B-2018-1091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1091
10400 N TANTAU AVE CUPERTINO,CA 95014-0726(316 06 065) S C BUILDERS INC
SUNNYVALE,CA
94085
OWNER'S NAME:CAMPUS HOLDINGS INC DATE ISSUED:06/28/2018
OWNER'S PHONE: PHONE NO:(408)328-0688
LICENSED DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#767t96
Contractor S C BUILDERS INC Date 08/31/2019 X BLDG ELECT_PLUMB
I herebyI'lirm that I am licensed under the provisions of Chapter 9 X MUCH_RESIDENTIAL X COMMERCIAL
a p I (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
AC2:APPLE TANTAU 12-T.I.;ACOUSTICAL UPGRADES TO LAB
I hereby affirm under penalty of perjury one of the following two declarations: 2962;MECHANICAL&ELECTRICAL UPGRADES TO LAB 2962 AND
s. I have end will maintain.certificate of consent to self-insure for Worker's 2946
Compensation,as provided for by Section 3700 of the.Labor Code,for the
1U' fonnance of the work for which this permit is issued.
I aveand will maintain Worker's Compensation htsenum,as provided for by
cation 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fluor Area: Valuation:$16000,00
APPLICANT CERT'IFiCAT1ON
I certify that I have read this application and slate 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 Improvemcnts),A(Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for (Tenant Improv mnts),A(Tenant Improv nents),A
Inspection purposes. (We)agree to save indemnify and keep harmless the (Tenont Improvemants),A(Tenant Improv nents),A
City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant hnprovcments),A
may accrue against said City in consequence of the granting of this permit. (Tenant bnpi ovcments),A(Tenant imps ovements),A
Additionally,the applicant unyyii rslands and will comply with all non-point (Tenant Improvements)
source regulations or
thePrti=ode,Section 9.18.signature Date 069.18. 18 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 exempt from the Contractor's License Law for one of the
following ben reasons: Issued by:Jasmine Archbald
t. I,as owner of the property,or my employees with wages as their sole Date:06/28/2018
compensation,will do the wok,and the someone is at intended or offered far
sale 111C 7044,Business&Professions Cade) RE-ROOFS,z—I,_asmwner_of_theTrnpecLy,am_cxclusivclysontractin�with-licensed All coo shall�nspecte<t prmr to any roe mg me ene emg msta e.1 a roo 1s
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 herebyaffirm under I f re of the following three declarations: inspection.
penalty o perjury or g
r. 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 ofthe work for which this permit is issued. Date:06/28/2018
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
1 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 provisiona of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,1 must forthwith comply with such provisions or this permit shall Health&Safety Cade,Section 25532(x)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 Ba Aren Ai ualfty)"nnagement District I
APPLICANT CERTIFICATION will maintain compliance with the C actino r idia Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Cot Sections 5 5 5533,ami,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 city
to enter upon the above mentioned property for inspection purposes. (We)agree Owner or authorized age
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:06/28/2018
judgments,costs,and expenses which may accrue against said City in CONSTRUCTION 1 ENDING AGCNCY
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!28/2018
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.