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B-2018-1002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1002 19540 VALLCO PKWY STE 100 CUPERTINO,CA 950[4(316 20 119) MAIN STREET CUPERTINO RETAIL PROPERTY LLC _ 965 PAGE MILL RD PALO ALTO,CA 94304- 1013 OWNER'S NAME:MAIN STREET COPERTINO RETAIL PROPERTY LLC DA'Z'E ISSUED:06/13/2018 OWNER'S PHONE:408-777-3081 PHONE NO:Nan. LICENSED CONTRACTOR'S BUILDING PERMIT INFO: License Class Lic.# Contractor MAINS TREET CUPERTINO RETAIL PROPERTY LLC Data X BLDG X ELECT_PLUMB I hereby affirm that I am licensed tinder the provisions of Chapter 9(commencing —MECH_RESIDENTIAL X COMMERCIAL with Section 7000)of Divislon 3 ofthe Business&Professions Code and that my license is In full force and effect. JOB DESCRIPTION: UPGRADE PANEL(200 AMPS) I hereby affirm under penalty of perjury one of the following two declarations: u 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. 1 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:81000.00 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 316 20 119 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 06/13/2018 Issued by:Jasmine Archbold Date:06/13/2018 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor Is License Law for one of the RE-ROOFS: following two reasons: All roofs shat]be inspected prior to etry roofing material being installed.If a roof is u I,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,I our cc to remove all new m aerials for compensation,will do the work,and the structure is not intended or offered for inspection, 6 sale(Sea7044,Business&Professions Code) 1,asowner ofthe property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/13/2018 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance,as provided fmby I have rend the hazardous materfals requirements under Chapter 6.95 at 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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that Pu the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)should I store or In elle hazardous shall not employ any pens 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 compliance defined h the up Area Air Quality Maangomcnt District a 1 will maintain compliance with the Cupertino Municipa Cade,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co e,Sections 25 5,3A5P31 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:06/13/2018 1 certify that I have read this application and state that the above information is CONSTRUCT DIN 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 co ply with all non-point source regulations per the Cupertino Municip ARCHITECT'S DECLARATION Code,S o 9. understand my plans shall be used as public records.