B-2018-1300 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1300
10200 N TANTAU AVE CUPERTINO,CA 95014-2557(316 19 062) S C BUILDERS INC
SUNNYVALE,CA
94085
OWNER'S NAME:PR CUPERTINO GATEWAY LLC DATE ISSUED:08/01/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT[NFO:
License Class B Lin.4767196 X BLDG_ELECT_PLUMB
Contractor S C BUILDERS INC Date 08/31/2019 —
I hereby affirm that I am licensed under tine provisions of Chnpter 9(commencing —MECH—RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force xad effect. JOB DESCRIPTION:
APPLE TANTAU 7A-T.I.PREP-(48,416 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for die
3700 of the Labor Code,for the,performance of the work for which this
permit is issued. Sq.Ft Flour Area: Vnluadia:$33400.00
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 Type:
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 a at liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agat t said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the pplicant un r tends and will comply with all non-point
source regula I s per the u rtino unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signage Date 08/1/2018 Issued by:Jasmine Archbold
Date:08/01/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first Obtaining an inspection,I agree to remove s11 new are, for
compensation,will do the work,and the struchur is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec 7044,Business&Professions Code). Date:08/l/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of'Comsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for due
performance of too 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
a. 1 certify that in the perfonnunce of the work for which this permit is issued,l Health&Safety Code,Section 25532(n)should 1 stare ur handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
,it,conhnminants as defined by[he Ba ArTAIF6,,,iiCco��;air.bditchgl
Worker's Compensation laws ofCalifornia,iQ after making this certificate of rvill mainunin compliance with the C nertih9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Sufety Cad actioand 25534.
Labor Coda,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized age `^--
APPLICANT CERTIFICATION' Date:0811120
1 8
I esrtify 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.)
toenter 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 AI2CIi1'I'EC9°S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08/1/2018 Licensed
Professional