B-2017-0116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0116
20955 STEVENS CREEK BLVD CUPERTINO,CA 95014-2107(326 31 022) BLUE ARC ELECTRIC
SANTA CLARA,CA
• 95054
OWNER'S NAME: WEISS PAUL E TRUSTEE&ET AL DATE ISSUED:05/12/2017
•
OWNER'S PHONE: PHONE NO:(408)727-6100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#830904
Contractor BLUE ARC ELECTRIC Date 06/30/2018 X BLDG X 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
license is in full force and effect. JOB DESCRIPTION:
TI-WHOLE FOODS-BATTERY ENERGY STORAGE UNIT(2)
I hereby affirm under penalty of perjury one of the following two declarations: EXTERIOR
1. I have and will maintain a certificateof consent to self-insure for Worker's REV#1-MINOR LAYOUT ORIENTATION CHANGES TO AVOID
Compensation,as provided for by Section 3700 of the Labor Code,for the CONFLICT WITH EXISTING GROUND OBSTRUCTIONS/OBJECTS-
performance of the work for which this permit is issued. ISSUED 11-28-2017
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 Floor Area: Valuation:$25000.00
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 ordinances• APN Number: Occupancy Type:
and state laws relating to building construction,•and hereby authorize 326 31 022 A(Tenant Improvements)
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]e e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.'
Signature
Date 11-28-2017
Issued by:Kim Dunbar
Date:05/12/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons:, All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. ' 1,as owner of theproperty,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
•
coinpensation,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: 11-28-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS,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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,fdr the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
• permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I 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
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 California. 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&Safeigo e,S tion 5505,25533,and 25534.
Labor Code„I must forthwith comply with such provisions or this permit shall
•
be deemed revoked. • Owner or authorized agent:
'APPLICANT CERTIFICATION - Date: 11-28-2017
I certify that 1 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 mentiohed'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 Municipal ARCHITECT'S DECLARATION
Code,Section'9.18.' • I understand my plans shall be used as public records.
Licensed
Signature Date 11-28-2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO: B-2017-0116
20955 STEVENS CREEK BLVD CUPERTINO, CA 95014-2107 (326 31 022) BLUE ARC ELECTRIC
SANTA CLARA, CA
95054
OWNER'S NAME: WEISS PAUL TRUSTEE & ETAL
DATE ISSUED: 05/12/2017
OWNER'S PHONE: 1 I PHONE NO: (408) 727-6100 1
License Class S -1Q Lic. #830904
Contractor BLUE ARC ELECTRIC Date 06/30/2018
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:
t. 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.
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.
Date 7/6/2017
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:
t. 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.
a. 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 1 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 7[8/2417
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
TI -WHOLE FOODS- BATTERY ENERGY STORAGE UNIT (2)
EXTERIOR
Sq. Ft Floor Area: I Valuation: $25000.00
APN Number: Occupancy Type:
326 31 022 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: Jasmine Archbold
Date: 05/12/2017
RF-ROOFS-
All
F 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: 7/6/2017
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, d 25534.
Owner or authorized agent: /
Date: 7/6/2017
N T"LENDtNG AGENCY
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
I understand my plans shall be used as public records.
Licensed