B-2018-0339 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0339
20450 STEVENS CREEK BLVD CUPERTINO,CA 95014-2265(369 01 027) STREAM LINE
VALLEJO,CA 94591
OWNER'S NAME:CUPERTINO CITY CENTER BUILDINGS CA LP DATE ISSUED:04/11/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL Lid.#877_499
Contractor STREAM LINE Date 05/31/2018 X BLDG—ELECT—PLUMB
I hereby affirm that I am 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,1.-NEW RUN FROM EXISTING PANELTO RELAYS
I hereby affirm under penalty of perjury one of the following two declarations: (7)MECHANICAL ROOM
I have and will maintain a certificate of consent to self-insure for Worker's USING EXISTING 4"PENETRATIONS
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
is issued. Sq.Ft Floor Area: 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 all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 01 027
representatives of this city to enter up e above mentioned property for
inspection purposes.(We)agr �a4e are and keep harmless the
City of Cupertino again�
1 hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roof's shall be inspected prim to any roofing material being installed.If a roof is
m. 1,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 sort 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 toconstruct the project(Sce.7044,Business&Professions Code), Date:04/11/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS 1'O BE CLASS"A"OR BETTER
m. 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
Parfet mance 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 Code,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Mmdci st Code, apter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I health&Safety Code,Section 25532(n)sh d I to handle hazardous
shall not employ any person in any manner so as to become subject to the
material.Additionally,should l use equipAl-a nt er i s which emit hazardous
nim contaminants as delined by the Bay fry Management District I
Worker's Compensation laws ofCalifomia.If,after making this certificme of will maintain compliance with the p tf u u `Iprd e,Chapter 9,12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 04/11/2018
Professional