BLD-2021-0283_SignedPermit.pdfBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19500 PRUNERIDGE AVE Cupertino
APN: 316 06 059
PERMIT NO: BLD-2021-0283
OWNER'S NAME: IAC AT CUPERTINO LLC
OWNER'S PHONE: 408 -838-9729
CONTRACTOR: I Q V CONSTRUCTION INC, 877 CHESTNUT STREET SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 6/8/2021 10:03:55 AM
ISSUED BY: Sean Hatch
VALUATION: $25000
JOB DESCRIPTION
PANIC BAR TO (E) GATE; INSTALL ADA KEY FOB PAD; INSTALL ADA POWER PUSH BUTTON.
HAMPTON APARTMENTS T.I. I INSTALL
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
07/31/2021
I hereby
force
I hereby
I Q V CONSTRUCTION INC
CLASS:
BUILDING CONTRACTOR, C39 ROOFING
NO: 963219
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work for
laws of California. If, after making this
with such provisions or this permit shall be deemed
three
to self -insure
Insurance, as
which this permit
certificate of
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
work
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter
and the Health
as
Code, Sections
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined 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
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
V
CONSTRUCTION LENDING AGENCY
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 there is
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state
representatives
liabilities, judgements,
will comply with all
that the above
of this city to
costs,
non -point source
enter
•
information 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
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify
construction,
harmless
the
Signature:
that I
the
applicant
have read this application
and hereby authorize
City of Cupertino against
understands and
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.