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B-2017-2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2014 10425 S DE ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019)110445 S DE TECTONIC BUILDERS ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019) CORPORATION CUPERTINO,CA 95014 OA NER'S NAME: DATE ISSUED:09/25/2018 OWNER'S PHONE: PHONE NO:(408)216-0804 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class A.B Lic.#1Q18 8 Contractor TECTONIC BUILDERS CORPORATION Date 09/30/2020 X 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: RANCH 99-T.I.GROCERY STORE(1,366 S.F.)AT 10425 S.DE ANZA I hereby affirm under penalty of perjury one of the following two declarations: FOOD HALL-T.I.FOOD COURT(10,708 S.F.)AT 10445 S.DE ANZA 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -DESIGN CHANGES-ISSUED 3/15/19 Compensation,as provided for by Section 3700 of the Labor Code,for the REV#2-REMOVE(1)CHECK-STAND-06/06/2019 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500000.00 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 359 17 019 A(Tenant Improvements),A(Tenant Improvements),M representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally,the applicant understands and will comply with all non-point (Tenant Improveinents),M(Tenant Improvements) source 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm tht I m exempt from the Contractor's License Law for one of the following two reasfin . Issued by:Kim Dunbar 1. I,as own r of the property,or my employees with wages as their sole Date:09/25/2018 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) RE-ROOFS: 2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:06/06/2019 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If,after snaking this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions_or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay ea Air Quality Management District I r APPLICANT CERTIFICATION will maintain compliance with the Cupe ino Munic' al Cod Chapter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety Code,Sec ions 2550 ,25533, nd 25534. correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. We agree Owner or authorized agent: .- p p p y p p p ( ) g Date:06/06/2019 to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and ex enses which may accrue against said City in CONSTRUCT consequence of the gran ing of this permit. Additionally,the applicant understands I hereby affirm that there is a constr ion lending agency for the performance and will comply with all n n-point source regulations per the Cupertino Municipal of works for which this permit is iss d(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature 06/06/2019 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2014 10425 S DE ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019)10445 S DE TECTONIC BUILDERS ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019) CORPORATION CUPERTINO,CA 95014 OWNER'S NAME: DATE ISSUED:09/25/2018 OWNER'S PHONE: PHONE NO:(408)216-0804 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class A.B Lic.#1018889 Contractor TECTONIC BUILDERS CORPORATION Date 09/30/2020 X 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: RANCH 99-T.I.GROCERY STORE(1,366 S.F.)AT 10425 S.DE ANZA I hereby affirm under penalty of perjury one of the following two declarations: FOOD HALL-T.I.FOOD COURT(10,708 S.F.)AT 10445 S.DE ANZA I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500000.00 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 359 17 019 A(Tenant Improvements),A(Tenant Improvements),M representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally,the applicant understands and will comply with all non-point (Tenant Improvements),M(Tenant Improvements) source 3/15/19 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by:Kim Dunbar 1. I,as owner of the property,or my employees with wages as their sole Date:09/25/2018 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) RE-ROOFS: 2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:3/15/19 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city Owner or authorized agent: to enter upon the above mentioned property for inspection purposes. (We)agree 9 to save indemnify and keep harmless the City of Cupertino against liabilities, Date: / 5 9 judgments,costs,and expenses which may accrue against said City in CONSTRUCT LENDING A ENCY hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit. Additionally,the applicant understands Y 9 9 Y and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 519 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2014 10425 S DE ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019)10445 S DE TECTONIC BUILDERS ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019) CORPORATION CUPERTINO,CA 95014 OWNER'S NAME: BDC HAYWARD LP DATE ISSUED:09/25/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1018889 Contractor TECTONIC BUILDERS CORPORATION Date 09/30/2020 X 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: RANCH 99-T.I.GROCERY STORE(1,366 S.F.)AT 10425 S.DE ANZA I hereby affirm under penalty of perjury one of the following two declarations: FOOD HALL-T.I.FOOD COURT(10,708 S.F.)AT 10445 S.DE ANZA 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 performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500000.00 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 359 17 019 A(Tenant Improvements),A(Tenant Improvements),M representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally,the applicant understands and will comply with all non-point (Tenant Improvements),M(Tenant Improvements) source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 9-25-2018 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I ant exempt from the Contractor's License Law for one of the following two reasons: Issued by:Kim Dunbar t. I,as owner of the property,or my employees with wages as their sole Date:09/25/2018 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) RE-ROOFS: z. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:9-25-2018 z. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety Code,Sections 25505,25533,and 25534. correct.I agree to comply with all city and county ordinances and state laws to enter upon the above mentioned property for inspection purposes. (We)agree Owner or authorized agent: to save indemnify and keep harmless the City of Cupertino against liabilities, Date:9-25-2018 judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 9-25-2018 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.