B-2018-0933 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0933
20950 STEVENS CREEK BLVD CUPERTINO,CA 95014-2122(359 07 006) S M I CONSTRUCTION
INC
SAN LEANDRO,CA
94577-4321
OWNER'S NAME:BARTELS PROPERTIES ET AL DATE ISSUED:05/31/2018
OWNER'S PHONE: PHONE NO:(510)351-3288
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lia#831166
Contractor S M I CONSTRUCTION INC Date 01131/2020 X BLDG—ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MELD—RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is In full farce and effect. SOB DESCRIPTION:
YUMTEAT.L RE-STRIPEPARKINGLOT
I hereby affirm under penalty of perjury one of the following two declarations:
1, 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
erformance of the work For which this permit is issued.
ave 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 Arco: Valuation:$3000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 07 006
representatives of this city to enter on the above mentioned property for
inspection purposes. (We)agree{,save Indemnify and keep harmless the
City of Cupertino against Iiabilltiq,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City ip-consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and�y�'i11 comply with all non-point
source regulations per aE 6faVir('Muflpal code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
C i
Signature / --— Date 05-31-2018 Issued by:Kim Dunbar
Date:05/31/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I m'ex empt firman the Contractor's License Law for ane of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If it 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(Scc.7044,Business&Professions Code)
z 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:05-31-2018
I hereby affirm under penalty of perjury one of the following three declarations: pLL 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 DISCLOSURE
z. 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
permit is issued. m aintain complmce hwith the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,l health&Safety Code,Section 25532(x)should 1 tyre or handle hazardous
to material.Additionally,should 1 use equipment o.tfevices which emit hazardous
shall not employ y any person in any manner so as to become subject m the am contaminants as defined by the Bay Area ApSr Q de".r Management District 1
Worker's Compensation laws oFCaliforms.If,after making this certificate of will maintain compliance with the Cupert�6 ml in I Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,See ti:fs,25 O5,25533JnY¢25534._
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Data:05-31-2016 1
I certify that I have read this application and state that the above information is CONS'fRUCT4 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 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 MunicipalAIiCHI'I'F.C'I"5 DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature - Date 05-31-2018 Licensed
Professional