B-2016-2939 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2939
10001 N DE ANZA BLVD CUPERTINO,CA 95014-2263(326 34 074) TCG BUILDERS INC
MILPITAS,CA 95035
OWNER'S NAME:TAMBELLINI DEANZA PROPERTIES LLC(TAMBELLINI DATE ISSUED:01/17/2017
DEANZA PROPERTIES LLC)
OWNER'S PHONE: PRONE NO:(
LICENSED BUILDING PERMITINFO'.
License Class @ Lic.#635597
Contractor TCG BUILDERS INC Date 04/30/2020 X BLDG—ELECT_PLUMB
I hereby affirm that I win licensed ander 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 fill[force and effect. JOB DESCRIPTION:
SITE IMPROVEMENT UPGRADES INCLUDING NEW AND
I hereby affirm anchor penalty of perjury one of the following live dechu•mioml REPLACED FLAT-WORK,INSTALLATION OF LANDSCAPING,
t. I have and will maintain a certificate of consent to self-insure for Worker's ACCESSIBILITY IMPROVEMENTS,INSTALLATION OF(4)
Compensation,as provided for by Section 3700 of the Labor Code,for the ELECTRICAL VEHICLE CHARGING STATIONS.
performance of the work for which this permit is issued. REV#I-DELETION OF SITE PLUMBING SCOPE-ISSUED 8.17 18
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance ofthe work for which this
permit is issued Sy.Ft Fluor Arco: Valuation:$75000.00
APPLICANT CERTIFICATION
I certify that I have read flits application and slate that the above
information Is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 326 34 074 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 WORK IS NOT STARTED
may accrue against said Clty 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 Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature —'' Date 8 17 18 Issued by:SEAN HATCH
Date:01/17/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing malarial being installed If a of is
n. I,as owner ofthe property,or my employees with wages as their sole ingelled without first obtaining an 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)
z, 1,as owner ofthe property,am exclusively contracting with licensed Signature ofAppli..t:
contractors to construct the project(Sec.7044,Business&Professions Code). Data 8.17 18
I hereby aM,,.under penalty of perjuvy one of the following three daelwratiarrs: ALL ROOF COVERINGS TO BE CLASS"A"Olt BETTER1. 11—.and will maintain a Certificate df Consent to self-inswe for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,m provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Laba Cade,for the performance of the work for which this Calff n-ala Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued,l Heath&Safety Code,Section 25532(a)should I store m•handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,shmdd 1 use equipment or devices which emit hazardous
ontominants as dented by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with[he par-tie unidpal Cuda,,Chapter 9.12 end
exemption,1 becomesubjectto the Worker's Compensation provisions of the the Ilemth&Safety C anti 25534.
Labor Code,I most forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:8 17.18
1 certify that I have read this application and slate that the above information Is CONSTRUCTION LENDING AGENCV
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 DUCLARA'I'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 8.17.18 Professional