OF T-BAR CEILING WITH (N) FINISHES IN OFFICES AND BACKROOM Compensation, as provided for by Section 3700 of the Labor Code, for the REV # 1 - DETAILS FOR STRUCTURAL & ELECTRICAL CALCS FOR performance of the work for which this permit is issued. 2 (I) ROOF TOP;A/C UNITS - ISSUED 1/24/2017 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. Sq. Ft Floor Area: Valuation: $10000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy 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 20 083 A (Tenant Improvements) 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 IF WORK IS NOT STARTED may accrue against said City in consequence of the granting this permit. Additionally, the applicant understands and willl comply with all ll non-point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 'Signature` ^ 1 4 17 Issued by: Susan Winslow - Dy,,AR ATION Date: 08/11/20161 I here y'hi rm 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 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, 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 ofApplicatrt: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 01/24/2017 I hereby affirm under penalty of perjury one of the following three declarations: r. 1 have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 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 a� 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 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall _ be deemed revoked. �! - -Owner or authori4ed age APPLICANT CERTIFICATION Date: 01/24/2017 j I certify that I have read this application and state that the above information is I I hereby affirm than there is ac9n ruction lend' for the correct. I agree to comply with all city and county ordinances and state laws gency performance for relating to building construction, and hereby authorize representatives of this city of work's which this per is issued c. 30.97, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name i 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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. i Signature Date 01/24/2017 Licensed Professional i CONSTRUCTION PERMIT APPL[C�T€ON COMMUNITYp.EVELDPAIIENT DEPARTMENT • BUILDING p{VIS10 1030-0 TORRE AVENUE • CUPERTINO, CA 95014-3255 � ,,^A CIIV?ERT1Hp� (408) 777-3228 - FAX (408) 777-3333 , bulldina(DouDertiro ora n i 11-Ttn)d n A nr11.11T1111 rl - F,,� _ ! 17 -7 J. ,. -.. .i. r -1-1 r '1 V - I.)L)c s 0S PROTECT ADDRESS I��� �, n r PHONE rq OWNER 1+4ME ` # , GA _ E -hi L 4 } vt STREETADDRESS til>< r� I CITY, STATE, ZIP f FAX CONTACT NAME � � PiiOy� •r�k✓t ��� VL�ZI_E-h "� �FI� A� � (/r� 0 �.S des v C��..fC 14 STREET ADDRESS VCr 1 f (f`''t y �i 4 CITY, STATE, ZIP q f yl �o FAX ` "t I © OR'k-ER CI OV,'!.�7i-BUMDER ❑ OWNER.AGI ?NT ❑ CCO%WMACTOR ❑ CONTRACTOR AGtT7 © ARCH77ECT ❑ EI,'GIT`EER ❑ DE1 ELOPrk [� TENANT CQIvTR4CT0R • /t ,�J v�1�E riLh BES �q (C t l LICEI SE TYPE BUS. C4h�PAt�T 1�AA ? 7 ' - - C r -......FAX STREET ADDRESS CITY, STATE, ZIP C/V' I s j mo\m. > - ARCkiTLCT�NGIkEERIi. 1,5£ LICENSE:y'G1,48ER C}S�C - I BITS: LIC � -`—"-- -FAX COMPANY NAME _ ' �-•- bc:lkr�- �e E' E-h4AIL s _ �.Il/1 a� (C� U 1 STREET ADDRESS i p r - p� I CITY, STATE, 71P,�;f DESCWTION OF AVORI - _�` t �tUyC �- EaIS5NIG L'SE PROPOSED USE COI:STR TYPE s STORI-e5 USE � Tl'PE OCC, I 5Q.FT, • \rAI..LIATIUN (S) EXISTG NEW FLooR DEMO TOTAL AREA APF -A AREA I I ETAREA BALT1100114 KITCHEN OTHER REMODELAREA MICIDELAREA I REMODELAREA I I I I PORCY, AREA TDECK AREh TOTAL DECK -PORCH AREA GAP,AGE ARE4: DETACH [] ATTACH I A1k'ELLII.OUNITS: 1SASECONDUNIT [)1xS SECOND STORY ❑YES ! - -NO nEL':G ADDED? (�-T- ,ADDITION? ❑M j i I I PR-r4&?1ICAT10N ❑ YES IF YES. PROVIDE COPY OF PL.Ah?dL�GAPPLi []NO PLA?,NENGAPPROVAL LETTER � IS THE BLDG .fit, YES >• ,�„-,-.�.,,_, - =.:- ❑ E Y .ter r' EICHLERHOME, ❑ "':.._-_^._ TOTAL VALUATION: - --- - --- _-...-."`.`-�'���"" By In)' signature belaW, I certify to each of the folloNving: I a a the proper,), owner or au$loriz gen {o act the Prop----:L3'ner's behalf. I haVe read this application and the information I have provided is corect, I have read the Description of Work and v ' ' is accurate. I a?ree to comply Alith all applicable Iocal ordinances and state laws relating to building construction. I authorize representatives of Cupe;Tino to e ter the above -identified prop -'ay for inspection purposes. Si--natureofApplicantrAge t• _ Date: [ ( 6 L1 . 1?\ RMATI ON REQUIRED �,..< _ - - _ -- P :« PI CI3ECIIIE` _'f: 4", 1111 _ _ r -`, C f I O r e,u �FD er Alultifalilil dla e11in_s: 1 for demolition z pF) p nnit IOr �•Y...y`btS�X$.� tr.{<.T�.,."ry'-tl_�:ti Wit: X.:'__:t±r_ _— �� - _ - auY:•:i -_ �2:":ti -«u 3 : __ _ _— ---", _=_•_ existing Demolition cnnit is re uired - - ,' 'nv q prior to issuance Oi bklldl. -- _} I er,Ditfernel\ b>.Ildia_. ___ _ _ _ _ _ - ..;....�,.�::.. :. �.�..=,r. .-":iia`^.='''_'-, - _ '„'Y _ •,-- El ��:�,��_;�::;�'.�:_ _..:�;`•U.ri�ti Wiz- - - ---'_--Sc�:i:��^� z=a_-:_;:. _�_�-.a: Commercial Bldgs: Provide a completed HaZGTUOLS Materials Di n'=.�_- - Pi.T3LIC Y;O�i<,cy r'g-;_ '_=_•-=;. i. 1 t� _ 7 U ior i" hazardo -i� ,n an L-.4 is a, �eir1 ed a I G t,n s al; of this :a'ec t P P• J = _ - _ _ - _ - - -- - - - - - - - - - -- - _ �Rc- - - . C0PY of Plannm �ApProlal Letter or Meeting _Iah Planning prior to _ ;• _ _ _ - _ - - -- - - - ;- r_« • 6 �' E 5LI171D]K3 Of ❑lldlll_ Pen_nt application._mW -ALAS(i7.i=='�=v�:F,::_.:,:r.•w.-x,c'. .,'.❑..s'S.'�IT4P�YSE�'EItDi�Ti2YC_T_- v'T _ ;r EA'1-IItOR?i�F,TAii'HEAL.Tiir L'ld;fpp_2011.doc revised 06121/11 Wpt CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19725 STEVENS CREEK BLVD CUPERTINO, CA 9'3014-2405 (316 20 083) CONTRACTOR: CUSTOMS PERMIT NO: B-2016-1308FATTS CONSTRUCTION SAN BRUNO, CA 94066 OWNER'S NAME: PORTAL PLAZA LP DATE ISSUED: 08/11/2016 OWNER'S PHONE: 650-919-3419 PHONE NO: (415) 244-3633 LICENSED CONTRACTOR'S DECLARATION ARATIOIV BUILDING PERMIT INFO: License Class ¢ Lic. #10167U Contractor FATTS CUSTOMG QN TR TION Date 08/31/2018 X BLDG _ ELECT _ PLUMB 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: I hereby affirm under penalty of perjury one of the following two declarations: CUPERTINO MARKET- REPLACE (E) PRODUCE CASES, (E) GLASS i. I have and will maintain a certificate of consent to self -insure for Worker's DOORS, (E) SINKS, (E) WATER HEATER; INSTALL 160 S.F. OF T BAR Compensation, as provided for by Section 3700 of the Labor Code, for the CEILING WITH (N) FINISHES IN OFFICES AND BACKROOM i performance of the work for which this permit is issued. I have and will maintain Workers Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. - Sq. Ft Floor Area: Valuation: $10000.00 APPLICANT CERTMCATION 1 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 APN Number: Occupancy Type: and state laws relating to building, construction, and hereby authorize 316 20 083 A-1 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, costsi and expenses which may accrue against said City in consequence of the granting of this PERMIT EXPIRES IF WORK IS NOT STARTED permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulati ns r e'Gupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 8/31/2016 Issued by; ABBY AYENDE OWNER -B UD R D CI AR ATiON Date: 08/11/2016 RE -ROOFS - I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole 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 compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) `- 2. 1, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: $/31/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 '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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S 2 5 Labor Code, I must forthwith comply with such provisions or this permit shall cti s , 25533, and 25534. be deemed revoked, y ' I .Owner or authorized agent: APPLICANT CERIMCATION Date: 8/31/2016 ( certify that I have read this application and state thaf the above information is CONSTRUCTION L NDINC ACFNC�� 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 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 ARCHITECTS DFCL RATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 8/31/2016 Professional Tb VIM Cowl, -H-V- -Itu ny'�L� `�n��.4S OU1we� CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-20j6-1308' 19725 STEVENS CREEK BLVD CUPERTINO, CA 95014-2405 (316 20 083) ALL I5 WELL Y TRAM INC IRVINE, CA 92614 11 OWNER'S NAME: PORTAL PLAZA LP DATE ISSUED: 08/11/2016i OWNER'S PHONE: PHONE NO: (949) 251 � 8838 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: f License Class B Lie. #533168 Contractor ALL IS WELL Y TRAN INC Date 09/30/2016 X BLDG ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH _ RESIDENTIAL X COMMERCIAL,I with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CUPERTINO MARKET - REPLACE (E) PRODUCE CASES, (E) GLASS I hereby affirm under penalty of perjury one of the following two declarations: DOORS, (E) SINKS, (E) WATER HEATER; INSTALL 160 S.F. OF T-BAR I have and will, maintain a certificate of consent to self-insure for Worker's CEILING WITH (N) FINISHES IN OFFICES AND BACKROOM Compensation, as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued. P, / z. 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. Sq. Ft Floor Area: Valuation: $10000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above - APN Number: Occupancy 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 20 083 A-1 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 IF WORK IS NOT STARTED may accrue against said City is�o sequence of the granting of this permit. Additionally, the applicant , Viers ds and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations p r'the C e Ko Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature / 1111 Date 08/11/2016 Issued by: PAUL O'SULLIVAN G, / OWNERIL;2&1 AATI'O/L'�' Date: 08/11/2016 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 inspection, 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 (See.7044, Business & Professions Code). Date: 08/11/2016 Ir ebv affirm under penalty of perjury one of the following three declarations: AI 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 Labor Code, for the performance of the work for which this permit is issued. HAZARDOUSMATERIALS DISCLOSURE 2. 1 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health &Safe Code Section 25532 t3 (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 become subject to the air contaminants as defined by the Bay _�rea Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the CupettinoM� i ' od Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Section 2505, nd 25 34. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: f APPLICANT CERTIFICATION Date: 08/11/2016 I 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 relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, iv 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 ARCHITECT'S DECLARATION Code, Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 08/11/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMU�!! r ; DEVELOPMENT DEPS •.� Ril�iElJl BLJfLDlI1VlSlo!! 1103M i ORRE AVENUE • CUPER I NO, CA 95014-3255 (408) 777-3228 , 17/'Y(408) 777-3333 • buifdinc) .cuu�lt!r�o.org C U P S IST E N O, I—� S t COTi�T UCioI T ❑ ADD-MON r` LT� 4T]ON ITI 1_I"vi501�1A�rR� OMGMd�? OWNER i,Jklr +v s i0h_ I l!kaT a Cd1yj.4{T wie>r a uo 57AT8, Zia `•�f.% Dii?vcn LJ. Du7vR•aVr-Ar`Ti !� Dii%h2,hG=n'T s-7.. co~�-;co DcDa.�cTo;�.t.-r.�r C] LIM„ TY-rs TY-rBUS, r ,c r r!E D 09 i9 �� EI3 Y SF.S% 2I? CA 0 "Jim I f tP :�TEC7/'k T} rRN lJ. ���� jj "t„ti tFAX ` D St l 1 ,D1it1 P.�i:It� bEsc;',lP;jol� or \vor,I; ' 4-A&OC re s ac,r$114 VA RIO- VA t4ld- -011J�A new ° cgs 4 PLA bA rvoKA&Kc� �►�,� ?:JOSirn'GU.E - I YP.D?OS�DtISiz - COAs,"'ti•TYPE rSTOMS j+ USE I TYPE 6c _Y �rG 1 cJ7 F 008 ( DEMO 170TfS f%aR h�ch t ZAI? Zi l 3Ai:Y0DI✓ III i..c"TCi- .�+.t II OTHER II �=7doozLf�.4 I P�1.44DEL?AFh (, ii0T0�Lx�-h I - � I i PORCHh_R?A j D?CKJ-YaA TOe;LDECKeO?C::,'jk A GtRAGE/RZA: :):-I A CH f! ©RiTSC3 DVIELUNI G WITS � 1S�,SECOND.IMrr DYES SFCO.'rDSrOrY 0).3 1{ � SEMG ADArD^ DNO �. MMMOX? ew7 r j - PP,=•._. rC.S_30yti' D1�5 � �,.5 i'ROS'� COPY or 15 � ✓E 3LDG �*t - �^' `-- D• I1 ��5, - r I ?Lfh7.TO4tP!,e D?,0 P� ?�'T�*Gf??ROl'P.r-S.cTi_? � E1Cf=LERfiOAE? [�1>•O - � T03. t VALU-iTlON: --.. B yic7z ure bet0wi ] ce: i :o Ch o the ?o ID-Nl�a: I em the property ov mr or author ze ztenA tD Be, on the PrODIM EM-ner s csehnlr I have read this and the i=n&T1 Ftioi Shz. ' pr v od is co ,ect, Ihave re_d the l)escr]pt]on oz Vork and verify it is 2ec' r2_a I Fcreefo-complywith F]I -pplicable focal es and s -, ]ars rel�0_.� #o by i' 'ir �sa1_tion. I aurhwi e ropresenta-fives or Cu c-Ht in to untcr ft. Lbon-i& tiY'mdn op; orinsge^_trop pv�csos. of Agp]ic-atl+a>n Date: t}� ppTL]Ia Du wSFD or Multifamm0Y Cl'�v�ll hr�. R T _t Dp1y .or c no x.]07 a 'mf =ar �jL't]C'iDv//c �OY�O]el?Oii �,i11tl5 : CL r Z RT— GOL�TE r Gars -1 f� ie� J_}Dr t0 2S..11 �'SGe D't 5U!]C''i:,g �{"' C -x-_ 'h Permit T_Ot new but1Cl7lg. �A--���'-�s���"�- _ _ _� -�,EL -R iSEtz• vex Co. es rc•"e.1 3]des: Provide & Coe le H ii fns. �,7. ted F.22i LIO S ]l,lct i�215. 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