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B-2016-1514CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO. 13-2016-1514 19479 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) WONG ELECTRIC INC' PALO ALTO, CA 94303- 4914 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 0311412016 ®PER'S kIIONU` ° PHONE NO: (650) 813-9999 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INTO: License Class C-10Llc. #464550 ContractorWONG ELECTRIC INC Date 10/31/2016 X_BLDG XELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing – MECH - 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: I hereby affirm under penalty of perjury one of the following two declarations: SHOP 6 - INSTALL TEMPORARY POWER (100 AMPS) B. 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. 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 Sq. Ft Floor Area; Valuation: $7000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above "NNumber. Occupaney Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20 112 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, Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAS CALLED INSPECTION. Signature Date 311417016 Issued by: PAUL O'SULLIVAN Date: 3/14/2016 O lW—WHUILDER DECi ARATION I hereby affirm that I am exempt fYom the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any rooting 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, 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sw.7044, Business & Professions Code). Date: 311412016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 DISCLOSURE 2. 1 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. Additinnally, 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 255051 33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFIC'ATIOlt� Date; 3114/2016 I certify that I have read this application and state :that the above information is t ASTRUCTION 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 Lenders Address consequence of the granting of this parmit, Additionally, the applicant understands and will comply with all no source regulations per the Cupertino Municipal ARCI3ITECT'S DECLARATION ' Code, Section 9.18. I understand m tans shall be used asCrecords. y p public Signature Date 3114 12016 Licensed Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 Ct1P RT1 N 0 (408) 777-3228 • FAX (408) 777-3333 • building(a7cuperti'no.arg PLUE413MG MECHANICAL ELECTRICAL Q MISCELLANEOUS PRorEcr AnDREss E-MAIL OWNERNAME Wwwwi✓!s+" � VIV STREET ADDRESS a�SQ ` r/ i , ` ptm",STATE, ZIP' , { 1/yI�}^� W f fj { r (� �(�E^MAIL- j` 5 CONTACT' NAME " f ' " { Q PHO f//1 f � e STREET ADDRESSSTATE, ZIP 1 r ^> FAX ❑ OwNER ❑ oi\%TR•$UILDEt ❑ OwNERAGENT Er"CONTRACTOR ❑ CONT�R�ACCTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER11 TENAITT CONTRACTORN O//j— LICENSEM3MBER itCENSHTYPEV1 BUS.LIC4(qA COMPANYNA�J /V - EMAIL FAX STREETADDRESS CITY, STATE� ZIP PHONE ARCHITECTIENGINEERNAME LICENSE NUMBER BUS. LIC COMPANY NAME F_ -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD.DUPI•EX .❑ MULTI -FAMILY PROJECT Qv WILDLAA'D , © YES PROTECT IN ❑. YES IS THE BLDG AN ❑ YES BUMI)ING: E] COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOODZONE ❑ NO EICHLER HOME? ❑. No DESCRIPTION OF WORK 12 9,QLWC>4 ,.CDS TOTAL VALUATION: RECEILER $y By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have pnvided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consnu on. I authorize representatives of Cupertino to enter the above4dentifie8 property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE NiI NTAL INFORMATION REQUIREDOuax�Tci ISEOJ.r% x e• -F v > a Q F7 PRESS - ST�ADARD wk's AEPMisc.4p,p 3011.doc rel'ised 06/2.1111 !E i 41 vo /, ?0 , y !-d - 4- L;11) AJ G PN A -T-