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B-2018-0686 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR PERMIT NO:B-2018-0686 19333 VALLCO PKWY CUPERTINO,CA 95014-2506(316 20 075) NOVO CONSTRUCTION INC MENLO PARK,CA 94025 OWNER'S NAME: DATE ISSUED:09/27/2018 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic.#791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2019 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECII_RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE VP02C 2 STORY T.I.-(103,900 SF) I hereby affirm under penalty of perjury one of the following two declarations: m. 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 permit is issued. Sq.Ft Floor Area: Valuation:$9715500.00 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 20 075 B(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 pfr nderstands and will comply with all non-point source regulati s p Cupertino Muni ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 09/27/18 Issued by:Samuel L Date:09/27/2018 WNE - DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is m. 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(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/27/18 I hereby affirm under penalty of perjury one of the following three declarations: ALL 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. 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 store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu o Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ecti 5505,255 3,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:09/27/18 I certify that I have read this application and state that the above information isG G correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there i a c n lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this per Red(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 ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 09/27/18 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0686 19333 VALLCO PKWY CUPERTINO, CA 95014-2506 (316 20 075) NOVO CONSTRUCTION INC MENLO PARK, CA 94025 OWNER'S NAME: DATE ISSUED: 09/27/2018 OWNER'S PHONE: PHONE NO: (650) 701-1500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2019 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 & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE VP02C 2 STORY T.I. - ( 103,900 SF) I hereby affirm under penalty of perjury one of the following two declarations: REV #1 - REVISIONS TO WORKROOM, CURTAIN, LIGHTING, 1. I have and will maintain a certificate of consent to self-insure for Worker's EQUIPMENT, ELECTRICAL, PLUMBING, MECHANICAL LAYOUTS. Compensation, as provided for by Section 3100 of the Labor Code, for the MODIFICATIONS TO STORAGE ROOM TO BE DISTRIBUTED performance of the work for which this permit is issued. ANTENNA SYSTEM ROOM W/ASSOCIATED EQUIPMENT ISSUED I have and will maintain Worker's Compensation Insurance, as provided for by 12/12/18 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $11115500.00 .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 20 075 A (Tenant Improvements),B (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 Additionally, thetafpplicant understands and will comply with all non-point OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION, Signatur Date 12/12/18 Issued by: Samuel L Date: 09/27/2018 O E BUILD" . R LARATION I heireb affirm th"at I am exem t from the Contractor's License Law for one of the RE-ROOFS: y t p All roofs shall be inspected prior to an roofing material being installed. If a roof is following two reasons: � p p y g g 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 (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/12/18 I hereby affirm under penalty of perjury one of the following three declarations: ALL 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 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 store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air (duality Management District I Worker's Compensation laws of California. If, after making this certificate ofwill maintain compliance with the Cupertin Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safe Cade Se do `s�25( �255 3 and Safety 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. �" Owner or authorized agent: APPLICANT CERTIFICATION Date: 12/12/18 •- �- I certify that I have read this application and state that the above information is CO RUC 10 LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that they is a constriction lending agency for the performance y relating to building construction, and hereby authorize representatives of this cit of work's for which this p �r. t is i - ued (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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 12/12/18 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0686 19333 VALLCO PKWY CUPERTINO,CA 95014-2506(316 20 075) NOVO CONSTRUCTION INC MENLO PARK,CA 94025 OWNER'S NAME: DATE ISSUED:09/27/2018 OWNER'S PHONE: PHONE NO:(650)701-1500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class I3 Lic.#791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2021 X BLDG _ELECT _PLUMB MECH_RESIDENTIAL X COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: j APPLE VP02C 2 STORY T.I.-(103,900 SF) I hereby affirm under penalty of perjury one of the following two declarations: DEF#1 -HAZARDOUS MATERIALS i. . I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REVISIONS TO WORKROOM,CURTAIN,LIGHTING, Compensation,as provided for by Section 3700 of the Labor Code,for the EQUIPMENT,ELECTRICAL,PLUMBING,MECHANICAL LAYOUTS. have and will maintain Worker's Compensation Insurance,as provided for by ANTENNA SYSTEM ROOM W/ASSOCIATED EQUIPMENT-ISSUED Section 3700 of the Labor Code,for the performance of the work for which this 12/12/18 ; permit is issued. DEF#2-ADDITION OF PIPE GRID THEATRICAL SYSTEM-ISSUED APPLICANT CERTIFICATION 1/24/19 I certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$11115500.00 information is 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 APN Number: Occupancy Type: inspection purposes. (We)agree to save indemnify and keep harmless the 316 20 075 A(Tenant Improvements),B(Tenant Improvements) City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the appiicarri�t understands and will comply with all non-point source regulatio per tte C perrtitao Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signature.' Date 1/24/19 180 DAYS FROM LAST CALLED INSPECTION. OWNE13ULI] Issued by:Samuel L I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:09/27/2018 following two reasons: s. I,as owner of the property,or my employees with wages as their sole RE-ROOFS: compensation,will do the Work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for z. I,as owner of the property,am exclusively contracting with licensed inspection. contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: i. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 1/24/19 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for,which this permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements,under Chapter 6.95 of the 3. I certify that in the performance of the work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Worker's Compensation laws of California. If,after making this certificate of Health&Safety Code,Section 25532(a)should I store or handle hazardous exemption,I become subject to the Worker's Compensation provisions of the material. Additionally,should I use equipment or devices which emit hazardous Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Se fki s 25505,25533,and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner or authorized agent: correct.I agree to comply with all city and county ordinances and state laws Date: 1/24/19 relating to building construction,and hereby authorize representatives of this city ( CONST�RUCTI NAGRNCY to enter upon the above mentioned property for inspection purposes. (We)agree I hereby affirm that there is a co>'truction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.) judgments,costs,and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address Code,Section 9.18. ARCHITECT'S DECLARATION Signature Date 1/24/19 I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0686 19333 VALLCO PKWY CUPERTINO,CA 95014-2506(316 20.075) NOVO CONSTRUCTION INC MENLO PARK,CA 94025 OWNER'S NAME: DATE ISSUED:09/27/2018 OWNER'S PHONE: PHONE NO:(650)701-1500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2021 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&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE VP02C 2 STORY T.I.-( 103,900 SF) I hereby affirm under penalty of perjury one of the following two declarations: REV#2-INSTALL CONDENSATE AND POWER-3-7-2019 1. I have and will maintain a certificate of consent to self-insure for Worker's DEF#1 -HAZARDOUS MATERIALS-ISSUED 3-7-2019 Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1-REVISIONS TO WORKROOM,CURTAIN,LIGHTING, performance of the work for which this permit is issued. EQUIPMENT,ELECTRICAL,PLUMBING,MECHANICAL LAYOUTS. I have and will maintain Worker's Compensation Insurance,as provided for by MODIFICATIONS TO STORAGE ROOM TO BE DISTRIBUTED Section 3700 of the Labor Code,for the performance of the work for which this ANTENNA SYSTEM ROOM W/ASSOCIATED EQUIPMENT ISSUED permit is issued. 12/12/18 APPLICANT CERTIFICATION DEF#2-ADDITION OF PIPE GRID THEATRICAL SYSTEM-ISSUED certify that I have read this application and state that the above 1/24/19 information is correct.I agree to comply with all city and county ordinances Sq.Ft Floor Area: Valuation:$11115500.00 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 to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which APN Number: Occupancy Type: may accrue against sa', ty in consequence of the granting of this permit. 31620075 A(Tenant Improvements),B(Tenant Improvements) Additionally,the ap cant derstands and will comply with all non-point source Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 3-7-2019 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. WNER -BUIL CLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: Samuel L following two reasons: Date:09/27/2018 1. I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior-to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Code,for the Date:3-7-2019 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 3. I certify that in the performance of the work for which this pen-nit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit hazardous be deemed revoked, air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance 25533,and 25534. 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 and state laws relating to building construction,and hereby authorize representatives of this city Owner or authorized agen to enter upon the above mentioned property for inspection purposes. (We)agree Date:3-7-2019 to save indemnify and keep harmless the City of Cupertino against liabilities, CON DING AGENCY judgments,costs,and expenses which may accrue against said City in I hereby affirm that there a co struction lending agency for the performance consequence of the granting of this permit. Additionally,the applicant understands of work's for which this per is issued(Sec.3097,Civ C.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code,Section 9.18. Lender's Address Signature Date 3-7-2019 ARCHITECT'S,DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0686 19333 VALLCO PKWY CUPERTINO,CA 95014-2506(316 20 075) NOVO CONSTRUCTION INC MENLO PARK,CA 94025 OWNER'S NAME: DATE ISSUED:09/27/2018 OWNER'S PHONE: PHONE NO:(650)701-1500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#791022 Contractor NOVO CONSTRUCTION INC Date 02/28/2021 X BLDG _ELECT _PLUMB _ 1 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&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE VP02C 2 STORY T.I.-( 103,900 SF) I hereby affirm under penalty of perjury one of the following two declarations: REV#2-INSTALL CONDENSATE AND POWER-3-7-2019 1. I have and will maintain a certificate of consent to self-insure for Worker's DEF#1 -HAZARDOUS MATERIALS-ISSUED 3-7-2019 Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1-REVISIONS TO WORKROOM,CURTAIN,LIGHTING, performance of the work for which this permit is issued. EQUIPMENT,ELECTRICAL,PLUMBING,MECHANICAL LAYOUTS. have and will maintain Worker's Compensation Insurance,as provided for by MODIFICATIONS TO STORAGE ROOM TO BE DISTRIBUTED Section 3700 of the Labor Code,for theerformance of the work for which this p ANTENNA SYSTEM ROOM W/ASSOCIATED EQUIPMENT ISSUED permit is issued. 12/12/18 APPLICANT CERTIFICATION DEF#2-ADDITION OF PIPE GRID THEATRICAL SYSTEM-ISSUED I certify that I have read this application and state that the above 1/24/19 information is correct.I agree to comply with all city and county ordinances Sq.Ft Floor Area: Valuation:$11115500.00 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 to save indemnify and keep harmless the APN Number: Occupancy Type: City of Cupertino against liabilities,judgments,costs,and expenses which 31620075 A(Tenant Improvements),B(Tenant Improvements) may accrue against ps �Ld City in consequence of the granting of this permit. Additionally,the a iant understands and will comply with all non-point source Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 3-7-2019 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. WN -BUIL DECLARATION I hereby a m that I am exempt from the Contractor's License Law for one of the Issued by:Samuel L following two reasons: Date:09/27/2018 1. I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Code,for the Date:3-7-2019 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the performance of the work for which this pen-nit is issued. HAZARDOUS MATERIALS DISCLOSURE 3. I certify that in the performance of the work for which this pen-nit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit hazardous be deemed revoked, air contaminants as defined by the Bay Ar . Quality Management District I will maintain compliance with 1 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 and state laws relating to building construction,and hereby authorize representatives of this city Owner or authorized agen Date:3-7-2019 - to enter upon the above mentioned property for inspection purposes. (We)agree CO?STRUCTIO DING AGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that the is a const ction lending agency for the performance judgments,costs,and expenses which may accrue against said City in of work's for which this rmit i sued(Sec.3097,Civ C.) consequence of the granting of this permit. Additionally,the applicant understands Lender's Name and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Lender's Address Signature Date 3 7-2019 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.