BLD-2022-0015CITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
CUPERTINO
BUILDING ADDRESS: 20605 VALLEY GREEN DR, Cupertino,
APN: 326 10 046
PERMIT NO: BLD-2022-0015
OWNER'S NAME: BERG FAMILY PARTNERS, L.P.
OWNER'S PHONE: (408)781-7595
CONTRACTOR: MILROY CONSTRUCTION INC
CONTRACTOR PHONE:
DATE ISSUED: 02/04/2022
ISSUED BY: KDUNBAR VALUATION: $28,000.00
JOB DESCRIPTION:
INSTALLATION OF NEW EQUIPMENT ASSOCIATED WITH ELECTRICAL AND STRUCTURAL ANCHORAGE. NO FIRE SPRINKLER MODIFICATION
LICENSED CONTRACTOR'S DECLARATION:
B - GENERAL BUILDING LICENSED NO: 579832 EXP DATE: 10/31/2023
9 (commencing with Section 7000) of Division 3 of the Business & Professions
CONTRACTOR: MILROY CONSTRUCTION INC LICENSED CLASS:
I hereby affirm that I am licensed under the provisions of Chapter
Code and that my license is in full force and effect.
declarations:
to self -insure for Worker's Compensation,
for which this permit is issued.
Insurance, as provided for by
is issued.
for which this permit is issued, I shall
laws of California. If, after making
Labor Code, I must forthwith comply
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury one of the following two
- I have and will maintain a certificate of consent
Labor Code, for the performance of the work
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
./ I have and will maintain Worker's Compensation
performance of the work for which this permit
- I certify that in the performance of the work
become subject to the Worker's Compensation
the Worker's Compensation provisions of the
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I
- I have read the hazardous materials requirements under Chapter
will maintain compliance with the Cupertino Municipal Code,
Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
No:
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification
N7 No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction
(Section 3097, Civil Code).
Yes •'No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
information is correct. I agree to comply
of this city to enter upon
of Cupertino against liabilities,
Additionally, the applicant
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
I certify that I have read this application and state that the above
laws relating to building construction, and hereby authorize representatives
purposes. (We) agree to save indemnify and keep harmless the City
accrue against said City in consequence of the granting of this permit.
source regulations per the Cupertino Municipal Code, Section 9.18.
Date 02/04/2022
Signature
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.