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15100099CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1642013UBB RD CUPERTINO CA 95014 (357 20 038) CONTRACTOR: PERMIT NO: 15100099 REHOBOTH CONSTRUCTION GROUP INC MILPITAS, CA 95035 OWNER'S NAME: ( HOME OF CHRIST CHURCH CUPERTINO LLC) DATE ISSUED: 08/26/2016 PHONE NO: (408) 404-3370 BUILDING PERMIT INFO: OWNER'S PHONE: LICENSED CONTRACTOR'S TOR'C D c r ARAmrnN License Class _FIRE PROTECTION QONTRACTOR. Lic. #la Contractor REHOBOTH CONBIRUCTION GRINCUP IN Date 06/30/2017 —BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH _ RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my Hcense is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: CHURCH OF CHRIST - T.I. TO RECONFIGURE & BUILD OUT i. I have and will maintain a certificate of consent to self -insure for Worker's SHELL TO (N) A-3 OCCUPANCY FOR RELIGIOUS ASSEMBLY USE (20,000 S.F.), INCLUDING EXTERIOR SITE WORK Compensation, as provided for by Section 3700 of the Labor Code, for the �G performance of the work for which this permit is issued. tI 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 Sq. Ft Floor Area: Valuation: $1500000.00 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 357 20 038 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 will comply with all non -point all WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18, 180 DAYS FROM LAST CALLEDINSPECTION. Signature , Date 08/26/2016 Issued by: Kim Dunbar OWNER -B Hr D R DECLARATION Date: 08/26/2016 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 for compensation, will do the work, and the structure is not intended or offered for materials inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/26/2016 I herb of Y penalty perjury declarations - nmaintain 1. have and will a Certificate of Consent to self -insure for Worker's Worker 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. 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. I` will permit is issued. maintain compliance with the Cupertino 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 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, 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 CERTWICATION Date: 08/26/2016 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 1 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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 08/26/2016 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100099 10420 BUBB RD CUPERTINO CA 95014 (357 20 038) REHOBOTH CONSTRUCTION GROUP INC MILPITAS, CA 95035 OWNER'S NAME: ( HOME OF CHRIST CHURCH CUPERTINO LLC) I I DATE ISSUED: 08/26/2016 OWNER'S PHONE: ( 1 I PHONE NO: (408) 404-3370 License Class 13 Lic. #934603 Contractor REHOBOTH CONSTRUCTION GROUP INC Date 06/30/2017 I hereby 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. I hereby affirm under penalty of perjury one of the following two declarations: 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. 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. APPLICANT CERTIFICATION 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 er the Cupertino Municipal Code, Section 9.18. Signature Date 8/15/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CHURCH OF CHRIST - T.I. TO RECONFIGURE & BUILD OUT SHELL TO (I) A-3 OCCUPANCY FOR RELIGIOUS ASSEMBLY USE (20,000 S.F.), INCLUDING EXTERIOR SITE WORK REV#1 12/01/2016 - M.E.P. & FIELD CHANGES - ISSUED 8/15/2017 Sq. Ft Floor Area: I Valuation: $1500000.00 APN Number:I Occupancy Type: 357 20 038 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApl Date: 8/15/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF 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. 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. 3. 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 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. Signature Date 8/15/2017 " 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. I 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 & Safety Cy e, Sections 25505, 25533, and 25534. Owner or authorized age Date: 8/15/2017 CONSTRUCTION LENDING AGENCY 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 ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professio CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15100099 10420 BUBB RD CUPERTINO CA 95014(357 20 038) REHOBOTH CONSTRUCTION GROUP INC MILPITAS,CA 95035 OWNER'S NAME:(He=Of Christ Church Cupertino LLC) DATE ISSUED:08/26/2016 OWNER'S PHONE:( PHONE NO:(408)660-0040 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class FIRE PROTECTION CONTRACTOR Lin,#934503 Contractor REHOBOTH CONSTRUCTION GROUP INC Date 0513012019 —BLDG_ELECT—PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH_RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is In full force and effect. JOB DESCRIPTION: CHURCH OF CHRIST-T.I.TO RECONFIGURE&BUILD OUT SHELL I hereby affirm under penalty of perjury one of the following two declarations: TO(N)A-3 OCCUPANCY FOR RELIGIOUS ASSEMBLY USE(20,000 1. 1 have and will maintain a certificate of consent to self-insore for Worker's S.F.),INCLUDING EXTERIOR SITE WORK Compensation,as provided for by Section 3700 of the Labor Code,for the REV 93-REMOVE PLAYGROUND STRUCTURE FROM SCOPE OF performance of the work for which this permit is issued. WORK-ISSUED 5-7-2018 I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-REAR SHADE ELEVATION;PG&E PAD ADDED FOR CMU Section 3700 of the Labor Code,for the performance of the work for which this WALL ENCLOSURE-ISSUED 5/25/2018 permit is issued. REV#1 12/01/2016-M.E.P.&FIELD CHANGES-ISSUED 8/15/2017 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 Sq.Ft Floor Area: Valuation:$1500000.00 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 APN Number: Occupancy Type: may accrue against said City In consequence of the granting of this permit. 357 20 038 Additionally,the applicant understands and will comply with all non-point source regulations ller the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature -- Date 612512018 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:ABBY AYENDE following two reasons: Date:08/26/2016 1. I,as owner of the properly,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) RE-ROOFS: z. I,as owner of the property,are exclusively contracting withlicensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(See.7044,Business&Professions Code). installed without fust obtaining an inspection,I agree to remove all new materials for inspection. 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 Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Cade,for the Data 5/2512018 performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. s. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California.If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534.I will exemption,I become subject to the Worker's Compensation provisions of the maintain complinnee with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I stare or handle hazardous Labor Code,I most forthwith comply with such provisions or this permit shall material.Additionally,should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that I have read this application and state that the above Information Is the Health&Safety Co e,Sections 25505,25533,and 25534. correct.I agree to comply with ail city and county ordinances and state laws _ relating to building construction,and hereby authorize representatives of this city Owner or authorized ager to enter upon the above mentioned property for Inspection purposes. (We)agree Date:5/25/2018 to save Indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY judgments,costs,and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit.Additionally,the applicant understands of work's for which this permit Is Issued(Sec.3097,Civ C.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code,Section 9.18. Lender's Address Signature Date 5/2512018 ARCHITECT'S DECLARATION I understand my plans shall be used as public records, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15100099 10420 BUBB RD CUPERTINO CA 95014(357 20 038) REHOBOTH CONSTRUCTION GROUP INC MILPITAS,CA 95035 OWNER'S NAME:(Home Of Christ Church Cupertino LLC) DATE ISSUED:08/26/2016 OWNER'S PHONE:( PHONE NO:(408)660-0040 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class FIRE PROTECTION CONTRACTOR Lir.#93 Contractor REHOBOTH CONSTRUCTION GROUP INC Dale 06/30/2019 —BLDG—ELECT_PLUMB 1 hereby affirm that[nm licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CHURCH OF CHRIST-T,I.TO RECONFIGURE&BUILD OUT SHELL I hereby affirm under penalty of perjury one of the following two declarations: TO(N)A-3 OCCUPANCY FOR RELIGIOUS ASSEMBLY USE(20,000 L I have and will maintain a certificate of consent to self-insure for Worker's S.F.),INCLUDING EXTERIOR SITE WORK Compensation,as provided for by Section 3700 of the Labor Cade,for the REV#3-REMOVE PLAYGROUND STRUCTURE FROM SCOPE OF I have and will maintain Worker's Compensation Insurance,as provided harry REV#2-REAR SHADE ELEVATION;PG&E PAD ADDED FOR CMU Section 3700 of the Labor Code,for the performance of the work for which this WALL ENCLOSURE permit is issued REV#I 12/01/2016-M,EP.&FIELD CHANGES-ISSUED 8/15/2017 APPLICANT CERTIFICATION I certify that I have read this application and slate 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 Sq.Ft Floor Aran: Volatile.:$1500000.00 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 APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. 357 20 038 Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature -- - Date 408-800-8080 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION I hereby nMr.that 1 am exempt Iain the Contractor's License Law for one of the Issued by:Kim Dunbar following two reasons: Date:08/26/2016 r. I,as owner fthe property,army 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) RE-ROOFS, z. 1,as owner of the property,am exclusively contracting with licensed All roofs.eholl be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sea 7044,Business&Professions Code), installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm under penalty of perjury one of the following three declarations: n. I have and will maintain a Certificate of Consou to self-insure for Worker's Signature of Applicant Compensation,as provided for by Section 3700 of the Labor Code,for the Date:408-800-8080 performance of the work foi-which this permit is issued z I have and will maintain Worker's Compensation hrsurence,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the pet foreaoce of the work far which this Permit is issued. 3. I certify that in(lie performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the 1 have read the hazardous materials requirements,ader Chapter 6.95 of the Worker's Compensation laws of California.If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534.I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Cade,Section 25532(a)should 1 store or handle Imzarduus Labor Cede,I must forthwith comply with such provisions or this permit shall nmterial.Additionally,should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Buy Area Air Quality Management District I APPLICANTCERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that I have read this application and state that the above information Is the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: I to enter upon the above mentioned property for Inspection purposes. (We)agree Date:408-800-8080 to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING A ENCY judgments,casts,and expenses which may accrue against said City in I hereby affirm that there Is a construction lending agency for the performance consequence of the granting of this permit.Additionally,the applicant understands of work's for which this permit is issued(Sec.3097,Civ C.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code,Section 9.18. Lender's Address Signature Date 408-800-8080 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.