B-2018-0597 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-0597
20745 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 055) LANKFORD
CONSTRUCTION
COMPANY
JOHNSBURG,IL 60050
OWNER'S NAME:PCG CUPERTINO LLC 100% DATE ISSUED:08/20/2018
OWNER'S PHONE: PHONE NO:(847)497-0900
LICENSED CONTRACTOR'S DECI ABATION BUILDING PERMIT INFO:
License Class 8 Lie.# 9974
Contractor LANKFORD CONSTRUCTION COMPANY Date 04/30/2019 X BLDG—ELECT_PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
witlr Section 7000)of Division 3 of the Business&Professions Corte and that my
license is In fail force and effect. JOB DESCRIPTION:
TARGET-TI(110,291 SF)
I hereby affirm ander penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of oonsenl to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
pe farna3ce ofthe work for which this permit is issued.
d will maintain Worker's Compensation Insurance,as provided for by
3700 of the Labor Code,for the performance of the work for which this
vvv"'"' permit is issued. Sq.Ft Floor Area: Valuation:$425000.00
APPLICANTCERTIFICATION
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 326 32 055 A(Tenant lnpr-runcnts),M(Tenant Impr ,nncnts),M
representatives of this city to enter upon the above mentioned property for (Tenant lmprovements)I S(Tenant lmprovements),A
inspection purposes.(We)agree to save indemnify and keep harmless the (Tenant bnprovements),A(Tenant Improvements),A
City of Cupertino against liabilities,judgments,costs,and expenses which (Tenon Improvements),A(Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit. (Tenon Impmvcments),A(Tenant Imp—oro urts),A
Additionally,the applicant understa and will cymq with all non-point (Tenant hnprovemems),A(Tenant Improvements),S
source regulations per the Cu a HS Mo on
III 9.18. (Teuantlmprovements)
Signature Date B-zo-zols PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
1 hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1,as owner of the property,or my employees with wages as their sole Issued by:Kim Dunbar
compensation,will do the work,and the structure is not intended or offered for Date:08/20/2018
sale(Sec.7044,Business&Professions Code)
z I,as owner ofthe property,am exclusively contracting with licensed RE-ROOFS:
contractors to construct the project(Sec.7044,Business&Professions Code). All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm nude penalty of pejury are of the following three dechnratfons: installed without first obtaining an inspection,I agree to remove all new material,re,
inspection.
I. I have and will maintain a Certificate of Consent to self-insure for Worker's
e
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of ire work for which this permit is issued. Signature ofApplicanc
x. I have and will maintain Worker's Compensation Insurance,as provided for by Date:8.20-2018
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
3. 1 certify that in file performance of the work for which this permit is issued,I
shoal not employ any person in any manner so as to become subject to the HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California,If,after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the
exemption,I become subject to the Worker's Compensation provisions of the California Heath&Safety Code,Sections 25505,25533,and 25534.I will
Labor Code,I must forthwith comply with such provisions or this permit all maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
be deemed revoked. Health&Safety Code,Section 25532(x)should I stare o-handle hazardous
material.Additionally,should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Mynirypal Corte,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety Cude,SrtA1 e�0``50,25533,a ul-2
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 fila City of Cupertino against liabilities, Owner or authorized agent: /�-
judgments,costs,and expenses which may accrue against said City in Date:8-20-2018
consequence of the granting of this permit.Additionally,the applicant understands CONSTRUCTION LENDING AGENCY
and will comply with all non-point source regulations per the Cupertino Municipal I hereby affirm that there is a construction lending agency for the performance
Code,Section 9.18, of work's for which this permit Is issued(Sec.3097,Civ C.)
Lender's Name
Signature Date 8-20-2018 Lender's Address