B-2018-1379 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1379
10900 N BLANEY AVE CUPERTINO,CA 95014-0599(316 03 045) GO WAN
CONSTRUCTION
COMPANY INC
TRACY,CA 95376
OWNER'S NAME:PACIFIC GAS AND ELECTRIC CO DATE ISSUED:08/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#696797
Contractor GOWAN CONSTRUCTION COMPANY INC Date 1 0131/2 01 8 X BLDG—ELECT_PLUMB
I hereby affirm that I am licensed ruder the provisions of Chapter 9(commencing —MECH—RESIDENTIAL A COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
INSTALL(3)CONCRETE PEDESTALS WITH(6)20A RECEPTACLES.
1 hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided far by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
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:$80000.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy'lype:
and stale laws relating to building construction,and hereby authorize 316 03 045 A(Tenant Improvements)
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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08-15-2018 Issued by:Kim Dunbar
Date:08/15/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law For one of tiro RE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any reefing material being installed.If i roof is
t. 1,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&Pro£essious Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09-15-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
perfomnnce 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 1 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 Culifarnta Health&Safety Code,Sections 25505,25533,and 25534,Twill
Pe
I nit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
material.Additionally,should I use equipment or devices which emit hazm dons
shall not employ any person in any manner so as to become subject to the ata contaminants as defined by the Bay Area At,-Quality Management District 1
Worker's Compensation laws of California..If,after making this cortiftente of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505„=,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: �
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 Municipal ARCIIiTECq"S Ub:CLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 08-15-2016 '
Professional