BLD-2021-0405BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10725 N DE ANZA BLVD Cupertino
APN: 326 10 065
PERMIT NO: BLD-2021-0405
OWNER'S NAME: 10725 DE ANZA LLC
OWNER'S PHONE: 4153105791
JOB DESCRIPTION
EXISTING MECHANICAL UNITS
APPLE DA08 - MAINTENACE UPDATE TO
LICENSED CONTRACTOR DECLARATION
C12 EARTHWORK AND PAVING, C29 MASONRY, C39 ROOFING, C-4 BOILER%2C HOT WATER HEATING AND STEAM FITTING,
C50 STEEL%2C REINFORCING, C51 STEEL%2C STRUCTURAL, C-9 DRYWALL, C-2 INSULATION AND ACOUSTICAL, C-6 CABINET%2C
DECORATING, C35 LATHING AND PLASTERING, C16 FIRE PROTECTION CONTRACTOR, C36 PLUMBING, C38 REFRIGERATION, C55
SYSTEM, C-5 FRAMING AND ROUGH CARPENTRY, D34 PREFABRICATED EQUIPMENT, C46 SOLAR, C1 0 ELECTRICAL, C21 BUILDING
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
C20
MILLWORK
WATER
MOVING%2C
LICENSED
EXP
08/31/2021
I hereby
force
I hereby
SWINERTON BUILDERS
CLASS:
BUILDING CONTRACTOR, A GENERAL
WARM -AIR HEATING%2C VENTILATING
AND FINISH CARPENTRY, C-8 CONCRETE,
CONDITIONING, C23 ORNAMENTAL
DEMOLITION
NO: 92
DATE:
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California. If, after
with such provisions or this permit
ENGINEERING CONTRACTOR,
AND AIR-CONDITIONING,
C33 PAINTING AND
METALS, C42 SANITATION
the provisions of Chapter
one of the following three declarations:
of consent to self -insure for Worker's
Compensation Insurance, as provided
of the work for which this permit is
making this certificate of exemption,
shall be deemed revoked.
Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
for by Section 3700 of the Labor Code, for 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 Worker's
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
Chapter 9.12 and the Health
Chapter
& Safety
as defined
Sections
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.
V
with
equipment
Municipal
Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
is required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm
Certified
CONSTRUCTION LENDING AGENCY
that 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the
of this city
liabilities, judgements,
with all non -point
keti.„0„,•...N
above information
to enter
costs, and
source regulations
is correct. I agree to comply with all city and county ordinances and state laws relating to building
upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
per the Cupertino Municipal Code, Section 9.18.
I certify that
construction,
harmless
the applicant
Signature:
I have read this application
and hereby authorize representatives
the City of Cupertino against
understands and will comply
.