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B-2016-2845 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2845 10950 N BLANEY AVE.CUPERTINO,CA 95014-0555(316 03 041) BERNARD DRAIN CLEANING& PLUMBING CAMPBELL,CA 95008 OWNER'S NAME: SPROUTZONE LLC DATE ISSUED:10/03/2016 OWNER'S PHONE:408-839-9778 PHONE NO:(408)603-9837 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class= Lic.#976873 Contractor BERNARD DRAIN CLEANING&PLUMBING Date 09/30/2018 X BLDG _ELECT X 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: S.' ,R- I hereby affirm under penalty of perjury one of the following two declarations: REPAIR T6N 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 ITARY Vperformance 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. Sq.Ft Floor Area: Valuation:$8000.00 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 316 03 041 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 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 1-012016 Issued by:Kim Dunbar Date: 10/03/2016 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(Sec.7044,Business&Professions Code). Date:10/3/201¢ 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 Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE i. 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. 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 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 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall `- be deemed revoked. Winer or authorized agent: APPLICANT CERTIFICATION Date:10/3/2016 l certify that I have read this application and state that the above information is CONSTRUC ON LEND-IN 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 ARCHITECT'S ARATION Code,Section 9.18. 1 understand my plans shall be used as public records. SiSignature Date 10/3/2016 Licensed 9 _ _ Professional ' B GENERAL PERNUT APPLICATION CONIJUNITY DEVELOPMIENT DEPARTMENT• BUILDING DIVISION MEF 0300 TORRE AVENUE• CUPER T INO, GA 95014-3255 (408)777-3228 • FAX(408)777-3333 build noQcuDertho.org. PLUM ING ❑hrECHA.\ZC.AL ❑ELECTRICAL [3A0SC]ELLANEOUS PROSECT BaADD "S 'I -PNT V'o -Tlvl)() 31�nt� miz, Cup OWNERN A?; PHOhr- E-MLAM STRrETJDRESS I CITY,STATE.ZIP FAX 0 b �� �t� I V \�) k'� GO'-r ACT\AA!EID PHO 4 �1 I E-I SAIL �Oy STREET ADDP.ESS CITY,STATE, ZIP FAX © OtiTtR ❑ O-A M-BuMD.R ❑ ovN-st-Gz,\rr CO'\-TPICTOR ❑COY-1-?-ACTORAG1I' ❑ ARC?:IIECT ❑--D�,GL'.'F—R ❑ DEti,LOPER ❑ TENANT CONIUCTORNA1,CE LICE SE lit. E C E E 3 ICS coy„N-W,' U.E �r �j� P) � lf� N.4rz—-� RP— `r �ls� !” r�IL FAX s- A6HAAM � coal:sT:.TE:ZIP PHO beef a -3-92-37 ARCHITECT;E'.CLNEER\-.A;E LICENSE MUMMER. 13L'S.LIC COMP NY?-ME E-MAIL STREET ADDRESS I CITY,STATE,ZIP I PHONE USE Or®® 0 Sri,arDUPLHX ❑ htiLTI-FAJ,1LY PROJECT L \a=II DLh M ❑ STs PROJECT N1 ❑ YES 15 T v t3LDC SA. [] 1 BIMI)NO: ❑COA2'=, C1-',L ERFACE APS A ❑ wo FLOOD ZONE ❑NO I EiCHLER HOME? ❑X-0 DESCRIPTION OF WORT ZA ZL97-1 TOT., \.."LLAT? 00 RECFI� 3y my si a pre Belo v;I ceriry to each of the fol?owiog: I am the property owner or author-aed agent to act on e propel y owners behalf. I have read this application and the infortnaticn 1 have provided is cor-ect. I have read the Description of>'dork and ve_ify itis accurate. I agree to comply with all applicable local Ordinances and state law's relating to building con `ioa. I au hor.'re re Jr sen atives of Luperi o to ewer the above-idem:red grope ty for inspection pu,roses. SignatareofApplicant•:A�e ' Date:Q "�i Z-GI& SUPPLEMWe,L DNFORAiA'ITION REQUIRED O\ER TnFOL17£R J �4 - ❑ AZA70R ' ri EP2147_rC,4p _?011.doe revised 06.121111