10: B-2018.0372 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0372
10945 N WOLFE RD CUPERTINO,CA 95014-061(316 05 05 1) MSC GENERAL
CONSTRUCTION INC
SAN JOSE,CA 95129
OWNER'S NAME:CUPERTINO VILLAGE LP DATE ISSUED:04/19/2018
OWNER'S PHONE:213-235-5802 PHONE NO:(408)642-9100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#1031146
Contractor MSC GENERAL CONSTRUCTION INC Date 09/30/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Cha ter9(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:
SPRINT-IST FLOOR;T.I.-OFFICE(2035 S.F.)
I hereby affirm ander penalty of perjury one of the following two declarations: REV#I-REVISIONS DUE TO FIELD CHANGES-ISSUED 06/19/2018
i. 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,
I have mud will maintain Worker's Compensation Insurance,as provided for by
SSection 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Fluor Area: valuation:$50000.00
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 slate laws relating to building construction,and hereby authorize 31605 051 A(Tenant Improve tents),B(Tenant Improvements)
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 fi Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatureate 06/1912018 Issued by:Abby Ayende
Date:04/19/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS;
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner of the property,m my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new mmcrials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code) ,
z. 1,as owner of the property,am exclusively contracting with licenced Signature ofApplicaut:
contactors to construct the project(Sce.7044,Business&Professions Code), Date:06/19/2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I I 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
Fiat ftsmance of lire 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 Municipal Code,Chapter 9,12 and the
I. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)should I store or handle huzdous
shall not employ any person in any manner so as to become subject to the materielur
.Additionally,should I use equipment m•devices which emit hazardous
Worker's Compensation laws of California.If, making this certificate of contaminants as defined by the Bay Arca Air Quality Management District I
P g will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod, fans 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or auized agent,
APPLICANT'CERTIFICATION Date:061191=
I certify that I have read this application and state that the above Information is CON UC T a END: A F
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there s a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this d unit 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 ARCIII'1'EC'f'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08/19/2018 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ts
(408)777-3228• building@cu2ertiiT2.orQ PEMIT xB-'�-70 L)
CUPERTIN4 REV A' DEF#_
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION k.I. ❑MEP ❑RE-ROOF ❑SWA2MING POOL/SPA
PROJECCAq(D/�RE$,5 � , ry��`U�- p�APNp
OWNEI,/T
STREET ADDRESS I CITY,STATE,ZIP
❑CONTRACTORNAME ❑OWNER-BUILDER COAil'AN1'NANiE LICENSE NUMBER WCENEE TI'PE
MSCCrevvrA Canslrflch Inc I b?i I I b
57PREETADDRESS (vLt(7 CITY,STATE,ZIP t ��
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E-DdAR. PHONE BUS.LIC tl
❑ARCHITECT El OWNER DOWNER AGENT❑CONTRACTOR AGENTD ENGINEER❑DEVELOPER❑TENANT
CONT.ACP NAME CO! E-MESE
3- �CAV-CA- V✓)
STREET ADDRESS CITY,STATE,ZE' PHONE
DESCRIPTON
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T-ovc-tile c, n inSYal led u t eX i4 '-c e Xtin I uYsheY ilnS+,?,JJed ctik e)(+
plans yevised •}e ve-Aecf -tulle m-P cmde+Tv, - pUs
vevLWA peY Code ' Secf04 PCs VI-Mwe& -
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTINGS1 NEWI-11 SF 10-111F I DECKSF I DEMO SF STO-11 TOTALNETSF USE TYPE OCC 'SQ.FT. VALUATION(S)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGEATTACHED .
BATHROOM SF SP SF 1-1
SF 0 DETACHED
EXISING 0 ITS EICHLER El YES SECOND STORY ADDITION El YES
FIRE SPRINKLERS 0 NO ❑NO ❑No
DWELLING ISECONDDWELLING DYES❑ATTACHED❑DETACHED I OTHER
UNITSf UNTrADDTTON: ONO SF
POOL$ ❑FIBERGL.gES ❑VINYL-LINED 0 GUNDEE 0 PREFABRICATED
POOL-SF _ SPA-SF_I SPA ATTACHED❑YES ONO TOTAL-SF
EIVED BY: TOTAL VALUATION:
Corn rnal m'Multi-Fan ilaB ildi ,�'thP iI'S P 7 � D 't t!E-' t iH tl -I
RP-ROOF EATBTTNG ROOF TYPE: ❑BUILT-UPROOF❑ASPHALT SHINGLES❑WOOD SHAKES[]WOOD SHINGLES❑TILE OTHER(SFECIF)J
REMOVE/REPLACE❑NO TF NO PLYWOOD ❑�A" ❑3/9" PLYf'100—: PITCH: ROOF CLASS
YES f OF LAYERS THICINESS❑S/S" OTHER ❑OSB ❑CDX OTHER —12 A
PROPOSED ROOF TYPE:OBUILT-UP ROOF DASPH.ALT SHINGLES O WOOD SHAKES OWOOD SHINGLES L)OTHER
'Provide a signed copy of the Cupertino's Tear-Off Policy SF Sof SQUARES
By my signature below I certify to each of the following I am the property owner or authorized agent to act on the property,Owner's behalf.I
have read this application and the information I have provided is correct.I have read the Descrip4authrize
d verify it is accurate.I agree
to comply With all applicable local ordinances and state laws relating to building construction. resentatives o£Cupertino to
enter the above-identified property for urspechon purposes. I acknowledge and authorize all intined on this application form
to be made available for public recor /_/Siaature of ApplicanUAgent: AA Db
SUPPLEMENTAL INFORMATION REQUIRED
'New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all neve construction.
`Commercial Buildings:Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
'Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
`HOA-Provide a letter of approval from the Home Owner's Association
B1dgApp_2017.doc revised 08101117