B-2019-0851 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10001 N DE ANZA BLVD CUPERTINO,CA 95014-2263 326 34 074 CONTRACTOR: PERMIT NO:B-2019-0851
( ) BARRON BUILDERS
INC
SANTA CLARA,CA
95054
OWNER'S NAME:
DATE ISSUED:05/20/2019
OWNER'S PHONE:
PHONE NO:(650)964-4493
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#916366
ContractorBARRON BUILDERS INC Date 07/31/2019 X BLDG _ELECT P
— LUMB
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:
I hereby affirm under penalty of perjury one of the following two declarations: APPLE DA05-T.I.(200 SF)ON SECOND FLOOR;INSTALL(4)
1. I have and will maintain a certificate of consent to self-insure for Worker's HANGING WALL PANELS ON THIRD FLOOR
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2 I have and will maintain ain Worker's Compensation Insurance,asrovided for b
p y
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
Sq.Ft Floor Area: Valuation:$145000.00
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 32634074 A(Tenant I Tenant B Improvements,
representatives of this city to enter upon the above mentioned property for ) ( mprovements),B
inspection purposes. (We)agree to save indemnify and keep harmless the (TImprovements),A(Tenant Improvements),A
(Tenant
nant Improvements),A(Tenant Improvements),A
City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A Tenant I
may accrue against said City in consequence of the granting of this permit. )� ( Improvements),A
9 9 p (Tenant Improvements),A(Tenant Improvements),A
Additionally,the applicant understands and will comply with all non-point (Tenant Improvements
source regulations per th-e--C�,upertino Municipal Code,Section 9.18. )�A(Tenant Improvements)
� �� � ��'
`�� Date 5/20/19 S F WORK IS NOT STARTED
a WITHIN 180 DAYS OF PERMIT ISSUANCE O
OWNER-BUILDER DECLARATION R
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:ffiley McKee
1. I,as owner of the property,or my employees with wages as their sole
g Date:05/20/2019
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed RE-ROOFS:
contractors to construct the project(Sec.7044,Business&Professions Code). All roofs shall be inspected prior to any roofing material being installed.If a roof is
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:5/20/19
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
permit is issued. NGS TO BE CLASS"A"OR BETTER
3. 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 HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California. If,after making this certificate of the hazardous materials requirements under Chapter 6.95 of the
I have read
exemption,I become subject to the Worker's Compensation provisions of theCalifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
Labor Code,I must forthwith comply with such provisions or this permit shall mHealth&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or
air contaminants as defined by the Ba Area Air devices which emit hazardous
APPLICANT CERTIFICATION Y Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:5/20/19
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 lendingy a enc 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
Signature Date 5/20/19 Lender's Address
ARCHITECT'S DECLARATION