B-2017-2049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2049
10475 BANDLEY DR CUPERTINO,CA 95014-1912(326 33 111) DEVCON
CONSTRUCTION
INCORPORATED
MILPITAS,CA 95035 - •
OWNER'S NAME: DPT BANDLEY DRIVE LLC DATE ISSUED: 11/30/2017
OWNER'S PHONE:408-942-8200 PHONE NO:(408)942-8200
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LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2019 11/30/2017 BLDG _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:
APPLE INC BANDLEY 5-T.I.PREP;DEMO WALLS,CEILINGS,
I hereby affirm under penalty of perjury one of the following two declarations: MECHANICAL ROOF TOP UNITS,REMOVE HEAT LAB CHAMBER;
4 have and will maintain a certificate of consent to self-insure for Worker's REMOVE&SAFE-OFF ELECTRICAL AND MECHANICAL
Compensation,as provided for by Section 3700 ofthe Labor Code,for the ASSOCIATED WITH DEMO AREA AS NEEDED.
performance of the 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 Floor Area: Valuation:$25301.00
APPLICANT CERTIFICATION
(certify that I have read this application and state that the above --- -
information is correct.l agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building.construction,and hereby authorize 326 33 111 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
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source regulations per the Cupertiho Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
c' r
"ii-ature v6142 _ Date Issued by:Jasmine Archbold
$ • Date: 11/30/2017
OWNER-BUILDER DECLARATION
I hereby affirm that L am exempt from the Contractor's License Law for one of the RE-ROOFS:
following tworeasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. I 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
' inspection.
coinpensation;will do they work,and the structure is not intended or offered for
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sale(SeC.7044,Business&Professions Code)
2. I,as owner of the property;am excl'usi'vely contracting with licensed Signature of Applicant:
I contractor's to construct,the project(Sec.7044,Business&Professions Code). Date:
i ..
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
i,,
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
Section3700 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
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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
shall notemploy 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 1
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&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.. •,y`er or authorized agent: ' ,
APPLICANT CERTIFICATION ur%ate:
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,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.
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Signature Date Licensed .
Professional