B-2018-0902 CITY OF CUPERTINO BUILDING PERMIT
13UILDINGADDIIESS: CONTRACTOR: PERMIT NO:B-2018-0902
10441 BANDLEY DR CUPERTINO,CA 95014-1912(326 33 079) SC
BUILDERS INC
SUNNYVALE,CA
94085
OWNER'S NAME: DATE ISSUED:08/21/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lid.#767 9
Contractor S C BUILDERS INC Date 08/31/2019 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:
APPLE OFFICE TI(13660 SF).
I hereby affirm under penalty ai perjnry one of the following two declarations:
t. I have and will maintain a cenifiesen 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 have and will maintain Worker's Compensation Insurance,as provided for by
i11� Section 3700 of the Labor Code,for the performance of the work for which this
Permit is issued. Sq.Fl Floor Area: Valuation:$1500000.00
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 32633 079 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 aid Cit i consequence of the granting of this permit WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ap Icanl ode stands and will comply with all non-point
source regulation per Cup rtl /Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
'Signature Date 08/21/2018 Issued by:Jasmine Archbold
Date:08/21/2018
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for o—of the RE-ROOFS
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
v I,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the shu.tuoc is not intended or offered for inspection.
sal"(See.7044,Business&Professimns Cotte)
z C,as owner of the properly,an exclusively contracting with licensed Signature of'ApplicanC
contractors to conshvct the project(Sec,7044,Business&professions Code). Date,08/21/2018
1 hereby affirm antler penalty of perjnry one a]the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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
perfonnancc of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,us 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&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued maintain cumplimrce 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 equip au or devices which oull hazardous
air eontamhuants as defined by the Bay re�1:�I�tjCarbc:,Cfl�
y Mae ,,,,at District I
Worker's Compensation laws of CnliCornia,If,ager making this ceiYifieete of will maintain emnpliunce with(he
Cow,
rfinpiter9.12and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code cion2 33,and 234.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen.
APPL ICANT'CER'CIFICATION Date:08/21!2018
I certify that I have read this application and state that the above Information is CONST CTION 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 08/21/2018 Licensed
Professional