B-2016-1147CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1147
193I9 STEVENS CREEK BLVD CUPERTINO CA 95014
(S C BUILDERS INC)
SUNNYVALE, CA 94085
OWNER'S NAME: MAIN STREET AGGREGATOR
DATE ISSUED: 01/26/2016
OWNER'S PHONE: 408-639-9322
PHONE NO: 408-328-0688
LEM, N.SEDCONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #767196
Contractor (S Q BUILDERS INC) Date 01/2612016
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed ender the provisions of Chapter 9 (commencing
MECIT RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is In full force and effect.
JOB DESCRIPTION:
15100205 DEF# 2 - RF Chambers submittal.
I hereby affirm under penalty of perjury one of the fallowing two declarations:
a. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided far by Section 3700 of the Labor Code, for the
performance offt work for which this permit is issued.
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.
Sq. Ft FloorArca:
Valuation: $10000.00
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
APN Number:
Occupancy Type;
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
PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally, the applicant understands and will
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
=18.
Signature `-- Date 01/26/2016
J J
Issued by:
Date: 01/26/2016
OWNER -B Iii D •R DoECLARATION
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
t. 1, 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 (See.7044,13usiness & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 01/26/2016
contractors to construct the project (Sec.7044, Business & Professions Code),
I hereby affirm under penalty of perjury one of the fallowing three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L I have and will maintain a Certificate of Consent to self insure for Worker's
Compensation, as provided for by Section 3700 ofthe Labor Cade, 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. 1 have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. Twill
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
IIealth & Safety Code, Section 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, 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 Califortria. 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 Codes, Sections 25 5, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this pormit shall`Zr
be deemed revoked,
Owner or authorized agent:
Date: 011261201 8
APPLICANT CERTIFICATION
CONSTRUCTION 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 (Sea 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
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Cade, Section 9.18,
Licensed
Signature pate 01126/2016
Professional
CQNSTRUC i CON PERMIT APPLICA T ICN
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