B-2018-1319 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:3-2018-1319
20510 STEVENS CREEK BLVD CUPERTINO,CA 95014-2130(35908 018) TECTONIC BUILDERS
CORPORATION
CUPERTINO,CA 95014
OWNER'S NAME:MARDESICH COMPANY CROSSROADS LLC DATE ISSUED:08/06/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#1018889
Contractor TECTONIC BUILDERS CORPORATION Date 09/30/2018 Z 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:
EVERTRUST BANK-T.I.PREP(1328 SF)
I hereby of'finr under penalty of perjury one of the following two declarations:
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
perfermence of the work for which this permit is issued.
have and will maintain Worker's Compensation Ihsurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft 111mi Area: Valuation:$30000.00
APPLICANT CERTIFICATION
I tify that I have read this application and slate 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 08 018
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
AdditionMDECLARATV
a ds and will comply with all non-point
source rti Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
08-06-20108 Issued by:Kim Dunbar
Date:08/06/2018
OWNERN
I hereby affirm thil I on,exempt from the Contractor'sLicense Law for one of the RE-ROOFS,
following two reasons: - All rods shall be inspected prior to any roofing material being installed.if e roof is
t. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining on 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 Cade). Date'.08-06-20108
I hereby affirm under penalty of perjury one of the fallowing three dechu•ations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERt. 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
perl'ormence of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z 1 have and will maintain Worker's Compensation Insurance,as provided for by I have and the hazardous materials regulrements order 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.f will
permit is issued. maintain compliance 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 Cade,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject Io the material.Additionally,should I use equipment or devices w rich emit haznrdons
Worker's Compensation laws of California,If,after making this certificate of nm contaadnants as defined by the Bay Area Air Quality nage at District I
P g will maintain compliance will,the Cupertino Municipal ode,C•pt,,
9.12 add
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectns 2 O5,255 3,and 534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agents
APPLICANT CERTIFICATION Date:08-06-20108
I certify that I have read this application and state that the above information is CONSTRUCTION
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction ler ding agency f r ,e 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 w111 comply with all non-point source regulations per the Cupertino Municipal AIiC11I'1'EC'P'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08-06-20108 Licensed
Professional