B-2018-1273 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1273
20400 STEVENS CREEK BLVD STE 600 CUPERTINO,CA 95014-2296(369 01 028) D P R CONSTRUCTION
INC
REDWOOD CITY,CA
94063
OWNER'S NAME:CUPERTINO CITY CENTER BUILDINGS DATE ISSUED:08/06/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lip.#599 O
Contractor D P R CONSTRUCTION INC Dale 0 8/3112 01 6 X BLDG—ELECT—PLUMB
I hereby affirm that I am 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 In full force and effect JOB DESCRIPTION:
AMAZON-T.I.PREP FOR 4TI-I,5TH,AND 6TH FLOORS-(64726 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
n. 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,for the
pciformance of the work for which this permit is issued.
x 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
have read this application and stale trains above
information is correct.I agree to comply with all city and county ordinances All Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 01 028 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 WORT{IS NOT S'TART'ED
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 0 810 6/2 01 8 Issued by:Jasmine Archbold
Data:08/06/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law]or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to icnmove st new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Scc.7044,Business&Professions Cade)
z I,as owner of due property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/06/2018
I hereby affirm under penalty of perjury oneofthe fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
u 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(lie
performance of the work for which this per is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mnrm•ials 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,.,ad 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
c. I certify that in the perenuart.ofine work for which this permit is issued,I Health&Safety Code,Section 25532(.)should 1 stare ar hostile h.aardmts
shall not employ any person many manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hit dour
air contaminants as defined by the Bay Are.Adr Quality Management District I
Worker's Compensation laws of Califen e.If,after making this certific.fe of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to file Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/06/2018
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 Data 08LQW2018 Licensed
Professional