B-2018-1157 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO;B-2018-1157
10100 N TANTAU AVE CUPERTINO,CA 95014-2540(316 19 062) NOVO
CONSTRUCTION INC
MENLO PARK,CA
94025
OWNER'S NAME:Pi Cupertino Gateway LLC DATE ISSUED:07/18/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lid.4791022
Contractor NOVO CONSTRUCTION INC Date 02/28/2019 X BLDG ELECT—PLUMB
I hereby affirm that 1 nm 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 fn fall farce and effect. JOB DESCRIPTION;
APPLETL-TEMP CDA SKID
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
perfomance of the work for which this permit is issued.
z. I haveand will maintain Worker's Compensation Immunex,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$25000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcallon and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy'Iype:
and slate laws relating to building construction,and hereby authorize 316 19 062
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 1$0 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source
I hereby affirm that I am exempt train the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any mofing material being installed.If a roof is
t. 1,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an Inspection,1 agree to remove all new materials 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 licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:07-18-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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 HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation insurance,as provided for by I hav,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.I will
permit is issued. m aintain,ampliance 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 hmidle I—ardous
shall not employ any person in any lit liner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
a air contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of Califomis.If,after making this certificate of will maintain compliance with the Cupertino Mrole rtYCo e,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety
)
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.
Signature Date 07-18-2018 Licensed
Professional