10010078CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD STE 400 CONTRACTOR: MCLARNEY PERMIT NO: 10010078
CONSTRUCTION
OWNER'S NAME: LAB 126 355 S DANIEL WAY 2ND FL DATE ISSUED: 02/05/20 I0
OWNER'S PHONE: 6507906517 SAN JOSE, CA 95128 PHONE NO: 4082468600
o LICENSED CONTRACTOR'S DECLARATION
License Class ¥~ Lic. # .s',;L 12. ~9 L
contractormC-!t+rAJYc, &;r Date ~J;'?//D
I hereby affirm that I am~ensed under the provisio~s 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 penalty of perjury one of the following two 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance ofthe work fo~h ,this(
permit is Issued ~
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 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 City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence ofthe
granting of this permit. Additionally, th~~plicant understands and will comply
:,~~' ;)t'~,rt;OO:':""~~~S~tiOO
o OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
I, as owner ofthe property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty 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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance ofthe work for which this
permit is issued.
I certifY that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
BUILDING PERMIT INFO: BLDG ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: COM'L TI-SCOPE INCLUDES TWO NEW CEILING HEIGHT
WALLS, NEW DOORS & RELOCATION OF EXIT SIGNAGE, AND
ADDITIONAL EXIT SIGNAGE AS REQUIRED
Valuation: $35000 Sq. Ft Floor Area:
APNNumber: 36901027.400 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by; _/_·--·_·-7-:T"2"".,~",-,---·--;·},..:....,,,.......",,-,-,,,-,,------'''-'----Date: {U -le,
, L-.
RE-ROOFS:
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
inspection.
Signature of Applicant Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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 or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sectio-~25505, 25533, and 25534.4Compensation laws of California. If, after making this certificate of exemption, I ~" ,~~~~
become subject to the Worker's Compensation provisions ofthe Labor Code, I mu¥"" ~r ~tA:A en ~ b. ') PiI 0
forthwith comply with such provisions or this permit shall be deemed revoked. \.. Date:
APPLICANT CERTIFICATION
1 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 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 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 source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONSTRUCTION LENDING AGENCY
1 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.)
Lender's Name _
Lender's Address. _
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
PERMIT NO: 10010078 BUILDING ADDRESS: 20450 STEVENS CREEK BLVD STE 400 CONTRACTOR: GIDEL AND KOCAL
DATE ISSUED: 02/05/20 I0 574 DIVISION STOWNER'S NAME: LAB 126
PHONE NO: (408) 370-0287 CAMPBELL, CA 95008 OWNER'S PHONE: 6507906517
Occupancy Type:
EXPIRES IF WORK IS NOT STARTED
IN 180 DAYS OF PERMIT ISSUANCE OR
DAYS FROM LAST CALLED INSPECTION.
ed~~Date:~:'-f-t{j
Sq. Ft Floor Area:
RE-ROOFS:
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
Date_----,lf-__-'l.
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
/":.-.ko [Contractor LTIll")i:L lJ-c..A.
I hereby affirm under penalty of perjury one of the following two 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.
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.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infonnation is
correct. I agree to comply with all city and county ordinances and state laws relating I----'E-
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 City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this pennit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfonnance of the work for which this
penn it is issued.
I certify that in the perfonnance of the work for which this pennit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I mus'vKlIlyi~;;QJ:)(Ib~~i
. tain
Heal
nt:
forthwith comply with such provisions or this permit shall be deemed revoked. \J;C=~=::t~:----=:::::------Date:--'-''-T--'----+-_
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infonnation 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 inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and e es which may accrue against said City in consequence of the
granting of his p nnit. . ionally, the applicant understands and will comply
with all no -point our regu ations per the Cupertino Municip Cod, secron(
9.18. () '5 ID
Signature Date
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL COMMERCIAL r
JOB DESCRIPTION: COM'L TI-SCOPE INCLUDES TWO NEW CEILING HEIGHT
WALLS, NEW DOORS & RELOCAnON OF EXIT SIGNAGE, AND
ADDITIONAL EXIT SIGNAGE AS REQUIRED
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BElTER
HAZARDOUS MATERIALS DISCLOSURE
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 or devices which emit hazardous air
eontaminants as defined by the Bay Area Air Quality Management District I will
Iiance with the Cupertino Municipal Code, Chapter 9.12 and the
Safet) Code, Sections 25505, 25533, and 25 4.
CONSTRUCTION LENDING AGENCY
I hereby affinn that there is a construction lending agency for the perfonnance Of work's
for which this penn it is issued (Sec. 3097, Civ C.)
Lender's Name _
Lender's Address, _
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional