B-2016-1675CITY OF CUPERTINO BUILDINGVERMIT
13UHMINGADDRESS:
CONTRACTOR:
PERMIT NO: B-201.6-1675
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112)
W L BUTLER
CONSTRUCTION INC
REDWOOD CITY, CA
94062
OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC)
DTE ISSUED: 07%01/2016
OWNER'S PHONE: 650-344-1500
P ONE NO: (650) 361-1270
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
O:
License Class a Lic. #355353
Contractor W L BUTLER CONSTRUCTION INC Date 03/31/2018
X BLDG _ELECT -PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIEDENTL4,L
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:
TARGET EXPRESS - T.I.
21,050 sq. ft. (included MEP), INCLUDES
I hereby affirm under penalty of perjury one of the following two declarations:
STORAGE RACKS
1. I have and will maintain a certificate of consent to self -insure for Worker's
TI PREP B-2016-2081
Compensation, as provided for by Section 3700 of the Labor Code, for the
REV # 1 - ADD DROPPED
CEILING TO STOCK AREA (REVISED
performance of the work for which this permit is issued.
SHEET A131).- ISSUED
-19-16
��I have and will maintain Worker's Compensation Insurance, as provided for by
REV #2 - (11/8/16) ADD
ITWALL TO SPACE BETWEEN WINDOW
Section 3700 of the Labor Code, for the performance of the work for which this
AND COLUMN AT EXI
- ISSUED 1/9/2017
permit is issued.
APPLICANT CERTIFICATION
TCO GOOD THRU 1-4-2
17
1 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
Sq. Ft Floor Area:
Valuation: $1200000.00
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
APN Number:
O cupancy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the
316 20112
A (Tenant Improvements),M (Tenant Improvements)
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.
PERMIT EXPIRES
IF WORK IS NOT STARTED
WITHIN 180 DAYS
OF PERMIT ISSUANCE OR
Signature Date 1/9/2017
180 DAYS FROM
LAST CALLED INSPECTION.
OWNER -BUILDER DECL•ARRATION
Issued by: Abby Ayende
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Date: 07/01/2016
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
RE
compensation, will do the work, and the structure is not intended or offered for
All roofs shall be inspected
-ROOFS:
prior to any roofing material being installed. If a roof is
sale (Sec.7044, Business & Professions Code)
installed without first obtaining
an inspection, I agree to remove all new materials for
2. I, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
Signature ofApplicant:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Date: 1/9/2017
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
ALL ROOF CO
RINGS TO BE CLASS "A" OR BETTER
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
MATERIALSHAZARDOUS
permit is issued.
I have read the hazardous
materials requirements under Chapter 6.95 of the
s. I certify that in the performance of the work for which this permit is issued, I
California Health & Safety
Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with
i he Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California. If, after making this certificate of
Health & Safety Code,
Section 25532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the
material. Additionally, sho
Ad I use equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
air contaminants as definec
I by the Bay Area Air Quality Management District I
be deemed revoked.
will maintain compliance
ith the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety
Code, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
;Owner or authorized agent:
correct. I agree to comply with all city and county ordinances and state laws
Date: 1/912017
relating to building construction, and hereby authorize representatives of this city
CONS
RUCTION LENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is
a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this per
it is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in
Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Address
Code, Section 9.18.
Signature Date 119/2017
AJM!HITECTIS
1 understand my plans shal
DECLARATION
I be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1675
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112)
W L BUTLER
CONSTRUCTION INC
REDWOOD CITY, CA
94062
OWNER'S NAME: ( MAIN STREETCUPERTINO AGGREGATOR LLC)
DATE ISSUED: 07/01/2016
OWNER'S PHONE: 612-338-0085
PHONE NO: (650) 361-1270
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #355353
Contractor W L BUTLER CONSTRUCTION INC Date 03/31/2018
X BLDG —ELECT _ PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
TARGET EXPRESS - T.I.21,050 sq. ft. (included MEP), INCLUDES
I hereby affirm under penalty of perjury one of the following two declarations:
STORAGE RACKS
m. 1 have and will maintain a certificate of consent to self --insure for Worker's
TI PREP B-2016-2081
Compensation, as provided for by Section 3700 of the Labor Code, for the
REV # 1 - (8/24/16) -ADD DROPPED CEILING TO STOCK AREA
performance of the work for which this permit is issued.
(REVISED SHEET A131).
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
Sq. Ft Floor Area:
Valuation: $1200000.00
permit is issued.
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
316 20112
A (Tenant Improvements),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 per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature �� Date 09/19/2016
Issued by: Abby yende
OWNER-BUIELDER DECLARATION
Date: 07/01/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
m. 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 ofApplicam:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 09/19/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
m. 1 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.
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
a. 1 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
material. Additionally, should I use equipment -or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. r--
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 09%19/2016
I certify that I have read this application and state that the above information is
CON TRT TION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct, I agree to comply with all city, and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 09/19/2016
Professional
vJ
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1675
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112)
W L BUTLER
CONSTRUCTION INC
REDWOOD CITY, CA
94062
OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC)
DATE ISSUED: 07/01/2016
OWNER'S PHONE:
PHONE NO: (650) 361-1270
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #355353
Contractor W L BUTLER CONSTRUCTION INC Date 03/31/2018
X BLDG —ELECT —PLUMB
-
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
TARGET EXPRESS - T.I. 21,050 sq. ft. (included ME
)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
of the work for which this permit is issued.
'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
Sq. Ft Floor Area:
Valuation: $1200000.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
316 20 112
A (Tenant Improvements),M (Ten
intImprovements)
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
PERMIT EXPIRES IF WORK ISN
T 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 per the Cuperti o Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur, 7/1/2016
Issued by: AbbyAyende
Date: 07/01/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material be'
ag installed. If a roof is
following two reasons:
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 (See,7W, Business & Professions Code).
Date: 7/1/2016
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 of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLO
URE
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, 255
3, and 25534. I will
maintain compliance with the Cupertino Municipal Code,
Chapter 9.12 and the
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) should I store
material. Additionally, should I use equipment or device
handle hazardous
which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 Cupertino Municipal
Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505,4mkv7n.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.Owner
or authorized agent:
ICANT CERTIFICATION
Date: 7/1/2016
APPT
I certify that 1 have read this application and state that the above information isCONSTRUCTION
LENDINGA E IN
I hereby affirm that there is construction lending agency
EX
for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ
C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
RITE T' DE LARA TIO
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 7/1/2016
professional