B-2018-1352 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1352
10210 N FOOTHILL BLVD CUPERTINO, CA 95014-089 (326 15 125) SILVER CREEK
CONSTRUCTION INC
MORGAN HILL, CA
95037
OWNER'S NAME: DATE ISSUED: 11/14/2018
OWNER'S PHONE: PHONE NO: (408) 321-9094
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic. #904474
Contractor SILVER CREEK CONSTRUCTION INC Date 10/31/2019 X BLDG X ELECT — PLUMB
MECH X RESIDENTIAL _ 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:
INSTALL (9) LEVEL-2 CHARGING DISPENSER PEDESTALS (8)
I hereby affirm under penalty of perjury one of the following two declarations: DUAL-PORT PEDESTALS AND (1) SINGLE-PORT PEDESTAL FOR A
I have and will maintain a certificate of consent to self-insure for Worker's TOTAL OF (17) CHARGING PORTS; AND (1) METER PEDISTAL (600
Compensation, as provided for by Section 3700 of the Labor Code, for the AMP PANEL)
performance of the work for which this permit is issued. REV #1 - CHANGE DISTRIBUTION PLAN DETAIL TO INCLUDE 4
z. I have and will maintain Worker's Compensation Insurance, as provided for by MIN CONCRETE SKIRT IN FRONT OF DISTRIBUTION PANEL. -
Section 3700 of the Labor Code, for the performance of the work for which this ISSUED 11/21/18
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $60000.00
information is 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 APN Number: Occupancy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the 326 15 125 A (Tenant Improvements)
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non-point PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST' CALLED INSPECTION.
Si 9nafiure ---� Date 1 2 8
OWNER-BUILDER DECLARATION Issued by. Haley McKee
Date: 11/14/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole RE-ROOFS:
compensation, will do the work, and the structure is not intended or 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, I agree to remove all new materials for
inspection.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations: Date: 11/21/18
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 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 HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certifythat in the performance of the work for which this permit is issued I California Health & Safety Code, Sections 25505, 25533, and 25534. I will
p p maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous
Worker's Compensation laws of California. 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 defined by the Bay Area Air Quality Management District I
Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
be deemed revoked. the Health & Safety Code, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is Owner or authorized agent:
correct. I agree to comply with all city and county ordinances and state laws Date: 11/21/18
relating to building construction, and hereby authorize representatives of this city CONSTRUCTIO ENDING AGENCY
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, costs, 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
understand my plans shall be used as public records.
Signature Date 11/21/18
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1352
10210 N FOOTHILL BLVD C'UPERTINO, CA 95014-089 (326 15 125) SILVER CREEK
CONSTRUCTION INC
MORGAN HILL, CA
95037
OWNER'S NAME: DATE ISSUED: 11/14/2018
OWNER'S PHONE: PHONE NO: (408) 321-9094
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class b, c-10 Lic. #904474
Contractor SILVER CREEK CONSTRUCTION INC Date 1.0/31/2019 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL _ 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:
INSTALL (9) LEVEL-2 CHARGING DISPENSER PEDESTALS (8)
I hereby affirm under penalty of perjury one of the following two declarations: DUAL-PORT PEDESTALS AND (1) SINGLE-PORT PEDESTAL FOR A
1. I have and will maintain a certificate of consent to self-insure for Worker's TOTAL OF (17) CHARGING PORTS; AND (1) METER PEDISTAL (600
Compensation, as provided for by Section 3700 of the Labor Code, for the AMP PANEL)
performance of the work for which this permit is issued.
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: $60000.00
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 326 15 125 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 City 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 regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ~ Date 11/14/2018 Issued by: Haley McKee
Date: 11/14/2018
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 material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole installed 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)
2. I, as owner of the property, am exclusively contracting with-licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/14/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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: HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as 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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certifythat 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
p p material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health& Safety Code, Section 25505, 2,553 , and 5534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: /
APPLICANT CERTIFICATION Date: 11/14/2018 .
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 11/14/2018 Licensed
Si
g Professional