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B-2016-1243 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1243 20664 HOMESTEAD RD CUPERTINO,CA 95014-0451(326 10 066) SALSGIVER CONSTRUCTION FALLBROOK,CA 92028 OWNER'S NAME: Sobrato Interests 1 Etal(Sobrato Interests 1 Etal) DATE ISSUED:04/26/2016 OWNER'S PHONE:408-446-0700 PHONE NO:(760)4684886 LICENSED CO ;CLARATION BUILDING PERMIT'INFO: License Class QENERAL BUILDING CONTRACTOR Lic.#938399 Contractor SALSGIVER CONSTRUCTION Date 10/31/2017 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — MECII RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: AT&T-BUILD OUT(E)SHELL TO(1)M OCCUPANCY(1,617 S.F.) I�y,y'iif firm under penalty of perjury on'e of the following two declarations: 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 r performance 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. Sq.Ft Floor Area: Valuation:$100000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 10 066 M(Tenant improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally;the applicant understands and will comply with all non-point source regulations he no Municipal Code,Section 9.16. 180 DAYS FROM LAST ED INSPECTION. SignatureZ' Date 04/26/2016 Issued by:MELIS ANAME Date:04/26/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/26/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper' o Muni ' Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S do 5 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent,. APPLICANT CERTIFICATION Date:04/26/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and-will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 04/26/2016 professional CONSTRUCTION PERMIT APPLICATION sr COIdiIt4UNl I i DEVELOP.AJiENT-DErP;=�R i ItiiEN T BUILDING DIVISION 10300 i ORRE AVENUE, CUPERTINO,CA 9501A 3255 CUPERTINO, (4aS)777-3223 t F,1X(408)777-3333-buildlnoecum<Ino.oro �0 K'I:W CONSTRUCTION ❑ ADDI TiQII ALTERATION/TI ❑ REVISION/BEF ERRED OPJGINA T PEP-Iya7 Iwo _ YL1- F?s�fF PsSS �( VIlV Ci Y SThF?, _t`r :hX f� — Q� COAi3CT STB:.:-,AJDP..$$ � ` V V 11% CT-5-Y,CTE' +h3 PAX +^ ©ORnZ'� Q Dil?�P.•3LTbrie 130WX AGENT ❑ GDhrZ4C10R ©COly C10s2}.C•=]T h?VGIa:=CT ❑ QGLhc�A ❑YD1 =LDp ❑ isT ftir COldii ACiOR1 Ahf^ t/} LICEt¢�1.'IA+4s BUS.LIC A� -- COtJpk1.7'T d 3 t --m-41L FA-11 STP'LEET RDDR.'-_SS C4T�,$This,Zi? I ?HOW--- B1 IS, ii0'h-3US.Lic I C010AW.l VIM r'•�11/`4��3111A��`A� G E-N.}�L iT}SiDPcSS � i 1 C: STATE,`F> I 3OT f/F c-" ,10N Or W P" �i`�``3 �- - �•�JG�L�,� n� c�' a� tom} �Q �• s4/��� ijy�2�u OBS PROPOSED LSc.. f C01,+StZt ��^ I �'S`eOP. 5 JJ p �°'\ 1 �.� USB 1 TAPE I DCC. 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