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B-2017-1427 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1427 19160 STEVENS CREEK BLVD CUPERTINO,CA 95014(375 07 00 1) Stevens Creek L P 1400 Parkmoor Ave Ste 190 San Jose Ca,CA 95126 OWNER'S NAME: DATE ISSUED:03/23/2018 OWNER'S PHONE: PHONE NO:None - LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# X BLDG ELECT PLUMB Contractor Stevens Creek L P Date — — — I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL—COMMERCIAL — with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: THE VERANDA-CONSTRUCT(N)3-STORY SENIOR HOUSING I hereby affirm under penalty of perjury one of the following two declarations: (12000 S.Q./19 UNITS)/SURFACE PARKING 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#3-RELOCATION OF ELEVATOR EXHAUST FAN- Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1 -ADDITIONAL STRAPPING AT SHEARWALL AT STAIR 1 - performance of the work for which this permit is issued. ISSUED 1.3.19 z. I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-ADDITIONAL ROOF-MOUNTED EXHAUST FAN FOR Section 3700 of the Labor Code,for the perfonnance of the work for which this ELEVATOR MACHINE ROOM-ISSUED 04/02/2019 permit is issued. Sq.Ft Floor Area: Valuation:$10000000.00 APPLICANT CERTIFICATION 12000 1 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 375 07 061 R-2(Apartment) 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. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 4-18-2019 Issued by:Abby Ayende ,._. Date: 03/23/2018 OWNER-BUILDER DECLARATION I hereby affirm that I am 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) affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 i. 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 I 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 Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Labor Code,1 must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534. be deemed revoked. . �.� -. Owner or authorized agent: APPLICANT CERTIFICATION Date:4-18-2019 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. 1 understand my plans shall be used as public records. 4-18-2019 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1427 19160 STEVENS CREEK BLVD CUPERTINO,CA 95014(375 07 00 1) Stevens Creek L P 1400 Parkmoor Ave Ste 190 San Jose Ca,CA 95126 OWNER'S NAME: DATE ISSUED:03/23/2018 OWNER'S PHONE: PHONE NO:None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor Stevens Creek L P Date X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: THE VERANDA-CONSTRUCT(N)3-STORY SENIOR HOUSING I hereby affirm under penalty of perjury one of the following two declarations: (12000 S.Q./19 UNITS)/SURFACE PARKING 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -ADDITIONAL STRAPPING AT SHEARWALL AT STAIR 1 - Compensation,as provided for by Section 3700 of the Labor Code,for the ISSUED 1.3.19 performance of the work for which this permit is issued. REV#2-ADDITIONAL ROOF-MOUNTED EXHAUST FAIN FOR 2. I have and will maintain Worker's Compensation Insurance,as provided for by ELEVATOR MACHINE ROOM-ISSUED'04/02/2019 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000000.00 APPLICANT CERTIFICATION 12000 1 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 375 Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 07 061 R-2(Apartment) 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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 04/02/2019 Issued by:Abby Ayende Date:03/23/2018 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any rooting 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) contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/02/2019 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 D 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 pen-nit 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&Safety Code,Sections 25505,25533,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:04/02/2019 1 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. Licensed Date 04/02/2019 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1427 19160 STEVENS CREEK BLVD CUPERTINO, CA 95014 (375 07 00 1) OWNER/BUILDER OWNER'S NAME: DATE ISSUED: 03/23/2018 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date X BLDG — ELECT — PLUMB _ I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: THE VERANDA - CONSTRUCT (N) 3-STORY SENIOR HOUSING I hereby affirm under penalty of perjury one of the following two declarations: (12000 S.Q./19 UNITS)/ SURFACE PARKING 1. I have and will maintain a certificate of consent to self-insure for Worker's REV #1 - ADDITIONAL STRAPPING AT SHEARWALL AT STAIR 1 - Compensation, as provided for by Section 3700 of the Labor Code, for the ISSUED 1.3.19 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. Sq. Ft Floor Area: Valuation: $10000000.00 APPLICANT CERTIFICATION 12000 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 75 Number: Occupancy Type: 3 and state laws relating to building construction, and hereby authorize 375 07 06.1 R-2 (Apartment) 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 the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: SEAN HATCH Date: 03/23/2018 OWNER-BUILDER DECLARATION I hereby affirm that I am 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 al.l new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) ( 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: 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 i. 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 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 agement District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cu Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: I certify that I have read this application.and state that the above information is C TRUCTI LENDIN GENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constr tion lendin 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 wit 11 non-point sour e regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 1 understand my plans shall be used as public records. Signature Date vV ` Licensed g Professional