B-2018-1038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1038
20730 VALLEY GREEN DR CUPERTINO,CA 95014-1704(326 10 047) MILROY
CONSTRUCTION INC
MOUNTAIN VIEW,CA
94043
OWNER'S NAME:SI 30 LLC DATE ISSUED:06/19/2018
OWNER'S PHONE: PHONE NO:(
LICENSED BUILDING PERMIT INFO:
License Class @ Lic.#579832
Contractor MILROY CONSTRUCTION INC Date 10131/2019 X BLDG—ELECT—PLUMB
MECH RESIDENTIAL X COMMERCIAL
1 hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE V02 TOAST LAB-INSTALL(N)PROBE TOOL,INSTALL
1 hereby affirm under penalty of perjury one of the following two declarations: CDA AND ELECTRICAL RECEPTACLES,
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.
z 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:$60000.00
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: Ocoup,nrry'I'ype:
and slate laws relating to building construction,and hereby authorize 326 10047
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 WORT{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 piicant understands and will comp wit all non-point
source regulati s per the Cupertino Municipa�Co Se on 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 06/19/2018 Issued by:Jasmine Archbold
Date:06/19/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of theRE-ROOFS
fallowing Ivo reasons: All roofs shall be inspected prior to any roofing material being instflled.If.roof is
1. I,as owner of the property,or my employees with wages as thou sole instelled without First obtaining an iuspecttou,1 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)
z Los owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/19/2018
1 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[lie
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as to for by I have read the hazardous materials requirements under Chapter 6.95 attire
Section 3700 ofthe Labor Code,for the performance of the work far which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. mainhdncompliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,[ 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 mlterial.Additionally,should 1 ase equipment or devices which emit hazardous
' contaminants es defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,ClY25534.1
t212 d
exemption,I become subject to the Worker's Compensation provisions of Inc the Health&Safety Cad Sections 25505,25533,anLabor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized a raAPPLICANT CERTIFICATION Date:I certify that I have read this application and state that the above information is CONSTRUCTION
correct.I agree to comply with all city and county ordinances and state laws I hereby afOrm that there is a construction lending agency for
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.
Licensed
Signature Date 06119/2018
Professional