B-2016-2979CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS?
CONTRACTOR: PERMIT NO: B-2016-2979
10500 N DE ANZA BLVD CUPERTINO, CA 95014-2033 (316 22 017)
S C BUILDERS INC
SUNNYVALE, CA
94085
OWNER'S NAME: MISSION WEST PROPERTIES LP II ETAL
DATE ISSUED: 10/25/2016
OWNER'S PHONE: 510-491-8424
PHONE NO: (408) 328-0688
BUILDING PERMIT INFO:
LICENSED CONTRACTOR'S DECLARATION
License Class D Lic. #7 71
Contractor S C BUILDERS INCDate 08/31/2017
X BLDG —ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH _ RESIDENTL4,L X COMMERCL&L
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:
THEATER; T.I. TO ENCLOSE SERVER ROOM BEHIND THEATER (150S.F.)
i. I have and will maintain a certificate of consent to self-insure for Worker's
-APPLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
l performance of the work for which this permit is issued.
a % 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.
APPT I NT
Sq. Ft Floor Area:
Valuation: $75000.00
RTIFI ATIOAT
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 22 017
A (Tenant Improvements),A (Tenant hnprovements),A
representatives of this city to enter upon the above mentioned property for
(Tenant Improvements),A (Tenant Improvements),A
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
(Tenant Improvements),A (Tenant hnprovements),A
(Tenant Improvements),A (Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non-point
(Tenant Improvements),A (Tenant Improvements),A
(Tenant Improvements)
source regulations per the Cup unicipal Code, Section 9.18.
Signat0r'e-_1 Date 10/25/2016
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-B rfT D R D CT ARATION
180 DAYS FROM LAST
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
Issued by: MELI A
1. I, as owner of the property, or my employees with wages as their sole
Dater 10/25/2016
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
RE-ROO FS:
contractors to construct the project (Sec.7044, Business & Professions Code).
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
I hereby affirm under penalty of perjury one of the following three declarations:
inspection.
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
Signature of Applicant:
performance of the work for which this permit is issued.
Date: 10/25/2016
2. 1 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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, atter making this certificate of
iRE
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
exemption, I become subject to the Worker's Compensation provisions of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 the
Labor Code, I must forthwith comply with such provisions or this permit shall
and
Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revoked,
material. Additionally,, should I use equipment or devices which emit hazardous
APPT I ANT RTIFI ATI N
air contaminants as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
correct. I agree to comply with all city and county ordinances and state laws
the Health &Safety Code, Sections 0 , 3, and 25534.
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree Owner
or authorized agent: %
to save indemnity and keep harmless the' City of Cupertino against liabilities,. Date:
10/25/2016 `
judgments, costs, and expenses which may accrue against said City in
CONSRCTION
consequence of the granting of this permit. Additionally, the applicant understands I
hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of
work's for which this permit is issued (Sec. 3097, Civ C.)
Code, Section 9.18. Lender's
Name
Lender's
Address
Signature Date 10/25/2016
ARCHITECT'S
I
DEC RATION
understand my plans shall be used as public records.
CONS i RUCTION PERMIT APPLICATION
COKWUNI TY DEVELOPMiiENT DEPAR T MiiENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (4-108) 777-3333 • buildinata cuoertino orq
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EXISTLNG USE PROPOSED USE CONSTR. nPE I _ STORIES. -
Ve — ? r ( USE TYPE OCC. I
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SQ.FT,
I VALUATION (S)
EXIS?G NEW FLOORI DE40 TOTAL
-AREA AREA AP.EA --ETA l� •
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ISASECORDL'QT ❑1cS
SECO',DSTORY ❑TES
BELNG ADDED? N0
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ADDITION? ❑?.0
PRE aPL?CATIC\ OYES IFLcS PROVIDE COPY OF - I
PL.A-\ND\GA?PL. ❑\O PLA\.,\LiG.=.PPROV.ALLET?ER
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By my sinature below, I certii}'to each ofthe follov, Lza: I an the property owner or authorized anent to ac: on the propeft) owner's beh 11. ad this
application and the infonnation I have provided is correct. I have read the Description of ,Wok and verify ;t is accurate. I agree to coLiply with all app icable local
y
ordinances and _tate lads relating to build e cons�nction. I authorize representatives of Cope, Lino to enter the above -identified property for inspection purposes.
S i gz zt re of :Applicant%Agenf: r o P
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Stiff PLE?�ZENTAL P� OR�ZATIO-NT REQliIRED
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per, ?t,or netit' building.
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PLA�\I\GPLA\RE1iE\\
�Conninerc:al Bldgs: ProN.-ide a Completed Hazardo', '%2_',,.rials Disclosure
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fbrm iI an); Hazardous lvlat .r alp are Delia used as pai i OI Lhis
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project.
C.1 r ARGE
FIRE DEPT
Copy of Pjan-ring Approval Letter or Meeting -with Planning prior to
Submittal ofBuilding Permit 2I7p11Ceti0n.
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S�'�I'I'4R1 SER'ERDiSTRICT
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BIdgApp_2011.doc 7-el,L7ed 06121111