B-2018-0621 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0621
10500 N TANTAU AVE CUPERTINO,CA 95014-0739(316 06 063) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME:CAMPUS HOLDINGS INC DATE ISSUED:08/15/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class)3 Lip.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2019 X BLDG—ELECT—PLUMB
I I—elaaffirm that I am licensed under the provisions of Cha ter 9 ...nein —MECH_RESIDENTIAL X COMMERCIAL
y prov p (con g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
AC2:MARCOM BUILDING(TANTAU 14)FOUNDATION ONLY FOR
I hereby affirm underpemdty of perjury one of the following two declarations: THREE LEVELS OF UNDER GROUND PARKING(63,756 SF
r. 1 have and will maintain a certificate ofconsent to self-insure for Worker's FOOTPRINT);FOUNDATION ONLY FOR OFFICE BUILDING(42,741
Compensation,as provided for by Section 3700 of the Labor Code,for the SF FOOTPRINT).
performance of the work for which this permit is issued.
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 316 06 063 A-1,Std Comm.Fnd w/o Podium,Std Comm.Fred w/o
representatives of this city to enter upon the above mentioned property for Podium,Std Comm.Fed w/o Podium,A-LA-LA-1,A-I,A-
inspectlon purposes.(We)agree to save indemnify and keep harmless the 1,A-1,A-1,A-1
City of Cupertino.against liabilities,judgments,costs,and expenses which
may accrue against said City In consequence of the granting of this permit.
Additionally,thffppint erstands and coal comply with all non-point PERMIT EXPIRES IF WORK IS NOT STARTED
source
Data:08/15/2018
1 hereby affirm that 1 am exempt train the Contractor's License Law for one of tho
following two reasons:
1. I,as owner of ire property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended of offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,1 agree to remove all new materials for
z. I,as owner of the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
Signature of Applicant
I hereby affirm under penalty ofperjury one of the following three declarations: Date:08/15/2018
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
performance of due work for which this permit is issued.
z I have and will maintain Worker's Cmnpensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
s. I certify that in the performance of the work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534.1 will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(x)should I stare or handle hazardous
Worker's Compensation laws of Cuhifarnia.If,after making this certificate of material.Additionally,should I use equipment or devices which emit hazardous
exemption,I become subject to the Worker's Compensation provisions of the air contaminants as dellned by the Bay Area Air Quality Management District I
Labor Code,I must forthwith comply with such pa visimne or this permit shall will maintaincompliance with the Cup rfino Municipal ode,Chapter 9.12 and
be deemed revoked. the Health&Safety
to enter upon the above mentioned property for inspection purposes. (We)agree I hereby affirm that there is a construction lending agency for the performance
to save Indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,casts,and expenses which may accrue against said City In Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Data 08!1512018