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B-2016-2940CITY OF CUPERTINO BUILDING PERM T BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2940 19500 VALLCO PKWY CUPERTINO, CA 95014 (316 20 999) SB CC INC CAMPBELL, CA 95008 OWNER'S NAME: ( Main Street Aggregator LLC) DA, TE ISSUED: 03/15/2017 OWNER'S PHONE: 408-777-3081 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT O: License Class 1a Lic. #336974 Contractor S B C C INC Date 03/31/2018 X BLDG _ELECT — P — UMB MECH RESIDENT 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: INSTALL 6 WALL-MOUI ITED ART SCULPTURES - MAIN STREET I hereby affirm under penalty of perjury one of the following two declarations: GARAGE 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 �ApA Section 3700 of the Labor Code, for the performance of the work for which this �Y � gyp' ermit is issued. Sq. Ft Floor Area: Valuation: $40000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: O an Type: information is correct. I agree to comply with all city and county ordinances 316 20 999 316 S (Tenant Improvements) 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 PERMIT EXPIRKS IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DA VS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will co ly with all non -point ection 9.18. source regul i s per t upert' oMate 1S0 DAYS FRO LA SPECTION. !: Signature .. ' 03/15/2017 Issued by: MELISSA N V" Date: 03/15/2017 OWNFR-Bilis DER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected RE -ROOFS: rior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtainii ig 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: 03/15/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COV MINGS TO BE CLASS "A" OR BETTER i. 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. HAZARD MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,'as provided for by I have read the hazardou 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 & Sa ty Code, Sections 25505, 25533, and 25534. I will maintain compliance with he Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Sction 25532(a) should I store or handle hazardous a. I certify that in the performance of the work for which this permit is issued I material. Additionally, sho Id 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 define by the Bay Area Air Quality Managem nt District I Worker's Compensation laws of.California. If, after making this certificate of will maintain compliance m ith the Cupertino Municip Co C ter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, ctions 505 53 , a 534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: , LENDING AGENCY APPLICANT CERTIFICATION Date: 03/15/2017 I certify that I have read this application and state that the above information is " CONS I hereby affirm that there is RUCTION a 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 this pei mit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree 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 ARI 7HITFCTIS DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal i understand my plans she II be used as public records. Code, Section 9.18. Licensed Signature Date 03/15/2017 Professional CONSTRUCTION PERMIT APPLICATION .= COMIALINITY DEVELOPMENT DEPARTI%4ENT , BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CLIPI=RAI (408) 777-3228 - FAX (408) 777-3333 - buiidinona cuDeTtlnG ora ❑ MY CONSMUCTION .A(DDITIONII ❑ ALTERATION / T1 ❑ REV1SIONIDEFEMD ORIGINAL PERMIT PR47ECTADDRESS j �a .�� Uri.- I. � �.O ��•3% 1 .4P;v STREET.4DDP.Zlla ZYto (-�..rf� 9�s' CONTACT Nsa,_ ( P'40"m E•M.=IIL, AQ -q 4 0C ' e 6© r�l�� ()a 4 iso � wtal�(. , q , STRIT ADDRES 61 2 , W C3 od 5 I CIL, f � �s..e/Qp�.'Y-i�-r1 om''ER 011'l�l-BLT.DER 11 OAn\ A'GTT ❑ COArmACTOR ❑CONTRACTORAGEN7 ❑ ,.pc HITECT ❑En'Git.°EER ❑ DEVEELOPER ❑ AS�^p CONMA.CTORNAME LICENSENbNMER 6 7 LIC SE TYPE 7 BUS. LIC n COA3PAI\'Y xmlm1 - L E•14hIL %"61�l FAX �14 0 I STREET E.t7DRESS CITY, STATE, ZIP PHONE -AR C'r7TECTrAGNSEER;A.AI;fE ( Ll ISEXU'Mmm BUS. LICK COMPANY I.gl„E ! E.hrAiL I FAX STREET ADDRESS 'p I CITY, STATE, 71P I - PHO? E _ _ --- q- �A -JA (1 �' ti (j.4 irirt l. i v ! EXISTIIIGL'SE PROPOSEDLrSE COI;STRT1PE STOP.i"t5 USE YPF OCC: I SQ.FT. VALUATION (S) EXISTG NEWFLOOR. DEMO TOT},L AREA P.REA ARF4 YPT AREA BlkMkoOhi WCHFN OTHER P,EMODELAREA REMODEL/ EA � REMODELAREA PORCH .AREA DICK AREA TOTAL DECKTORCH .SREA GARAGE AREA: F)1 DETACH ❑ ATTACH I Dll-'ELLN L•'_SfS: lSASECONDL-hIT ❑YES SP-CO\D STORY .❑1ES BENGADDED? 13 No ADDITIO\? ❑ko P,P.E•.SPPLICATION ❑:-=S IF ITS,PROMECOPY OF PLA\•FL\G A..9PL ❑\O PL"�?�L3iG.iPi',20VAL LETTER ISTHEBLDGAY ❑1'_ EICHLER H01iE7 ❑ ti0 7RF - --- _ _ - -' -- <,r •->- _ �•, .:->.Hr;_ TOT4 VAI_ - �_ -: (z BY Iny signature below, I certi)w to each of the follo%vine; I am Lhe properly ov ler or authorized n rx act on ic properi' ommer'S behalf. I have read this I have read the Description of Work and verify it is ac,urate. I z� ee to comply \vitb all applicable local application and the inionnlation I have provid�nscti" ordinances and state IaWS relating t i -I authorize representatives of Cupertino to enter thea ave-• 'enti Ied Property for inspection PutposeS• Signature of Applicant/ADate: SUPT LEMY-14T L INFOR4ATIO T RE UTREb Q -_-- '; ECJi,`f5`PE=` =-"' _ „_=�;`::� _<:sA•«:::_zs;;. --= RDLiI IPsv * =-€ e'rC Multifamily lr t 1 FD or _ �ultif 71 3 dwellings: Apply for demolition pe: for :;z -'-_'=tF'c:= = _ -- _ til€''�- +75irP.EbLllding 5. DBI?1011tiOr! permit - o } I prior to issuance of building ;_tea -0\ ER -TIS_ CQt TEPA`=`- -- --- — -- - _ -_ - - _ - Yom:.`_ . J3LiiIiJtiGPI:,4-'�R_E}yE\1'..•;°_`=1;; _C zl;Bit for ne11 L ]diZ -= r�7 - - _COIni772'CiaJ Bldgs• Provide a con I - 7 completed Hazardous Materials Ai5clo5ure - --- - _----•c1;x,::-_ `:ID,�s�_✓x �� �- =_ : v�_.; _ IEA - - ~ ' _ -_ _-- _ _-.�.:.,._.- ( Y'�r.PLTiLI - -- X01-11) if any Hazardous Materials are being usad as alt of this project, of P ann n5 Approval Letter or RFeetln, with Planning prior to kCaPY -' SLbmi' al of Builds '# n, Perrot application. _ - - - _ - - .� - - �IT3121FSE:1iT=c•-D R z_rT- _ _ _ _ _ �:�, _ _ _ __-- -`-=-z:�--•. - _ B1dgt.IPP_20ILdoe revised 06/21111 r7