B-2018-0781 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0781
10475 BANDLEY DR CUPERTINO,CA 95014-1912(32633111) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME:DPT BANDLEY DRIVE LLC DATE ISSUED:06/15/2018
OWNER'S PHONE:408-738-4444 PHONE NO:409-9645657
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#229163
Contractor DEVCON CONSTRUCTION INCORPORATED Data 0212812019 X BLDG ELECT X PLUMB
I hereby affirm that I am licensed tinder the provisions of Chapter 9(commencing —MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code mid that my
license is in full force and effect. JOB DESCRIPTION:
APPLE-T.I.INSTALL NEW WASTE TANK AND TRANSFER
I hereby affirm under penalty of perjury one of the following two declarations: STATION,REPLACING(E)EMERGENCY EYE WASH/SHOWER AND
r. I have and will maintain a certificate of consent to self-insure for Worker's ADD(N)WASTE TANK SINK
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the wank for which this
permit is issued. Sq.Ft Floor Area: Valuation:$160000.00
APPLICANT CERTIFICATION
I certify that I have read Zap, 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 326 33 111 A(Tenant Lnproveaeuts),A(Tenant loquevemeuts),A
representatives of this city to enter upon the above mentioned property for (Tenant trnprovements),A(Tenant bnprovements),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 hoprovements),A(Tenant Improvements),A
Additionally,the app1lcant understands and will comply with all non-paint (Tenant Improvements)
source regulatpp per the Cupertino Municipal Code,Section 9.18.
Signature Date 06/1512018 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I aro exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Jasmine Archbold
r. 1,as owner ofthe property,or my employees with wages as their sole Date:06/15/2018
compensation,will do the work,and the structure is not intended on offered for
sale(Sec.7044,Business&Professions Code) RF ROOFS
z. 1,as owner ofthe properly,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a reef 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 corder penalty of perjury one of the following three declarations: impechea.
t. 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 Cade,for the Signature ol'Appli-in
performance of the work for which this permit is issued. Date:06/15/2018
z. I have and will naiinc in 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. 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE
shat[not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements antler Chapter 6.95 of the
Worker's Compensation laws of California.If,mpe making tbfs certificate of
California 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 Cade,Chapter 9.12 and the
Labor Code,l must forthwith comply with such provisions or this permit sball health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material.Additionally,should I use equipment or devices which emft hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Cod tions 25505,25533,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)agree Owner or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:06/15/2018
judgments,Costs,and expenses which may accrue against said City In CONSTRUCT! N 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 Data 06/15!201 B