B-2018-0906 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERM IT NO:B-2018-0906
10626 S DE ANZA BLVD CUPERTINO,CA 95014-4450(369 38 039) AD&C DESIGN INC
FREMONT,CA 94539
OWNER'S NAME:BYER PROPERTIES LP DATE ISSUED:05/25/2018
OWNER'S PHONE: PHONE NO:(510)625-9566
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-45 Lid.4929828
Contractor AD&C DESIGN INC Dale 11/30/2019 X BLDG_ELECT_PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 ol'the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
INSTALL ILLUMINATED CHANNEL LETTERS(CALCOLOR
I hereby affirm under penalty of perjury one of the following two declarations: ACADEMY)(24.5 SF).
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.
I have and will maintain Worker's Compensation Insurance,as providod for by
Section 3700 of the Labor Code,for the performance of the work for which this
' permit is issued. Sq.lit Floor Area: Valuation:$2500.00
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 slate laws relating to building construction,and hereby authorize 36938 039 A('Pennant 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 th Cupertino Municipal ode,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5 25 18 Issued by:SEAN HATCH
Date:05/25/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following live reasons: All roof's shall be inspected prior to any roofing material being installed.Ito.of is
r, 1,as owner of the property,or my employee with wages as their sole nslallcd without first obtaining an inspection,I agree to remove all new materials to,.
compensation,will do the work,and the struciare is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplieanr.
contractors to cunshuut the project(Sec.7044,Business&Professions Code). Date:5.25.18
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. 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 Ore work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Suction 3700 ofthe Labor Code,for the performance of the work for which thisCalifornia 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
a. 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 maturer so as to beoome subject to the mterinl.Additionally,should I use equipment or devices which emit hazardous
oilantumiumme as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws oCCaliforuia,If,after making this certificate of will mnintain 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 5505,25533,and 25534.
Labor Cade,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CER'I7FICA'I'ION Date:5.25.18
I certify that I have read this application and state that the above information is CONST CTION 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(Sao,3097,Civ C.)
toenter 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 ARCHITF,C'f'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6 25 18
Processional