B-2018-0985 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0985
19450 STEVENS CREEK BLVD STE 100 CUPERTINO,CA 95014(375 01 022) CHENGUAN
CONSTRUCTION LLC
FREMONT,CA 94536
OWNER'S NAME:ARCADIA DEVELOPMENT LLC DATE ISSUED;06/13/2018
OWNER'S PHONE: PHONE NO:(650)863-7995
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#1002166 X BLDG_ELECT_PLUMB
Contractor CHENGUAN CONSTRUCTION LLC Date 06/3012020 —
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH_RESIDENTIAL 2C COMMERCIAL
with Section 7000)of Division.3 of the Business&Professions Code and that my
license is In full forceand effect, JOB DESCRIPTION:
OFFICE T.L-(2705)INTERIOR TI AND ADA UPGRADES
I hereby affirm under penalty of perjury one of the fallowing two declarations•.
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.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: V.1mrimu:S 10000.00
APPLICANT CFRITIFICATION
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; occu Parc
y Typal
and state laws relating to building construction,and hereby authorize 37501 022 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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
" \ Date Issued by:Phuong Devries
Date:06/t3/2018
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 prim to any roofing material being installed.if a roof is
r, f,as owner of the property,or my employee with wages as their sole misted without first obtaining at inspection,l agree to remove all new materials for
ompensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner ofthe property,am exclusively contracting with licensed Signature ofApplieant
contractors to constrvet the project(Sm.7044,Business&Professions Code). Data
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 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 birbe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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,Secflons 25505,25533, ad 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. 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 on in an manner se as to become subject to the umlerial.Additionally,should 1 use equipment or devices which emit hazardous
p y any pars y ma 1 air contaminants as dellned 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. Owner or authorized agent:
APPLICANT CERTIFICATION Date: //�y (
I certify that I have read this application and state that the above information is e�/� J INSTRUCTION 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'SDECLARATION
Code,Section 9.18. 1 understand my plansshall be used as public records.
Licensed
Signature Date Professional