B-2017-2181U�
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-2181
10441 BANDLEY DR CUPERTINO, CA 95014-1912 (326 33 079)
S C BUILDERS INC
SUNNYVALE, CA
94085
OWNER'S NAME: LV CUPERTINO LLC
DATE ISSUED: 12/19/2017
OWNER'S PHONE: 408-783-3025
PHONE NO: (408) 328-0688
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO'
License Class B Lic. #767196
Contractor S C BUILDERS INC Date 08/31/2019
X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH _ 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
APPLE - 1 ST FLOOR T.I. (308 S.F ); ADD HVAC CONDENSING UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
AT ROOF
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.
,<z �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: $57250:00
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
and state laws relating to building construction, and hereby authorize
326 33 079
A (Tenant Improvements),A (Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for
(Tenant Improvements),A (Tenant Improvements),A
inspection purposes. (We) agree to save indemnify and keep harmless the
(Tenant Improvements),A (Tenant Improvements),A
City of Cupertino against liabilities, judgments, costs, and expenses which
(Tenant Improvements),A (Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit.
(Tenant Improvements),A (Tenant Improvements),A
Additionally, the applicant understands and will comply with all non -point
(Tenant Improvements)
source regulations er the Cu rtino Municipa�Code, Section 9.18.
'
PERMIT EXPIRES IF WORK IS NOT STARTED
Signatua� Date 12/19/2017
U
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER -BUILDER DECLARATION
180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
foflowing two reasons:
Issued by Abby Ayende
1. I, as owner of the property, or my employees with wages as their sole
Date: 12/19/2017
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
RE -ROOFS:
z. I, as owner of the property, am exclusively contracting with licensed
All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (See.7044, Business & Professions Code).
installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations:
inspection.
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
Signature of Applicant:
performance of the work for which this permit is issued.
Date: 12/19/2017
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any maturer so as to become subject to the
I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If, after making this certificate of
Cafifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will
exemption, I become subject to the Worker's Compensation provisions of the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Labor Code, I must forthwith comply with such provisions or this permit shall
Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revoked.
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay ea Q ality Management District I
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
will maintain compliance with the Cu ertino uni ipal Code, Chapter 9.12 and
the Health & Safety Code ection 2550 , 25533 and 25534=
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) agre-_
-Owner or authorized age
-11
to save indemnify and keep harmless the City of Cupertino against liabilities,
Date: 12/19/2017
judgments, costs, and expenses which may accrue against said City in
CONS RUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally, the applicant understands
I hereby affirm that there is a construction lending agency for the performance
and will comply with all non -point source regulations per the Cupertino Municipal
of work's for which this permit is issued (Sec. 3097 Civ C.)
Code, Section 9.18.
Lender's Name
Lender's Address
Signature Date 12/19/2017
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.