B-2018-0576 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0576
10420 BUBB RD CUPERTINO,CA 95014-4150(357 20 038) T MARSHALL
ASSOCIATES LTD
PLEASANTON,CA
94588
OWNER'S NAME:HOME OF CHRIST CHURCH IN DATE ISSUED:05/08/2018
OWNER'S PHONE:408-996-8208 PHONE NO:(925)734-9999
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lie.#664428
Contractor T MARSHALL ASSOCIATES LTD Date 02/28/2019 X BLDG ELECT—PLUMB
I herebyaffirm that l am licensed tinder the t'Cha Chapter (commencing —MECH—RESIDENTIAL X COMMERCIAL
provisions o p (a g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
APPLE-1ST AND 2ND FLOOR;RELOCATION OF(E)120V CUBICLE
1 hereby affirm under penalty of perjury one of the following two declarations: CIRCUITS TO(E)RELOCATED CUBICLE FURNITURE
t. 1 have and will maintain a certificate of consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issuecl.
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 I'm which this
permit is issued. Sq.Ft Flom Area: Valentina:$15000.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 357 20 038 A(Tenant Improve nests)
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 Cu no Municipal Code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-08-2018 Issued by:Kim Dunbar
Date:05/08/2018
OWNER-BUILDER DECLARATION
1 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 prior to any mating material being installed.If a roof is
L I,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended of offered far inspection.
sale(Se,7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors(a construct the project(Sce.7044,Business&Professions Cade). Date:05-08-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO 13E CLASS"A"OR IIETTEI2
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 Cade,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 for by I have read the hazardous materials requirements under Chapter 6,95 of the
Section 3700 of the Labor Cade,Cor the performance of the wok for which this California 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
e. I certify that in the performance of the work for which this penult is issued,I Health&Safety Code,Section 25532(1)should 1 store or handle hazardous
shall not employ material,Additionally,should I use equipment or devices which emit hazardous
p y any person in any manner so as to became subject to the air contaminants as defined by tire 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 32W,25533,and 25534.
Labor Code,Imust forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agenl:/
APPLICANT CERTIFICATION Date:05-08-2018
1 certify that I have read this application and state that the above information is CONSTRUCTION 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 ARC I'I'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 05-08-2018
Professional