BLD-2019-1447BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10400 N TANTAU AVE Cupertino
APN: 316 06 065
PERMIT NO: BLD-2019-1447
CONTRACTOR:
HOLDER CONSTRUCTION GROUP LLC, 3000 RIVERWOOD PKWY STE 1200 ATLANTA
CONTRACTOR PHONE:
8508663393
DATE ISSUED 12/19/2019 9:47:08 AM
ISSUED BY: KDUNBAR
VALUATION: $200000
JOB DESCRIPTION
IMPROVEMENTS TO INCLUDE INSTALLATION OF A RF SHIELD ROOM/CHAMBER - (178 SF)
APPLE TA12 - LEVEL 01 ROOM 12A TENANT
LICENSED CONTRACTOR DECLARATION
provisions
of the following
of consent
work for
making this
shall be deemed
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
HOLDER
LICENSED
B GENERAL
LICENSED
977963
EXP
10/31/2020
I hereby
force
I hereby
CONSTRUCTION GROUP LLC
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after
with such provisions or this permit
three
to self -insure
Insurance,
which this
certificate
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements
9.12 and
under
the Health
Code,
project.
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this
Certified
v
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that
No
V
Lender's
Name:
APPLICATION CERTIFICATION
state that
of
judgements,
with all non
°
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.