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B-2019-0093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0093 1 INFINITE LOOP CUPERTINO,CA 95014-2083(316 02 105) NOVO CONSTRUCTION INC MENLO PARK,CA 94025 OWNER'S NAME: DATE ISSUED:07/11/2019 OWNER'S PHONE: PHONE NO:(650)701-1500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2021 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: APPLE-IL CAMPUS-OVERALL SITE ACCESSIBILITY PLAN FOR I hereby affirm under penalty of perjury one of the following two declarations: COMPLIANCE TO CHAPTER 11B OF THE 2016 CBC. 1. I have and will maintain a certificate of consent to self-insure for Worker's CoiTpensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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:$200000.00 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 316 02 105 A(Tenant Improvements),A(Tenant Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against,liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against sai'dity in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements) Additionally,the appli-a`nt understands and will comply with all non-point source 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUIEI)ER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:Kim Dunbar following two reasons: Date:07/11/2019 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) RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Code,for the Date: -11-201 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 3. I certify that in the performance of the work for which this permit is issued'I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Bay Are i uality Management District I will maintain compliance relating to building construction,and hereby authorize representatives of this city Owner or authorized a 9 to enter upon the above mentioned property for inspection purposes. (We)agree Date:7-11-2019 " to save indemnify and keep harmless the City of Cupertino against liabilities, CONS UCTION NDING AGENCY judgments,costs,and expenses which may accrue against said City in I hereby affirm that there is a c�rrrst-- tion lending agency for the performance consequence of the granting of this permit. Additionally,the applicant understands of works for which this permit is issued(Sec.3097,Civ C.) Lender s Name and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Lender's Address Signature Date 7-11-2019 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.