B-2016-2710CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10001 N DE ANZA BLVD CUPERTINO, CA 95014-2263 (326 34 074)
CONTRACTOR:
TCG BUILDERS INC
PERMIT NO: B-2016-2710
MILPITAS, CA 95035
OWNER'S NAME: FOUR CORNERS
DATE ISSUED: 12/12/2016
OWNER'S PHONE: 408-974-5951
PHONE NO: (408) 321-6450
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ja Lic. #835597
Contractor TCG BUILDERS INr. Date 04/30/2018
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:
APPLE T.I. - OFFICE (27,636 S.F.)
1. I have and will maintain a certificate of consent to self -insure for Worker's
REV #1 - 2NDFLOOR; RECLASSIFY 4 LABS INTO EMPLOYEE
Compensation, as provided for by Section 3700 of the Labor Code, for the
LOUNGE - ISSUED 3/8/2017
TCO - ISSUED 02/10/2017 - GOOD TIL 8/10/2017
-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: $3400000.00
APPLICANT CERTIEI ATI N
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 34 074
A (Tenant Improvements),B (Tenant Improvements)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting this permit.
Additionally, the applicant understands and will comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Si nature Date 3/_$[20]_7
Issued by: ABBY AYENDE
Date: 12/12/2016
OWNER -BUILDER DECLARATION
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: 3/8/2017
I hereby affirm under penalty of perjury one of the following three declarations:ALL
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
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
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
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 authorized agent:lfm�
APPLICANT CERTIFICATION
Date: 3/8/2017 1
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
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 DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 3/8/2017
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2710
10001 N DE ANZA BLVD CUPERT.INO, CA 95014-2263 (326 34 074)
TCG BUILDERS INC
MILPITAS, CA 95035
OWNER'S NAME: FOUR CORNERS
DATE ISSUED: 12/12/2016
OWNER'S PHONE: 415-999-4505
PHONE NO: (408) 321-6450
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERIV
IT INFO:
License Class Ja Lic. #835597
Contractor TCG BUILDERS INC Date 04/30/2018
X BLDG — ELEC
—
_PLUMB
MECH RESENTIAL
X COMMERCIAL
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.
JOB DESCRIPTION:
T.I. - OFFICE (27,6
36 S.F.) -APPLE
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.
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
Sq. Ft Floor Area:
Valuation: $3400000.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this applicationand 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
326 34 074
B (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 E3
PIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 18
DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regula' he Cupertino Municipal Code, Section 9.18.
180 DAYS F
OM LAST CALLED INSPECTION.
_Sign a Date 12/12/2016
Issued by: Kim Dibar
Date: 12/12/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be ins
RE -ROOFS:
pected prior to any roofing material being installed If a roof is
following two reasons:
m. 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 Applican
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/12/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF
COVERINGS TO BE CLASS "A" OR BETTER
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.
ILI
ZARDOUSMATERIALS DISCLOSE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha
iardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Heald
& Safety Code, Sections 25505, 25533, and 25534. I will
maintain complianc
D with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
S. I certify that in the performance of the work for which this permit is issued I
Health & Safety Code,
material. Additionally,
Section 25532(x) should I store or handle hazardous
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 Code1-SrfUousZ5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
her or authoriz
d agent:
APPLICANT CERTIFICATION
Date: 12/12/2016
certify that I have read this application and state that the above information is
i
I hereby affirm that
�ONSTRUCTION LENDING AGENCY
here is construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which
his permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans
shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 12/12/2016.
Professional