B-2016-2475CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
20520 STEVENS CREEK BLVD STE A CUPERTINO, CA 95014-2120 (359 08 018)
OWNER'S NAME;
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #763589
Contractor CIRKS CONSTRUCTION INC Date 05/31/2017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
2. v' 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.
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
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 expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source
_ Date 03/08/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three 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.
2. 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.
s. 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, after making this certificate of
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
be deemed revoked.
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 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 expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 0 310 812 01 7
CONTRACTOR: PERMIT NO: B-2016-2475
CIRKS
CONSTRUCTION INC
ORANGE, CA 92865
DATE ISSUED: 03/08/2017
PHONE NO: (
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
SUTTE A; T.I. - (2348 S.F.) - STARBUCKS
Sq. Ft Floor Area:
Valuation: $500000.00
APN Number:
Occupancy Type:
359 08 018
A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS E ANCE OR
180 DAYS F SPECTION.
Issued by:
Date: 03/0
RE -ROOFS:
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
inspection.
Signature of Applicant:
Date: 03/08/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cu , Hh Municipal Code, Chapter 9.12 and
the Health & Safe
: `
Date: 03/08/2017 <;
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMITNO:H-2016-2475
20520 STEVENS CREEK BLVD STE A CUPERTINO,CA 95014-2120(359 08 018) CIRKS
CONSTRUCTION INC
ORANGE,CA 92865
OWNER'S NAME:MARDESICH COMPANY CROSSROADS LLC DATE ISSUED:03/08/2017
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B,C-20 Lin.#763589
Contractor CIRKS CONSTRUCTION INC Date 05/31/2017 X BLDG ELECT_PLUMB
1 hereby affirm that 1 am licensed tinder the provisions of Chnpter J(commMUCH_RESIDENTIAL X COMMERCIAL
encing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
SUITE A;T.I.-(2348 S.F.)-STARBUCKS
I hereby affirm under penalty of perjury one of the Following two declarations: REV#2-ALTERATION OF TRASH ENCLOSURE-ISSUED 5/1/2018
r, I have and will maintain n certificate of consent to self-insure for Worker's REV#1-SLAB DETAIL-ISSUED 5/3/2017
performance ofthe work for which this permit is issued.
2. I have rind will maintain Worker's Compensation Insurance,as provided far by
Section 3700 ofthe Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Vnluation:$500000.00
APPLICANT CERTIFICATION
I certify that I have read this applicallon and slate 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 35908 018 A fronant In,proveincnts)
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 05/09/2018 Issued by:MELISSA NAMES
Date:03/08/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one of the RE-ROOFS:
following two reasons: All roofs shell be inspected prior to any roofing mote,in]being installed,If a roof is
r. I,as owner ofthe property,or my employees with wages as their sole instal led without first obtaining an inspection,I agree to remove nil new materials for
compensation,will do the work,and the strvctore is not intended or offered for tnspc&km.
sale(Soe.7044,Business&Professions Cade)
s. 1,as owner ofdre property,am exclusively contracting with licensed Signature o£Applicane
contractors to construct the project(Sce.7044,Business&Professions Code). Date:05/09/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. I have and will maintain a Certificate of Consent to self-inswp for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
not ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation insurance,as provided for by I have read the hazardous materials requirements under Chnpter 6.95 of the
Section 3700 ofthe Labor Code,for the performance of the work For which thisCalifornia Health&Safety Cade,Sections 25505,25533,and 25534.I will
r
permit is issued. ,.1motn compliance will,the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 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 in Marini.Additionally,should I use equipment or devices which emit hnznrdeus
ah'contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California, If,after making this-nifcate 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 HeaBh&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I most forthwith comply with such provisions or this permit shall �� ,
be deemev
ed roked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/09/2018
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 MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/09/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2475
20520 STEVENS CREEK BLVD STE A CUPERTINO, CA 95014-2120 (359 08 018) CIRKS
CONSTRUCTION INC
ORANGE, CA 92865
OWNER'S NAME: MARDESICH COMPANY CROSSROADS LLC
OWNER'S PHONE:
LICENSED CONTRACTOR'S ACTOR'S D C •RATION
License Class ¢ Lic. #763589
Contractor CIRKS CONSTRUCTION INCDate 05/31/2017
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.
I hereby affirm under penalty of perjury one of the following two deglarations:
r. 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.
2.: 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. I
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
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 expenses which
may accrue against said City in consequence of the granting of thil permit.
Additionally, the applicant understands and will comply with all non -point
sourq egu a ion -pent a Cupertino Municipal Code, Section 9.18!
Signatur
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law
following two reasons:
1. I, as owner of the property, or my employees with wages as th
compensation, will do the work, and the structure is not intend
sale (See.7044, Business & Professions Code)
i. I, as owner of the property, am exclusively contracting with lic
contractors to construct the project (Sec.7044, Business & Pro
I hereby affirm under penalty of perjury one of the following three da
i. I have and will maintain a Certificate of Consent to self -insure
Compensation, as provided for by Section 3700 of the Labor C
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance, as
Section 3700 of the Labor Code, for the performance of the we
permit is issued.
3. I certify that in the performance of the work for which this per
shall not employ any person in any manner so as to become su
Worker's Compensation laws of California. If, after making tl
exemption, I become subject to the Worker's Compensation pr
Labor Code, I must forthwith comply with such provisions or 1
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in
correct. I agree to comply with all city and county ordinances and s
relating to building construction, and hereby authorize representati,
to enter upon the above mentioned property for inspection purpose
to save indemnify and keep harmless the City of Cupertino against
judgments, costs, and expenses which may accrue against said Ci
consequence of the granting of this permit. Additionally, the applic:
and will comply with all non -point source regulations per the Cuper
Code, Section 9.18.
DATE ISSUED: 03/08/2017
PHONE NO: (
PERMIT INFO:
X BLDG —ELECT _PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
SUITE A; T.I. - (2348 S.F.) - STARBUCKS
REV #1 - SLAB DETAIL -ISSUED 5/3/20107
Sq. Ft Floor Area: I Valuation: $500000.00
APN Number: Occupancy Type.-
135908018
ype:35908018 A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: MELISSA NAMES
Date: 03/08/2017
r one of the I RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
sole installed without first obtaining an inspection, I agree to remove all new materials for
or offered for I inspection.
sed I Signature of Applicant:
Bions Code). I Date: 05/3/2017
)r Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
ie, for the
HAZARDOUS MATERIALS DISCLOSURE
rovided for by I have read the hazardous materials requirements under Chapter 6.95 of the
: 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
it is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous
ect 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
certificate of will maintain compliance with the peKta Municipal Code, Chapter 9.12 and
isions of the the Health & Safety ,C�6dee,, Sections!955, 25533, and 25534.
s permit shall ( +
Owner or authorized a , eni:
to laws I hereby affirm that there is a construction lending agency for the performance
s of this city of work's for which this permit is issued (Sec. 3097, Civ C.)
(We) agree Lender's Name
abilities,
in Lender's Address
t understands
o Municipal ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
(Licensed
Signature Date 05/3/2017 Professional