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BLD-2019-1235_SignedPermit.pdfti BUILDING PERMIT CU►ERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-325S PHONE 408-777.3=8 YWWW.CL°DEr BUILDING ADDRESS: 10445 $ DE ANZA BLVD ST OWNER'S NAME: BCC HAYWARD LP 106 CUPERTINC APN: 359 17 0 i 9 CONTRACTOR: KE UN, 15265 ti1Or.7EREY AVENUE CHINO HILLS DATE ISSUED 5/26/2021 7:11.06 AM ,JOB DESCRIPTION DAINTY CUISINE INC - 1,560 S=+ LICENSED CONTRACTOR DECLARATION CONTRACTOlt KE L'N 7 ISSUED BY: hobo-n PERMIT NO: B_D-2019-' 235 OWNER'S PHONE: Not 'rovded CONTRACTOR PHONE: VALUATION: $45000 LICENSED CLASS: LICENSED NO: ;72695 B GENERAL BUILDING CCI EX? DATE: 05/31 /2022 I hereby affirm that I am licensed under the provisions of Qigplet 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my scene is in full force and effect. I hereby affirm under penally of perjury one of the following three declarations: Elnave and w l mo:rto r a certfcote of consent to self-inswe for Worke's Compersorion. os orevoeo for by Section 3700 of the Labe, Code, 'or the pe-ferrrence of the work for which +his permit is Issued Vi nave ord wl moirtoir+. Workers Connoensation r nsurorce, os pfovioe© tar by Section 3700 of the Lcoor Ccoe for the ceocrrnarce of tie work for whicn this perrn't is issued. certify that it tie performonce of the work for which this permit is issued. I shot not employ any person in any n+onner so os to aecor a st.oieat to the Worker s Cornoensotion ows of Cotforria. f, after making this cer'ficote of exemotion. I become s.,b;ec• to the Worker's Compensation p+ovisions of the Labor Code. I most fora ith corroy with sucn orovisions or this permit she l be deerred revcKeo. HAZARDOUS MATERIALS DISCLOSURE ? nave read the hazardous rnoterias requirements 4noer Ciopter 6.95 of tie Cotfcrr�a -ec -h & SQfe•v Code Sectiors 2550.5 :5531 or d 25534, I wil mointoir cornofionce w th the caioerino t 1,ricipa' Coo., Chocter 9.' ortid the Heatti E. Safety Code, Sec•cn 25532:ashoo'-o store or nondie noxoroous moterio . Add7tionet!y. shcuid I'.se equipment a• oevices wn:ch em'r nazaroous cif contamironts os oefireo oy the Boy A-ec A;► wuolity Management Dstrict I wii maintain comrpforce with tie Cuperlirc Fr4uricipol Code, Choater 9.12 and the Heolth 8, Safety Code. Sections 25505, 25533. and 25534 EPA LEAD -SAFE DISCLOSURE An PA .eoo-Sofe Certif,eo Rencvo•or will be resoons ble for th s project. Cer':fieo Firm Norse: I, Firm Cert;ticotion No: i 2 No EPA Leoo-Sofe Certified Firm is ►ecu"red for this pro;ect. CONSTRUCTION LENDING AGENCY neeeby affirm vnder penalty of perjury trot there is a corstruction lending ogency for the perforrnonce of the work which this term t is ;saved i'Sect'on 3097, CM Code(. 11 vas. I to r :enders '4orne: ; Lenaer s Adoress: APPLICATION CERTIFICATION certify that I hove ►eoo tri's opo`icotion and stote tnot the above information is correct_ I agree to comply with all city ono county oroinonces and state bun ►eoring to bui;ding constrvcticn. and hereby outhorze representatives of this city to erter coon the above mentioned proaerty far inspectior ourpcses. ;We! agree to save 'ndamrify and Keep harmless the City of Cupertino against liabilities.;udgemerts, costs. ona excerses which may accrue against said City in conseavence of the granting of this permit. Additonoi:y, the applicant unoerstonds ono wt I comply wits all non -point source regular ors per the ge ro Mvricipol Code. Sect Or 9. 8, i • Sig rof,ore' Every permit issued shots become invnUd unless the work on the site authorized by such perms is commenced within MS cloys oflr is issuance. or I the work aushorLed on the site by such pemrit b suspended or abandoned For a period of dts day) a$er the None the work is commenced