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B-2016-1539CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1539 19319 STEVENS CREEKBLVD CUPERTINO, CA 95014 (316 20 111) S C BUILDERS INC SUNNYVALE, CA 94085 OWNER'S NAME. ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 03/1712016 OWNER'S PHONE: 650-906-7350 PHONE NO: (408) 328-0688 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILD[ NG CONTRACTOR Lic. #76_ Z Contractor S C B - I D R INCDate 08(3112017 BSG _SECT PLUME I hereby affirm that I am licensed ander the provisions of Chapter 9 (commencing MECH RESIDENTIALX COMMERCLAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full fdree and effect. JOB DESCRIPTION: Installation of construction trailer (576 sq ft). I hereby affirria under penalty of perjury one ofthe following two declarations: 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. 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: $500.00 permit is issued. 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 Numher: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 20113 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 ' gm pts, costs, and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED may accrue against sold City's onseque ce of the granting of this permit. Additionally, thpplica tun land a will comply wl a non -point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR sourceZregsiions pert upertino nicipal Co , ectian 5.19. /••Signat 180 DAYS FROM LAST C LED I ECTIONo Date 03/17/2016 Issued by: ALEX UALLELUNGA Date: 03/17/2016 ER DECLARATION I hereby of arm that I am exempt from the Contractor's License Law for one of the following two reasons: RF -ROOFS; All roofs shall be inspected prior to any roof"3ng 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 (Sce.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construet the project (Seo.7044, Business & Professions Code). Date: 03117/2016 I hereby affirm under penalty ofperjury one of file following three declaratlanv ALL ROOF COVE RINGS 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 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3, I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I lare—orb t ndle hazardous materaad, Addtionally, should I use equipment device h-e�mot hazardous shall not employ layperson in any manner so as to become subject to the gin contaminants as defined by cr ay r y M a 6aent District I Worker's Compensation laws of California. If, after making this certificate of will maintain -compliance 'tb the Cope o M copal d� hapter 9.12 and exemption, I become subject to the Worker's Compensation provisions the the Health & fety Code, Sec ' ns 2 OS 53 ,and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorize en APPLICANT CERTIFICATION Date: 031117120165 'GAGENCY I certify that I have read this application and state that the above information Is CON5T t hereby affirm that there a construction lending agency for the performance correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city of work's for which thi ermit is issued (Sec. 3087, 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, 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 ARCHITI CT'S D> CLARATION and will comply with all non -point source regulations per the Cupertino Municipal (understand my plans shalt be used as public records. Code, Section 9.18. Licensed Signature date 03/17/2016 professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVi510N 10300 TORRID AVENUE - CUPERTINO, CA 95014-3255 , JPtml%TINCJ (408) 777-3228 FAX (408) 777.3333 build! npC7a,cupeltino.pr. j0:—JE f Lei U NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION f Tl n REVISION 1 DFFEPRFT] ORTGTI.TAT. PFR1WT a PRO71 CTADDREs S9511 "V APN #�� • a .1� O'WNERNAME AA^ -1 fi !;-r,, .� J " 1A1�j ONE _ E-MAIL /t PH6:1.102 l.1 l Lv d 1 STREET ADDRESS j y CITY, STATE, ZIP �f FAX Co i!°'$ {7Ca Y Ph I� �r�/ 1 C0N'TACT NAME PIZNE / E .�Pit-- ® 04 ®C btl STREET ADDRESS CITY, STATE, ZIP FAX j®o vslilr i sem` © OWNER E3 Ol\NER-BUILDER ® OWNER AGENT R CONTRACTOR i3yCONTRACTORAGENT ❑ ARCHITECT ❑ ENQwEER ❑ DEVELOPER ❑ TENAA'T CONTRACTORNAMEl LICENSENU+3BER LICENSETYPE BUS. LIC COMPANY NAME L € � E-MAIL ��S '� FAX C� U �� '� �i • t' s't'1 S ETADDRF.g_— --' CITY, STATE, ZIPCA PHOATE ARCAITECTIENGiNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME � E-MAIL FAY STREET ADDRESS ` ' CITY, STATE, ZIP PHONE DESCRIPTION OF WORK,12 1 Del � (s i - � �� 'T� ✓_ • c�!'� 6 � � l "[ •r,w( [ - V � �V 7 G G �'V� any. \ �' V °��'�« e ✓'.. Qw.� ce kv'• LJ / • R `ab 4 ` ! • vc6R S < t. �afd 6• lTw..$ E-XISTING USE PROPOSED:USE CONSTR. TYPE Ir, STORIES USE TYPE OCC. SQ.F-r. t VALUATION (S) EXISTG AREA NEW FLOOR AREA. DEMO AREA TOTAL NET AREA ® BATHRO%4 .KITCHEN OTHER i REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECIUPORCH AREA GAP.AGE AREA; DETACH - ❑ ATTACH #DWELLR,GUNITS: ISA SECOND UKIT ❑YES SECOND STORY [:]YES BEItiG ADDED? ONO ADDITION? []NO �. PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS TIIE BLDG AN [] YESRECEIVEDBY rF'; �'` TOTAL VALUATION: PLANWING ADPL# ❑ NO PLAT WING APPROVAL LETTER /ET Ii LER HOME? [] NO z z-� -' By nay signature below, I certiVa66�_h of the foll ` g: jd� the property owner or authorized agent to act on the property owner's behalf. I have read this application and the inforniat efi I have provided l met, a��e read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lai 8 relating to building sll�tio I authorize representati�'es of Cupertino to enter the above-identifie pdroperty for inspection purposes. . Signature of App ab ntlAgent: Date: J r q_UTPFEMENTX IRFORMATION REQUIREi7- =,;..; ITew SSED or Multifar ° y dwellings: Apply for demolition permit for ;G�ERTIiEC(3U\TER cSUILpGI?L4\RE�IL�V existing building(s). D Trolition permit is required prior to issuance of buildnig� 3 Me - permit for new buil `Ig, rT Commercial Idgs: Provide a completed Hazardous Materials Disclosure ©sT�1DARn } �s ruBLicazGRlws� _ Foran if any Hazardous Materials are being used as part of this project.` L HYD LARGES x PIREDEPT v a _ Copy of Platrnin,- Approval Letter or Meeting with Planning prior to ra 25,1 - submittal ofEuildina Permit application. }� NLAAOR"S�\IT4RYSEiiERI}ISTRICT r 5 t�EALT Elde$111ajOlI.doe ri %ised06/31/11 tSHOP 1 5,930 SF ► ��r ilk=� �Matr��x�������- e e I