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B-2018-0767 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONT'RACT'OR: PERMIT NO:B-2018-0767 10350 N TANTAU AVE CUPERTINO,CA 95014(316 06 065) S C BUILDERS INC SUNNYVALE,CA 94085 OWNER'S NAME: DATE ISSUED:06/25/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie.#767196 X BLDG_ELECT_PLUMB Contractor S C BUILDERS INC Date 08/3112019 — I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing —MECH—RESIDENTIAL X COMMERCIAL with Seaton 7000)of Division 3 of the Business&Professions Cade and that my license is in fall force and effect. JOB DESCRIPTION: AC2 TANTAU 11 SECOND FLOOR TI IN CONFERENCE ROOM(525 1 hereby affirm under penalty of perjury one of the following two declarations: SF);INSTALL(6)DOORS. 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 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation hnsurance,as provided for by / Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$85000.00 APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is correct.I agree to comply with all city and countyordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 06 065 A(Tenant Improvements),A(Tenant Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant hnprovements),A inspection purposes. (We)agree to save Indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Impruvements),A(Tenant Improvements),A may accrue against s City in c sequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally,the app c t under rids and will comply with all non-point (Tenant Improvements) source regulations the Cu r no icipal Code,Section 9.18. Signature ~ Date 06-25-2018 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am cxmnpt from the Contractor's License Law for one of the following live reasons: Issued by:Kim Dunbar u 1,as owner of the property,or my employees with wages as their sot. Date:06/25/2018 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) RE-ROOFS: z. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installer)without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance ofthe work for which this permit is issued. Date:06-25-2018 z. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance o£the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. a. I certify that in the performance of the work fir,which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements order Chapter 6.95 of the Worker's Compensation laws of California.If,after making this certificate of California health&Safety Cade,Sections 25505,25533,and 25534.1 will exemption,I become subject to the Worker's Compensation provisions of them aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,1 must forthwith comply with such provisions or Oris permit shall health&Safety Carle,Section 25532(a)should I store ar handle hazardous be deemed revoked. material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay ea Air Quality Management District I APPLICANT.CERTIFICATION will maintain compliance with9he Cu •tiro M" Code tt Clmpter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety 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 Owner or authorized agent to save indemnify and keep harmless the City of Cupertino against liabilities, Date:06-25-2018 judgments,coals,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit.Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is Issued(Sec.3097,Civ C.) Code,Section 9.18. - Lender's Name Lender's Address Signature Date 06-25-2018 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0767 10350 NTANTAU AVE CUPERTINO,CA 95014(316 06 065) S C BUILDERS INC - SUNNYVALE,CA , 94085 OWNER'S NAME: DATE ISSUED:06/25/2018 OWNER'S PHONE: PHONE NO:(408)328-0688 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class j3 Lic.#767196 ' Contractor S C BUILDERS INC Date 08/31/2019 X BLDG ELECT _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&Processions Code and that my license is in full force and effect. JOB DESCRIPTION: AC2 TANTAU 11 SECOND FLOOR TI IN CONFERENCE ROOM(525 I hereby affirm under penalty of perjury one of the following two declarations: SF);INSTALL(6)DOORS. 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 REVISION#1: REVISE EGRESS PATH FOR CONFERENCE ROOM performance of the work for which this permit is issued. AND RELOCATE EXIT SIGN. ISSUED 1.23.19 /' 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$85000.00 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 316 06 065 A(Tenant Improvements),A(Tenant Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally,the applican understands and will comply with all non-point (Tenant Improvements) source regulations pe (e Cupertino Municipal Code,Section 9.18. Signature 0�//�, � Date 1-23-2019 PERMIT EXPIRES IF WORK IS NOT STARTED / WITHIN 180 DAYS OF PERMIT ISSUANCE OR AWN. '-t 'ell:: I : :. .•N' 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by:Kim Dunbar a 1,as owner of the property,or my employees with wages as their sole Date:06/25/2018 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) RE ROOFS. z. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 1.23-2019, z. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 APPLICANT CERTIFICATION will maintain compliance with the Cupertino, unicipal Code,Chapter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety Code,Secti 1 25505,25533,and 25534. correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this cityn -t • i consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a cInstruction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ G.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 1-23-2019 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.