B-2017-0384 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0384
21666 STEVENS CREEK BLVD CUPERTINO,CA 95014-1149(357 17 012) SSW CONSTRUCTION
CORP
FOLSOM,CA 95630
OWNER'S NAME: KALMAN BARBARA TRUSTEE&ET AL DATE ISSUED:08/22/2017
OWNER'S PHONE:925-314-4233 PHONE NO:(916)773-9595
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#850461
Contractor SSW CONSTRUCTION CORP Date 12/31/2018 X BLDG _ELECT X PLUMB
X 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:
PIZZA HUT-T.I.;RESTAURANT(1900 S.F.);(N)A/C ROOF TOP UNIT;
I hereby affirm under penalty of perjury one of the following two declarations: (N)SEWER MAIN
1. I have andwill maintain a certificate of consent to self-insure for Worker's REV#1-FANS FOR NEW FRYER HOODS;GREASE DUCT
Compensation,as provided for by Section 3700 of the Labor Code,for the CHANGE;FRYER HOOD CHANGE;ADD.FRYER FAN TO ROOF 2
A �, rwrformance of the work for which this permit is issued. FRYERS INSTEAD OF 4;ADD FLOOR DRAINS;RECONFIGURE
... I have and will maintain Worker's Compensation Insurance,as provided for by OUTLETS AT MANAGER STATION-ISSUED 9/28/2017
'&`' Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$150000.00
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 357 17 012 A(Tenant Improvements),B(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 per e Cupertino M4',icip Code Sion 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
nature df.,—� # Date 9/28/2017 Issued by:Abby Ayende
000��� Date:08/22/2017
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. I,as owner of the property,or my employees with wages as their sole installed without first obtaining 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:9/28/2017
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
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,for 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 1 store or handle hazardous
shall'not employ any person in any manner so as to become subject 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
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuperti o Municipal C,,e,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions.of the the Health&Safety Code,Se ' ns 255 5,25 (,an. .534.
Labor Code,I must forthwith comply with such provisions or this permit shall 1 7v/
be deemed revoked. 40,Leser seer w.or authorized agent: ��—
APPLICANT CERTIFICATION Date:9/28/2017
I 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,posts,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 9/28/2017Professional
CITY OF CUPERTINO BUILDING PERMIT -
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0384
21666 STEVENS CREEK BLVD CUPERTINO, CA 95014-1149 (357 17 012) SSW CONSTRUCTION
CORP
FOLSOM, CA 95630
OWNER'S NAME: KALMAN BARBARA TRUSTEE & ET AL
OWNER'S PHONE: 925-3144233
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #850461
Contractor SSW CONSTRUCTION CORP Date 12/31/2018
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:
1.. I have and will maintain a certificate of consent to self -insure for Worker's
/- Eave
ensation,as provided for by Section 3700 of the Labor Code, for the
murnce of the work for which this permit is issued.
i. I.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.meniioned 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 8/22/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
i. 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)
z; I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I
I hereby affirm under penalty of perjury one of the following three 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 thejwork for which this permit is issued.
2.. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3706 of the Labor Code, for the performance of the work for which this
permit is issued.
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. -
Date 8/22/2017
DATE ISSUED: 08/22/2017
PHONE NO: (916) 773-9595
BUILDING PERMIT INFO:
X BLDG _ ELECT X_ PLUMB
X MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
PIZZA HUT - T.I.; RESTAURANT (1900 ST.); (N) A/C ROOF TOP UNTI;
(I) SEWER MAIN
Sq. Ft Floor Area:
Valuation: $150000.00
APN Number:
Occupancy Type:
357 17 012
A (Tenant Improvements),B (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A, e� nde
Date: 08/22/2017
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 8/22/2017
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, and 25534.
finer or authorized ag
Date: 8/22/2017
CONSTRUCTION LENDING 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
Professional