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HomeMy WebLinkAboutB-2016-1285 PermitI CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CCONTRACTOR: PERMIT NO: B-2016-1285 10600 N TANTAU AVE CUPERTINO, CA 95014-0739 (316 06 063) (RUDOLPH & SLETTEN INC) REDWOOD CITY, CA 94063 OWNER'S NAME: CAMPUS HOLDINGS INC (DATE ISSUED: 02/02/2016 OWNER'S PHONE: 408-996-1010 PHONE NO: 415-297-0528 1J' a License Class j} Lic. #18$Q¢9 Contractor ( RUDOLPH & SLETTEN INC) Date 02/02/2016 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 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 whi 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 rqy accrue against said City in consequence of the granting of this p resit. Aflditionally, the appintunderstands and will comply with all rt n-poin source regulgtions per the Cupertino Municipal Code. Section 9118. A A Date 02/02/2016 hereby affirm thaI4 a>gkxempt from the Contractor's License Law for one of the 1. 1, 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. a. 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. BLDG _ELECT _PLUMB MECH _ RESIDENTIALX COMMERCIAL DESCRIPTION: Phase II: Tantau 4 Tenant Improvement to include minor construction w non -load bearing partitions, doors, furniture and associated finishes at meat Control Area and removal of non -load bearing wall at Big Island :ction History Available Upon Request* Charged Per Development Agreement* Ft Floor Area: I Valuation: $75000.00 063 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofAppl Date: 02/02/2016 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. 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 Air Quality Management District I will maintain compliance with th Cuaaertino Municipal Code CChaptel9.12 and the Health & Safety Co e, Sdctlons 25505,15633; and 25534. .r or authorized 02/0212016 hereby affirm that there is a con trot n len in agency for the performance f work's for which this permit is is d (Sec. 3097, Civ C.) ender's Name Address understand my plans shall be used as public records.