B-2018-1850 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1850
20745 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 055) LANKFORD
CONSTRUCTION
COMPANY
JOHNSBURG,IL 60050
OWNER'S NAME: DATE ISSUED:04/11/2019
OWNER'S PHONE: PHONE NO:(847)497-0800
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#669974
Contractor LANKFORD CONSTRUCTION COMPANY Date 04/30/2021 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:
TARGET/STARBUCKS T.I.PHASE 2 -(6700 SF);INTERIOR AND
I hereby affirm under penalty of perjury one of the following two declarations: EXTERIOR UPGRADES; STARBUCKS COFFEE MODIFICATION;
1. I have and will maintain a certificate of consent to self-insure for Worker's SALES FLOOR CHANGES;EXTERIOR WORK INCLUDING
1X2. , e
pensation,as provided for by Section 3700 of the Labor Code,for the FINISHES,GREEN SCREEN;NEW STOREFRONT ENTRY AND
rmance of the work for which this permit is issued. PANELS,CANOPIES,CONCRETE SLAB,GREEN SCREEN FOR
and will maintain Worker's Compensation Insurance,as provided for by EXISTING MECH&ELEC YARD
3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$250000.00
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 32632055 M(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 wij).,.co�y with all non-point
source
-'' ,� Date 4-11-2019 Issued by:Kim Dunbar
Date:04/11/2019
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:4-11-2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 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
z. 1 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. 1 certify that in the performance of the work for which this pen-nit is issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
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 -u'nicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&SafetyCode, 34.
Labor Code,I must forthwith comply with such provisions or this permit shall - �
be deemed revoked. � �'�✓
Owner or authorized agent:
APPLICANT CERTIFICATION Date:4-11-2019
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 4-11-2019 Licensed
Professional
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS:
OWNER'S NAME: Not provided
OWNER'S PHONE: Not Provided
CONTRACTOR:
LANKFORD CONSTRUCTION COMPANY, 1455 KARLENS WAY CUPERTINO
CONTRACTOR PHONE:
815-355-4938
DATE ISSUED 11/7/2019 10:11:41 AM
ISSUED BY: KDUNBAR
VALUATION: $250000
JOB DESCRIPTION
TARGET/STARBUCKS T.I. PHASE 2 - (6700 SF); INTERIOR AND EXTERIOR UPGRADES; STARBUCKS COFFEE MODIFICATION; SALES FLOOR CHANGES; EXTERIOR WORK INCLUDING FINISHES,
GREEN SCREEN; NEW STOREFRONT ENTRY AND PANELS, CANOPIES, CONCRETE SLAB, GREEN SCREEN FOR EXISTING MECH & ELEC YARD REV #1 - MULTIPLE NEW AND REVISED SHEETS
(SEE REVISION NARRATIVE IN DOCUMENTS FOR FULL DETAILS) - ISSUED 11-7-2019 REV#2 - MULTIPLE NEW AND REVISED SHEETS (SEE REVISION NARRATIVE IN DOCUMENTS FOR FULL
DETAILS)
LICENSED CONTRACTOR DECLARATION
CONTRACTOR:
LANKFORD CONSTRUCTION COMPANY
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR
LICENSED NO:
669974
EXP DATE:
04/30/2021
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.
I hereby affirm under penatiy of perjury one of the following three declarations:
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.
V
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.
I 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 Worker's
Compensation
comply
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
with such provisions or this permit shall be deemed revoked.
HAZARDOUS
MATERIALS DISCLOSURE
V
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505. 25533, and 25534. I will maintain compliance
with
the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment
Municipal
or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified
Firm Name:
v
Firm Certification No:
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
: