B-2018-1142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1142
18920 FORGE DR CUPERTINO,CA 95014-0701(316 09 030) MILROY
CONSTRUCTION INC
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: DATE ISSUED:07/10/2018
OWNER'S PHONE: PHONE NO:(650)625-0300
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#579832
Contractor MILROY CONSTRUCTION INC Date 1 0/3112 01 9 X BLDG_ELECT_PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that 1 am licensed tinder the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Cade and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE-T.I.-INSTALLATION OF ROBOT ARM AND POWER
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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 Code,For the
performance of the work for which this permit is issued.
i. I have and will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$90000,00
APPLICANT CERT'IF'ICATION
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 316 09 030 A(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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
OWNER-BUILDER DECLARATION
I hereby affirm that f am exempt from the Contractor's License Law for one of the RE-ROO'S:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If a roof is
t. I,as owner of the property,m rayearployeas with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the strueune is not intended or offered for inspection.
sale(Saa.7044,Business&PI'afessimis Code)
i. i,as owner ortba property,our,e.co.,vely co um,,ting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Eric:07/10/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 hazm-dous 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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in perita nauce ofthe work for which this permit is issued,I Ilealth&Safety Code,Section 25532(a)should I store at az
handle hordons
shall not employ any pet son in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contamil ants us defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maletui complinn'a with the Cape4ine Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the thal,ettSa£e y Code,Sections 25505,25533, ,,it 25534.
Labor Code,I most forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/10/2018
1 certify that I have read this application and state that the above information is CONST IL 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 ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 0 711 0/2 01 8 Licensed
Professional