B-2016-1186CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR,
PERMIT` NO: B-2616-1186
10033SAICHWAY CUPFRTINO,CA95014-2124(32632041) (SILICONX
CONSTRUCTION INC)
SAN JOSE, CA 95131
OWNER'S NAME; (SAICIT WAY STATION LLC)
DATE ISSUED: 01/1412016
OWNER'S PHONE:
PRONENO:
IXENSED CONTRACT R'SDECLARATION
BUILDING PERMIT INFO:
License ClassVic. # Z,-
Contractor (sILICONX CO STRUCTION INDate 1 -7a -1/r.,
2i BLDG —ELECT —PLUMBC)
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:
CREATED SUB PERMIT FOR PARENT PHIU41T # 14030088 TO
.I hereby affirm under penalty of perjury one of the following two declarations:
REVIEWCOMPARE OFFICE/JOB SETS
1. 1 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 tate Labor Code, for the performance of the work for which
Sq, FtFloorArea:
Valuation. $0,00
this permit is issued.
AP MT CEMFICATION
I certify that I have read this application and state ftit the above
APN Number:
Occupancy Type:
is correct. I agree to comply with all city and county
32632041
ordinances and state laws relating to building construction, and hereby
authorize 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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said city in consequence of the
WITIIIN 180 DAYS OF PFRh1IT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FR LED INSPECTION.
Code, Section 9.18.
Signature Date
_d 44
V
Date:
1 994L
OY E'R IJFLDERD+ TTRE_-ROOFS:
I hereby affirm that I am exempt fronsI the Contractor's License Law for one of the
All roofs shall be inspected priortoany rooting material being installed. If roof is
installed Without fust obtaining an inspection, I agree to remove all new materials for
following two reasons,
inspection.
1. 1, as owner of the property, or try employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Sce.7044, Business & Professions Code)
Signature of Applicant:
L 1, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sce.7044, Business & Professions Code).
ALLROOF COVE RINGS TO BE CLASS "All OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 1 have and will maintain a Certificate of Consent to self insurc for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for file
HAMO—Q0— MAT5RIALS DISCLOSUR
performance of the work for which this pertnit is issued,
I ]love read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
2. 1 have and will maintain Worker's Compensatiou Insurance, as provided for
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
by Section 3700 of the Labor Code, for the performance of the work for which
Health & Safety Code, Section 25M(a) should I store or handle hazardous
this permit is issued.
material. Additionally, should I use equipment or devices which emit hazardous
1 1 certify that in the performance of the work for which this permit is issued, I
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to became subject to the -
will maintain compliance with tilt I ' Municipal Code, Chapter 9.12 and
I e"'m
Worker's Compensation laws of California. If, after making this certificate of
the Health &Salety Col�qluS tillus?'5505,25533,4025534.
P
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized age -
be deemed revoked,
Date:
AI!PIACAME CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance
I certify that I have read this application and state that the above Information Is
of works for which this permit is Issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws
Lender's Name
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for Inspection PUTPOS138. (We) agree
Lender's Address
to save Indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City In
ARCHITECT'S DI
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
CUPERTINO,
PROMEcr AMMSS r
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOFIMIENT DEPART MENTi BUfLCj11%FG DIVISIDN
1030D TORRE AVENUE: - CUPERT ]NO, CA C,15014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildino(ftupartino.org
F?OP0SZ--1D USE
zo 16 - I
EJ ADDri-ION - [I ALTBR-hT1014 i TI [I M ISTON / DMF
OPJCiN'AT- PMaj-
OWERINIAI'M
F?OP0SZ--1D USE
STOMMS
Vt W
USS Typ_ occ. SQ.FT. I
ii
STAM A.DDRESS;
:Uff LA
EMS1 0
BY, STATE, ZIP
FAX
COWLACT I"Amm
Iq4v-�
PHONETL
1.110b �-'Zl
77' KktV6*.& 1612"t,
cc3m
yif,?DrSZ
I
IIET AREA
CITY S -AT- ZIT
FAX
171 mm' 11 mmm"Sulmm OWN ---g
AC ---.'Tr
CO'QMkCT0R C0lZ,-?,kCTO7L,1-c'M1rr :)-N -LD - J' -T
calrjuc"TORXIFLl
C---Nls B _3 YF B
BUS. LIC 9
&usz
r27:,
PORMARIA
bompmy)"'A-W.-
C,40RAGE AREA:
-"--WWL
FAX
Z'I'
I
P alr.
UIP!,
4! D WT1.1 1110 uNrl S:
c
SECOND STORY
ONTES
All N.Aills
I
BEING ADDED? [ANOADDMON7
Bus, Lic N
Vcr
jj
.PRZ- cx'rlo'.q ovz-s
-rr FROMIDE Copy OF
C64PAW XA�E
is THE BLDG Ajq'
[14:5
Om R h� T UATION:
Mr,\mN,
0.\10
FICK
ZICHLERHONfr.
1, tt-1-wM/
M:507110W OF WO= cbd-1
C>(=-- -- P -A -1-k
PU
z=11BRO 1lS5
F?OP0SZ--1D USE
STOMMS
USS Typ_ occ. SQ.FT. I
ii
V.kLu-, TIOV (S)
EMS1 0
mrVIFLOOK F D ---E ,,, —c)
TOTI--L
-
AREA
AREA
I EsLEA
I
IIET AREA
BA74MY'0ow
Ori�p
REMOVFL.Am.k
PORMARIA
DECK AREA T0T/-.LM=0RCHi.RSA
C,40RAGE AREA:
I
ATTACH
4! D WT1.1 1110 uNrl S:
is A SECON'D UNIT D YrESI
SECOND STORY
ONTES
I
BEING ADDED? [ANOADDMON7
DPO
jj
.PRZ- cx'rlo'.q ovz-s
-rr FROMIDE Copy OF
I
is THE BLDG Ajq'
[14:5
Om R h� T UATION:
Mr,\mN,
0.\10
ZICHLERHONfr.
W'=-;-;-- M7010ft
jjj
By my Signe-ture Belo v, I cc-mfy 10 e rh of the fell owing, I zm the property ovmer 0_thoriz!ct to Eq -.M th��, OVIMBr ' S behalf. i hE1,1 � r-' Ed this
application and the information Irovidcd is cierlest; 1. read t, " on Of)VDTk and Vt
•Ordinances 2nd state 1pvqs relatin-
D .7 CtiQ i re nt=lives of cupeHi no to enter the Lbove-identilied propeey for inspeetion purposts.
Sig mhrcofApp]icPnt/AE
SUPPLE W1 rA'f- M0171ATIM RBQL41RED
7
New SFD o, MiLthu'Pummily dve'allings: Apply for demolition pe -r -mit ---'Or
e)�dsrm- buildixle(S), De-molftioxi per -mit is required Drior to lsS)'Ja--ooe of b,.Adin�g
Permit for nm building.
CODIMMW WES: PTOV-;de a completed Hm-rdow Materials Discloium
for -in it my HP,-z-rdous bffamrials '2T8 being used Ls pert ofthis proj-.0t,
.- Copy of Planiming Approval L-c-tter or 1weeting with Flu~mm-g prior to
su-bnriupl of BuDdin—.. Pe ;alit application,
B 011. doc revised 0612 J/j 1
0