HomeMy WebLinkAboutB-2016-1557 PermitCITY OF
10400 N TANTAU AVE CUPERTINO, CA 95014-0726 (316 06 065)
OWNER'S NAME: (CAMPUS HOLDINGS NC)
PHONE:
License Class GENERAL BUILDING CONTRACTOR Lic. #174637
Contractor CUPERTINO ELECTRIC INC Date 08/31/2016
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
rith Section 7000) of Division 3 of the Business & Professions Code and that my
icense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
1. L 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
,r.�Section 3700 of the Labor Code, for the performance of the work for which this
J permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
iformation is correct. I agree to comply with all city and county ordinances
ind state laws relating to building construction, and hereby authorize
epresentatives of this city to enter upon the above mentioned property for
ispection 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.
tdditionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino ?yj 1jsl Code, Section 9.18.
Date3/�(,
hereby affirm that I am exempt from the Contractor's License Law far one of the
allowing 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. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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.
r. 1 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
certify that I have read this application and state that the above information is
orrect. I agree to comply with all city and county ordinances and state laws
elating to building construction, and hereby authorize representatives of this city
D enter upon the above mentioned property for inspection purposes. (We) agree
o save indemnify and keep harmless the City of Cupertino against liabilities,
idgments, costs, and expenses which may accrue against said City In
onsequence of the granting of this permit. Additionally, the applicant understands
ind will comply with all non -point source regulations per the Cupertino Municipal
:ode. Section 9.18.
BUILDING PERMIT
CONTRACTOR: PERMIT NO: B-2016-1557
CUPERTINO
ELECTRIC INC
SAN JOSE, CA 95112
DATE ISSUED: 03/17/2016
PHONE NO: (408) 808-8000
BUILDING PERMIT INFO:
X BLDG _ELECT _PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
temporary power from (e) site main switchboard 'MSBTP' to (4)
Ioorary skid locations.
*Inspection history available upon request*
*Fees charged per development agreement*
Ft Floor Area: I Valuation: $150000.00
IAPN " 06umber: I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by:l ✓m'/✓ z4-,/ ✓'/7'/l0
RE -ROOFS:
All roofs shall 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.
Signature of
IA 1111 tUD]Zefp7St71i'.fe);b 1[0:3 We)1GFX7V:4[O77 sll Y Y D4q
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. twill
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, S ns 25505,2 33, and 2 4.
Owner or authorized agent:
Date: / /j�
CONSTRUCTION E
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.
Date
Licensed