B-2018-1079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1079
20745 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 055) LANKFORD
CONSTRUCTION
COMPANY
JOHNSBURG,IL 60050
OWNER'S NAME:PCG CUPERTINO LLC 100% DATE ISSUED:07/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#669974
Contractor LANKFORD CONSTRUCTION COMPANY Dale 04/30/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECI4—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:
TARGET-IST FLOOR;T.I.PREP-MINOR DEMOLITION(11,0291 SF)
I hereby affirm under penalty of perjury one of the fallowing two declarations:
L 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.
have and will maintain Worker'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 Fluor Area: Valuation:$30000.00
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'rype:
and state laws relating to building construction,and hereby authorize 326 32 055 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 p//er//thheJe Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7-20-2018 Issued by:Kim Dunbar
Date:07/20/2018
OWNER-BUILDER DECLARATION
I hereby u1Brm that I am exempt from the Contractor's License Lav 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
1. 1,as owner of the property,or my employee with wages as their sole n,failed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and fire shoemre is not intended or offered for inspection.
sole(See.7044,Business&Professions Code)
2. 1,as owner of the property,are exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:7-20-2018
I hereby affirm tinder penalty of perjury one of the following three declarations: ALL ROOF COVERINGS'1'O BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as in for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
t,. I have and will maintain Worker's Compensation Insurance,m provided for by I have read the hazardous mx[a•ials requirements under Chapter 6.95 of Bre
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Cuda,,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Clmpter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Ilealrh&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ an person in an to become subject to the material.Additionally,should I use equipment m,devices which emit hazardous
p y y p y manner so as J air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Solely Code,Seetio 5,25593,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen•
APPLICANT CERTIFICATION Data:7-20-2018
I certify that I have read this application and slate that the above information is CONSTRUCTION LENDING AGENCY
correct,r agree to complywith 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 DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 7-20-2018 Professional