B-2016-1699 (Permit)CITY OF CUPERTINO BUILDING PERMIT
BUH,DING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1699
10400 N TANTAU AVE CUPERTINO, CA 95014-0726 (316 06 065) TRUE13ECK-WEBCOR
IV
REDWOOD CITY, CA
94065
OWNER'S NAME: (
PHONE NO: (650) 227-1957
LICENSED CONTRACTOWS DECLARATION BUILDING PERMIT INFO:
Class GENERAL BUILDING CONTRACTOR Lic. #990050
or TRUESECK-WEBCOR JV Date 01/31/2018
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
vith Section 7000) of Division 3 of the Business & Professions Code and that my
icense is in fug force and effect.
ueby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
t Compensation, as provided for by Section 3700 of the Labor Code, for the
jA fIlerfmmance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
nformation is correct. I agree to comply with all city and county ordinances
mnd state laws relating to building construction, and hereby authorize
epresentatives of this city to enter upon the above mentioned property for
nspection purposes. (We) agree to save indemnify and keep harmless the
;ity, of Cupertino against liabilities, judgments, costs, and expenses which
nay accrue against said City in consequence of the granting of this permit.
\ddidonally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Date 121812016
hereby affirm that I am exempt from the Contractor's License Law for one of the
iBowing two reasons:
r. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance, m provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
s. I certify that in 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 Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I most forthwith comply with such provisions or this permit shag
be deemed revoked.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save Indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL 7X COMMERCIAL
DESCRIPTION:
PHASE H - TENANT IMPROVEMENT (TANTAU 12) (71664 SQ
?CTION H[STORYAVAMABLE UPON REQUEST"
CHARGED PER DEVELAPMENTAGREEMENT"
Floor Area: l Valustion: $6400000.00
ArN Number: Occupancy Type:
3/606065 1 A(Tenant lmprovements),B(Teonot Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
RF_ROOFS:
All roofs shag be inspected prior to any roofing material being installed Ha roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
lure of Applicant
12/8/2016
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area AR Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505,
agent:
Date: 12/8/2016
CONSTRUCTION LENDING AC-ENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Signature Date 12/8/2016