B-2018-1143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1143
20330 STEVENS CREEK BLVD CUPERTINO,CA 95014-2268(369 01 020) 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&Lie.#579832
Contractor MILROY CONSTRUCTION INC Date 10/31/2019 X BLDG ELECT_PLUMB
1 hereby affirm that T nm licensed ander the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of(he Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
APPLE TI,-INSTALL THERMAL CHAMBERS,POWER,
I hereby affirm under penalty of perjury one of the following two declarations: CONDENSATE DRAIN
r. 1 have and will maintain a certificate ofconsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued.
z 1 have and will maintain Worker's Compensation Insurance,as provided far by
, Pection 3700 o£the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$70000.00
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 stale laws relating to building construction,and hereby authorize 36901 020 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� Date 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one DI tile RE-ROOFS:
£allowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an nspection,I agree to remove all new materials for
compensation,will do the work,and the strmcmre is not intended or offered for inspection,
sale(Sm.7044,Business&Professions Code)
z. 1,as owner ofthe propel,am exclusively contracting with licensed Signature o£Applicm7E
contractors to construct the project(Sec.7044,Business&Professions Cade), Date:07/10/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERi. 1 have and will maintain a Certificate of Conserv[w self=insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cede,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided ter 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 Cede,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 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(a)should I store or handle hazardous
shall not employ to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
1 y any person in any manner so as J sit contaminants as defined by the Bay Arco Air Quality Management District 1
Worker's Compensation laws o£Califarniu If,after making this certificate oC will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the file Health&Safety,ode,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions a this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/10/201 B
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 ARCHITECT'S DECLARATHON
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 07/10/2018 Licensed
Professional