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B-2019-0136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2019-0136 20230 STEVENS CREEK BLVD CUPERTINO, CA 95014-2210 (369 02 03 1) HATHAWAY DINWIDDIE CONSTRUCTION COMPANY SAN FRANCISCO, CA 94111-3330 OWNER'S NAME: DATE ISSUED: 01/22/2019 OWNER'S PHONE: PHONE NO: (415) 986-2718 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ab Lic. #729664 Contractor HATHAWAY DINWIDDIE CONSTRUCTION COMPANY Date x BLDG _ ELECT ^ PLUMB 11/30/2020 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 JOB DESCRIPTION: license is in full force and effect. APPLE SC-04 - T.I. PREP (43,953 S.F.) 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 Sq. Ft Floor Area: Valuation: $50000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 369 02 031 B (Tenant Improvements) 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 to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE may accrue against said City in -consequence of the granting of this permit. NCE OR Additionally, the appIcant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source Date 1/22/19 Date: 01/22/2019 OWNER-B LDER DECLARATION RE-ROOFS: I hereby a firm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the-property, or my employees with wages as their sole inspection. compensation,will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 1/22/19 contractors to construct the project (Sec.7044, Business & Professions Code). 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section! 25532(a) should I store or handle hazardous. 3. I certifythat in the performance of the work for which this permit is issued I material. Additionally, should I use equipment or devices which emit hazardous p p air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupe tino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, ions 25505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the � Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date: 1/22/19 APPLICANT CERTIFICATION CONSTRU TION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands A.RCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18.