13120073 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120073
19111 PRL NERIDGE AVE(316 07 049) YOUNG ELECTRIC CO
SAN FRANCISCO,CA
94103
OWNER'S NAME: ( DATE ISSUED:02/28/2014
OWNER'S PHONE: PHONE NO:(415)648-3355
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#390749
Contractor YOUNG ELECTRIC CO Date 06/30/2020 —BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
AC2 SW-S2B-ON-SITE UTILITIES.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's REVISION#4-INSTALL(N) SEAL TIGHT FOR DATA BOX IN
Compensation,as provided for by Section 3700 of the Labor Code,for the CRISTY BOX;(N)DETAIL WILL INCLUDE NEMA 4X BOX INSTEAD
performance of the work for which this permit is issued. OF NEMA 6-ISSUED 5/10/19
Section 3700 of the Labor Code,for the performance of the work for which this DAMP/WET LOCATIONS AROUND MAIN BUILDING.ISSUED
permit is issued. 1.16.19
APPLICANT CERTIFICATION REVISION#2(5-17-15): CHANGE OF CONTRACTOR FROM DPRS
certify that I have read this application and state that the above TO BNB.-ISSUED 1-25-2019
information is correct. I agree to comply with all city and county ordinances 5/16/2014-REVISION#1
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property forr
inspection purposes. (We)agree to save indemnify and keep harmless the INSPECTION HISTORY AVAILABLE UPON REQUEST"
City of Cupertino against liabilities,judgments,costs,and expenses which FEES CHARGED PER DEVELOPMENT AGREEMENT
may accrue against said City in consequence of the granting of this permit. Sq.Ft Floor Area: Valuation:$23300000.00
Additionally,the applicant understands and will comply with all non-point
source regulatioVperthepertino Municipal Code,Secti n 9.18.
APN Number: Occupancy Type:
316 07 049
Signature Date 5/10/19
IV
OWNER-BUILDER DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED
I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
following two reasons: 180 DAYS FROM LAST CALLED INSPECTION.
1. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Issued by: Legacy
2. I,as owner of the property,am exclusively contracting with licensed Date: 02/28/2014
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: RE-ROOFS:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any roofing material being installed.If a roof is
Compensation,as provided for by Section 3700 of the Labor Code,for the installed without first obtaining an inspection,I agree to remove all new materials for
performance of the work for which this permit is issued.
inspection.
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 Signature of Applicant:
permit is issued. Date:5/10/19
3. 1 certify that in the performance of the work for which this permit is issued,I
shall not employ any person in any manner-so as to become subject to the ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Worker's Compensation laws of California. If,after making this certificate of
exemption,I become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE
Labor Code,I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the
be deemed revoked. California Health&Safety Code,Sections 25505,25533,and 25534. I will
APPLICANT CERTIFICATION maintain compliance with the Cupertino Municipal Code,Chapter-9.12 and the
I certify that I have read this application and state that the above information is Health&Safety Code,Section 25532(a)should I store or handle hazardous
�correct. I agree to comply with all city and county ordinances and state laws
material. Additionally,should I use equipment or devices which emit hazardous
relating to building construction,and hereby authorize representatives of this city air contaminants as defined by the Bay Area Air Quality Management District I
to enter upon the above mentioned property for inspection purposes. (We)agree will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
to save indemnify and keep harmless the City of Cupertino against liabilities, the Health&Safety Code,Se 'ons 2550 533,and 25534.
judgments,costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Owner or authorized agent:
and will comply with all non-point source regulations per the Cupertino Municipal Date: 5/10/19
Code,Section 9.18. CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued(Sec.3097,Civ C.)
Signature Date 5/10/19 Lender's Name
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:13120073
19111 PRUNERTDGE AVE(316 07 049) YOUNG ELECTRIC CO
(David Morehouse)
SAN FRANCISCO,CA
94103
OWNER'S NAME: ( DATE ISSUED:02/28/2014
OWNER'S PHONE: PHONE NO:(415)732-9488
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#390749
Contractor YOUNG ELECTRIC CO(David Morehouse)Date 06/30/2020 —BLDG _ELECT _PLUMB
_MECH_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:
AC2 SW-S2B-ON-SITE UTILITIES.
I hereby affirm under penalty of perjury one of the following two declarations:
L I have and will maintain a certificate of consent to self-insure for Worker's EVISION#3=COW-20-9-INSTALLNEMA 6'`ENCLOSUKES-AT,(58)A
Compensation,as provided for by Section 3700 of the Labor Code,for the 1DAMPET/WLOCATIONS;AROUND MAIN'BUILDING ISSUED%
performance of the work for which this permit is issued. `l 16 19-. —
`z. T 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:$23300000.00
APPLICANT CER 1`II'iCATiON
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 316 07 049
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 wilfcomply with all non-point
'source'regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION,.
--- --, ,
Signature Date 1.16.19 Issued by:Sean Hatch
Date:02/28/2014
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
r. 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. T,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Dates 1.16.19
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. T 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
3. 1 certify that in the performance of the work for Which this permit is issued,l
Health&Safety Code,Section 25532(a)should T store or handle hazardous
H
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,T become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2550 C33,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: 1.16.19
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
:orrect. 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
'elating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
o enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
o save indemnify and keep harmless the City of Cupertino against liabilities,
udgments,costs,and expenses which may accrue against said City in Lender's Address
:onsequence of the granting of this permit. Additionally,the applicant understands
Ind will comply with all non-point source regulations per the Cupertino Municipal ARCHiTECT'S DECLARATION
,ode,Section 9,18. I understand my plans shall be used as public records.
Licensed
Signature Date 1.16.19 Professional