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B-2017-0207 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0207 20080 STEVENS CREEK BLVD STE 106 CUPERTINO,CA 95014(369 03 009) AB C CONSTRUCTION SAN LEANDRO,CA 94577 OWNER'S NAME: (Preg Biltmore,Lp) DATE ISSUED:02/02/2017 OWNER'S PHONE:510-677-4664 PHONE NO:(510)895-6200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#806263 Contractor A B C CONSTRUCTION Date 04/30/2018 X BLDG X ELECT X PLUMB MECH RESIDENTIAL 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: ROUND TABLE PIZZA;SUITE 106-INSTALL(7)OUTLETS;MOVE I hereby affirm under penalty of perjury one of the following two declarations: AND REINSTALL SINK 18 INCHES 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 -1,erformance of the work for which this permit is issued. Z:. .ave 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:$2200.00 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 369 03 009 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 again t said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulationsperthe Cu•ertino unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 2/2/2017 Issued by:AbbyAyende Date:02/02/2017 OWNER-BU ER 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 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:2/2/2017 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. 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. a. 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 Code,Secti s 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. / Owner or authorized agent: t/ APPLICANT CERTIFICATION Date:2/2/2017 I certify that I have read this application and state that the above information is cONSTRUCTION TENDING 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, 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 2/2/2017 professional 1-3-)--0 n- - 07/69— V li 'rf:' '‘ GENERAL PERMIT APPLICATION . E p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING'DIVISION mis. .At-s-,,,,,,,,, 10300 TORRE AVENUE••CUPERTINO,CA 95014 3255 . (408)777-3228• FAX(408)777-3333•buildina(a�cupertino.orq CUPERTItifCi PLUMBING ❑MECHANICAL I;/�ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 00 c)-0 , c_�� e v��__✓ APN 8 })b_coq OWNER NAME Su ^t NS /^N)fQ o l./�v2^ PH i V .E-MAII. STREET ADDRESS !" —(` ©CIT STATE,ZIP FAX it/.'C'!1 L ��jv�!�rC�? h(' Q V M� fr�' Lt CONTACT NAME k� t/ l 1(, PH i o s o`,71006 7 1 e 0(1)N')v_a C�-t0\`�3 o �,, STREET ADDRESS / � e4_ � 'i CITE ST ZIP(( vi J D fl EA. 9 t + o owNER 0 OWNER-BUILDER 0 OWNER AGENT. 0 CONTRACTOR CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT ON7RACTOR NAME _ . , LICENSE NUMBER LICENSE TIME BUS.LIC SZ ��A d7,7 �3 � coN35c �IU4-ll c 06 26. I�D� COMPANY NAME L.Q 4 5 e FC5 E-MAIL FAX STREET ADDRESS e��6 f CTT STATE,ZIP PHONE o 9- 4^°4 ARCHITECT/ENGINEER NAME `Ik p=� LICENSE NUMBER ' BUS.LIC 4 W COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ D or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES - IS THE BLDG AN 1:1 YES BUILDING: COMMERCIAL I URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO DESCRIPTION OF WORK 3-N S'*-.__ ___.1:2_4V. _f ( � CO T- if A r1T 'E, II635 1 ( 3i IC , Roo (3h TA taesz. - P 7i- TOTAL VALUATION: 11 0201 9S() RECEIVED B q 1 r CI IJ f ( �L1 � f' .. By my signature below,I certify to each of the`ollowing: I am the property owner or authorized a ent to act on the property own is beh if. I have read this application and the information I have provid-o , .Tec. 1: read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu'. g construction. author:.- -presentatives of Cupertino to enter the above-identified property for inspection purposes. ( 1 Signature of Applicant/Agent: frEf'$i pr dit \ Date: 6 2—G 7 1 P SUP• it ENTAL INFORMATION REQUIRED -.::‘OFFICE USE ONL 1 11, .> .-C.O\ERRTRE-COUDTER.::::::'4:::::: - - ©-EXPRESS- y yL °I❑ STANDARD, : ., ; < ,a-LARGE U TSAJOR AIEPMiscApp_2011.doc revised 06/21/11