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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