B-2016-2827 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR:, PERMIT NO:B-2016-2827
20520 STEVENS CREEK BLVD STE A CUPERTINO,CA 95014-2120(359 08 018) IDEAL ELECTRIC INC
PERRIS,CA 92570
OWNER'S NAME: MARDESICH COMPANY CROSSROADS LLC DATE ISSUED:09/28/2016
OWNER'S PHONE:206-624-9496 PHONE NO:(951)813-5169
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#906354
Contractor IDEAL ELECTRIC INC Date 11/30/2017 X BLDG X 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: T.I.-INSTALL 1 OUTLET FOR NITRO FRIDGE-STARBUCKS
is 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.
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:$675.00.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 08 018
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature � Date 9/2$/2.015 Issued by:•AbbyA ende
y
Date:09/28/2016
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 roofmg 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(Sec.7044,Business&Professions Code). Date: /29 8/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
s. 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
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. 1 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 become subject to the 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_ Co ctions 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: (A/
APPLICANT CERTIFICATION bate:9/28/2.016
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 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 ARCHI Fd DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 9/28/2016 Professional
GENERAL PERMIT APPLICATION MEP
COIViMUNITY DEVELOPI-0ENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERT[No (408)777-3228 - FAX(408)777-3333•building(cicuoerino.ora misc
❑PLliT1,BD G ❑I\1,ECiLkMCAT LECTRiC:AL ❑b6jSCELL,1,T7E0US
PROIiCL4DDREES - WVe � � .S3N
�D
ILA,
LE Edi-,II.L
STREET ADDRES I CI! ' STATE 4IF I F.AX
1�
CONT'CT\A:,,E W� �61 V' PHOI\EWI 7 i E-11
STREETADDRESS � Sd� CITY; :�Tt��P.
ED Owmm ❑ OAw�,-BUILpER ❑ 0\WM, .,GE?.rI ❑ CO'.'TRtiCTOR ❑CONTRACTORAGI-NT ❑ P.RCH=r-T ❑M G=.fit ❑ DE\cLOP R ❑ TENANT
`31t�i�+ .F.1L , /1 V I LICCL Rh.mrn V g w
�•� I
LICENSE i} 1 I BUS.LIC= b-ito-
CO?�4P.�Y�PJJE t-A/AILFAX
led Y�c-
STREET ADDRESS L41 Vj'S I CITY T..T=:ZIP Ps
I \'
tSe - 2t� Ii SSG
ARC' GII EER\A E LICENSE L?"EER BUS,LIC
E-',v'i4IL F.S}
STREET ADD S Ck�
Cjm�kz p q) 5356
Ve-�VlltiA K/1
USE OF ❑SFD orDliPLEX UTULT1-FAMILY PRDiECT L\R'1LDLA?.i ❑ }-.s I PP.OJ=CTA ❑}`ES IS TIM BLDG AN ❑ '1�S
BUHMNG: ❑COMEMERCIAL LT&IN L*ZTERF.ACE AREA ❑ \''0 FLOOD ZONE ❑NO EICHL ER HOME? ❑ NO
DESUIPTION,OFR%OPI GC,
TOTAL VALUATION: ` �� 00 R CFI FD 3I
By my signature btlo\3,I certii,to each of Lhe following. I a:n the prope+-L)+owner or authorized anent to act on the propery owner's behalA I have read this
application and the infonnatien 11, 'e -C-7ied is coirect. I have read the Description of �`ork and v ,ij it is accurate. I agree to comply'vvith all applicable local
ordinances and ate]a\\s relati e to' ild' cons c ion. I a ho ` e i eJreSeL`3i1\e5 Of CLpe,rino to ter the above-id�tifi'd p', r ins �cti n purposes.
e, �Pf p
Simature of;nplicant-.gent: Dater 0
SUPPLE1\1 :ITA_LL'TPORI\d ONTREQUIRED oFETc LSEo.L >a
•��''
O}ER TnE OOL\T£I2
❑ E�PR£� ;'
f
CI t�Z470R. .=
?r�FP_?�%iscwp_?Dll.doc remised 06.i�1/11