B-2016-2696 Permit + Rev 1, Rev 2 and Def 1CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2696
10235 S DE ANZA BLVD CUPERTINO, CA 95014-3007 (359 10 060) HUAWELL
CONSTRUCTION
DEVELOPMENT
GROUP INC
SAN JOSE, CA 95132
OWNER'S NAME: DATE ISSUED: 03/31/2017
OWNER'S PHONE: PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #1024653 X BLDG _ELECT —PLUMB
Contractor HUAWELL CONSTRUCTION DEVELOPMENT GROUP INC Date —
03/31/2019 — MECH — RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my JOB DESCRIPTION:
license is in full force and effect. T.I. - KITCHEN AND RESTROOM (620 S.F.) - XLB RESTAURANT
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
i. I 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.
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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
,
Sianatur Date 3/3V2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
Sq. Ft Floor Area: I Valuation: $20000.00
APN Number: Occupancy Type:
359 10 060 A (Tenant hnprovements),B (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aye
nde
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
sale (Sec.7044, Business & Professions Code) I Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed Date:3/31/2017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. I 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.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions, of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. t
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
COVERINGS TO BE CLASS "A" OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized age--
Date: 3/31/2017
CONCTRUCTION L'.F.1�fiTli•1VE: kF.F,IYOit-
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2696
10235 S DE ANZA BLVD CUPERTINO,CA 95014-3007(359 10 060) AMAYA'S CONCRETE
SAN MARTIN,CA
95046
OWNER'S NAME: DATE ISSUED 03/31/2017
OWNER'S PHONE: PHONE NO:(408)857-4156
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-8 Lic.#730908
Contractor AMAYA'S CONCRETE Date 12/31/2018 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
T.I.-KITCHEN AND RESTROOM(620 S.F.)-XLB RESTAURANT
I hereby affirm under penalty of perjury one of the following two declarations: DEF#1-TRASH ENCLOSURE-ISSUED 8/13/2018
n. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REPLACE GREASE TRAP-ISSUED 3/26/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#2-REVISE TRASH ENCLOSURE'S STRUCT FRAMING FROM
performance of the work for which this permit is issued. WOOD TO STEEL-ISSUED 02/27/2019
:' I 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 Floor Area: Valuation:$20000.00
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 state laws relating to building construction,and hereby authorize 359 10 060 A(Tenant Improvements),B(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 e consequences of the granting with
this WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source
Date 02/27/2019 Issued by:AbbyAyende
C;- Date:Date:03/31/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law 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. I,as owner of the property„or my employees with wages as their sole installed without first obtaining an inspection,I 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)
2. 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:02/27/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
n, 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
perfonnance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2 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 8z Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3 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 any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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&Safety and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION bate:02/27/2019
I 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 DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 02/27/2019 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2696
10235 S DE ANZA BLVD CUPERTINO,CA 95014-3007(359 10 060) AMAYA'S CONCRETE
SAN MARTIN,CA
95046
OWNER'S NAME: DATE ISSUED:03/31/2017
OWNER'S PHONE: PHONE NO:(408)857.4156
LICENSED CONTRACTOR'''S DECLARATION BUILDING PERMIT INFO:
License Class g_-@ Lip. 0908
#73
ContractorAMAVA'S CONCRETE Data 1 2131/20 1 8 X BLDG_ELECT_PLUMB
1 hereby affirm that 1 am licensed under the provisions et'Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
T.I.-KITCHEN AND RESTROOM(620 S.F.)-XLB RESTAURANT
I hereby affirm under penalty of perjury one of the following two dcelarations: DEF#1-TRASH ENCLOSURE-ISSUED 8/13/2018
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REPLACE GREASE TRAP-ISSUED 3/26/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
is issued Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
1 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: Oceupancy7ype:
and state laws relating to building.construction,and hereby authorize 359 10 060 A(Tenant Improvements),D(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 WORT{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.
Sign
CION
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-120OFS•
following two run ncic All roofs shall be inspected prim b any roofing material being installed.It a roof is
a. 1,es owner of the property,army employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the shvetme is not intended er offered for inspection.
'no(Soc.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Corte), Date:08/13/2018
I hereby affirm under penalty of perjury one of the following three dcelarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr, 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,I'or 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 have read the hazardous materials regrdremcnts under Chapter 6.95 of the
Section 3700 of the Labor Cade,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
3. 1 certify that in the performance of the work for which this permit is issued,l Health&Safety Cade,Section 25532(x)should 1 stare or handle hazardous
shall not employ any person in any moaner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air contaminants ns defined by the tiny 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 suit
exemption,l become subject to the Worker's Compensation provisions of the
APPLICANT CERTIFICATION Date:OIIl13/2018
I Certify that I have read this application and slate 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 DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 0811312018 Licensed
Professional