B-2018-0338 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-0338
20400 STEVENS CREEK BLVD CUPERTINO,CA 95014(3 69 01 028) STREAM LINE
VALLEJO,CA 94591
OWNER'S NAME:CUPERTINO CITY CENTER BUILDINGS DATE ISSUED:04/11/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ilii Lie.#877499
Contractor STREAM LINE Date 05/31/2018 X BLDG ELECT_PLUMB
I hereby affirm that I nm licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
THE TOWERS-T.I.-NEW RUN FROM EXISTING PANEL TO RELAYS
1 hereby affirm under penalty of perjury one of the following two declarations: (7)MECHANICAL ROOM
t. I/rave and will maintain a certificate of consent to self-lore for Worker's USING EXISTING 4"PENETRATIONS
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued,
have and will maintain Workei'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 Flom-Arco: Valuation:$15000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Information is correct.I agree to comply with ail city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 36901 028
representatives of this oil�b'l
o enter opo a above mentioned property for
Inspection purposes.(Wagree t e indemnify and keep harmless the
City of Cupertino against 'd dgments,costs,and expenses which PERMIT EXPIRES IF WORT{IS NOT STARTED
may accrue ag nst sal nseqund w of the granting all
this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,t
code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 04/1112018 Issued by:Jasmine Archbold
Date:04/11/2018
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 roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole 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 or offered for inspection.
sale(See'7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/11/2018
I hereby affirm under penalty of perjury one of the following three declarations: pLL ROOF COVERINGS TO BE CLASS"A"OR BETTOR
r. I have and will maintain a Certificate of Consent to self-insure for Walker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which[[its 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 Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Mmrlcipal Co ,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532( r uld I or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally, ""'old
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Data:04/11/2018
I certify that I have read this application and state that the above information isCONSTRUCTION LE DINGAGENCY
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,Clv 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.
SignatureLicensed
Date 04111!2018
Professional