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B-2016-2991 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2991 10815 N WOLFE RD STE 104 CUPERTINO,CA 95014(316 05 056) SMITH DEVELOPMENT AND CONSTRUCTION COMPANY CITRUS HEIGHTS,CA 95610 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED:05/04/2017 OWNER'S PHONE: PHONE NO:(916)966-7325 _ I II► •_C'. 1 : tc . BUILDING PERMIT INFO: License Class B Lic.#422096 Contractor SMITH DEVELOPMENT AND CONSTRUCTION COMPANY Date X BLDG _ELECT _PLUMB • • 05/31/2018 _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 JOB DESCRIPTION: license is in full force and effect. UNIT 104;T.L-RESTAURANT(1741 SF)-POKE WORKS • I hereby affirm under penalty of perjury one of the following two declarations: REVISION#1: RFI#13: ROOF SUPPORT FOR(N)HVAC UNITS ON 1. I have and will maintain a certificate of consent to self-insure for Worker's ROOF. ISSUED 11.9.17 Compensation,as provided for by Section 3700 of the Labor Code,for the ormance of the work for which this permit is issued. 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 Sq.Ft Floor Area: Valuation:$104460.00 permit is issued. APPLICANT CERTIFICATION I 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 316 05 056 A(Tenant Improvements),B(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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE-OR may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulatio er the Cupertino Municipal Code,Section 9.18. Issued by:ABBY AYENDE g• nature Date 11/9/2017 Date:05/04/2017 OWNER-BUILDER DECLARATION • RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for i. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:11/9/2017 contractors to construct the project(Sec,7044,Business&Professions Code). 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I 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 will maintain compliance with the Cu ertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, ecti s 25505,25533,and 25534. exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shallner or authorized agent: be deemed revoked. Date:11/9/2017 APPLICANT CERTIFICATION CONSTRUC ION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is 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 permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name toenter 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 expenseswhich 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. • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2991 10815 N WOLFE RD CUPERTINO, CA 95014-0614 (316 05 056) SMITH DEVELOPMENT AND CONSTRUCTION COMPANY CITRUS HEIGHTS, CA 95610 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 05/04/2017 OWNER'S PHONE: PHONE NO: (916) 966-7325 LICENSED D ONT ACTOR' DECLARATION BUILDING PERMIT INFO: License Class B Lic. #422096 COMPANY Date X BLDG Contractor SMITH DEVELOPMENT AND CONSTRUCTION 05/31/2018 _ELECT _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 JOB DESCRIPTION: license is in full force and effect. UNIT 4; T.I.-RESTAURANT (1741 SF) -POKE WORKS 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. 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 Sq. Ft Floor Area: Valuation: $104460.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above 16 Number: 316 OS 056 3 Occupancy Type: A (Tenant Improvements),B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said in consequence of the granting of this permit. Additionally, the applica nderstands and will comply with all non -point 180 DAYS FROM LAST CALLED INSPECTION. source regula' s p r Cupertino Municipal Code, Section 9.18. Issued by: Kim Dunbar Signature Date 05/04/20107 Date: 05/04/2017 -BUILDER DECLARATIORE- I hereby affirm that I am exempt from the Contractor's License Law for one of the 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 following two reasons: 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 05/04/20107 contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment evices which emit hazardous air contaminants as defined by the Bay AreaA6 Auality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cuperti nicipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: / be deemed revoked. Date: 05/04/20107 CONST CTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there i 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 pArmit 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18.