HomeMy WebLinkAbout15030056 (Permit)CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030056
10435 N TANTAU AVE (316 06 039) (B N BUILDERS /
WEBCORAJV)
REDWOOD CITY, CA
94065
OWNER'S NAME: (CAMPUS HOLDINGS INC)
OWNER'S PHONE: 408-996-1010
LICENSED CONTRACTOR'S DECLARATION
License Class 1 Lic. #990050
Contracllor ( B N BUILDERS / WEBCORAJV_) Date 8/16
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby 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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit i issued.
2. 1 have and will maintain Worker's Compensation Insurance, as provided for
f1 v3 by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
APPLICANT CERTIFICATION
I 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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulatio s per the Cuperti unicipal
Code, Section 9W
18
Signature i 2Date 03/08/16
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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. I, 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:
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 of the work for which this permit is issued.
2. 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.
3. 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 must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I 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 accrue 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.
DATE ISSUED: 03/09/2015
PHONE NO: 650-227-1957
BUILDING PERMIT INFO:
_ BLDG _ ELECT _ PLUMB
- MECH - RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
AC2 - PHASE II -INSTALL (N) TEMPORARY CONSTRUCTION
TRAILER. I
Revision #1: Relocate Construction Trailer on site. Issued 3/8/16.
Sq. Ft Floor Area: I Valuation: $6000.00
APN Number: Occupancy Type:
316 06 039
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: SEAN HATCH
Date: 03/08/16
RE -ROOFS:
All roofs shall be inspected prior to any roofmg material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 03/08/16
TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
/i-44 1ivlu1
Owner or authorized agent:
Date: 03/08/16
CONSTRUCTION LENDING AGENCY
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
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 03/08/16
Licensed
Professional