B-2018-1811BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10490 S DE ANZA BLVD CUPERTINO, CA
OWNER'S NAME: LIAONING BENEFIT PETROLEUM (US) CORPORATION
OWNER'S PHONE: 7073640388
CONTRACTOR: ARMER/NORMAN & ASSOCIATES INC, 2600 WILLIAMS ST SAN LEANDRO
CONTRACTOR PHONE:
DATE ISSUED 8/25/2020 12:57:52 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $890000
JOB DESCRIPTION
(N) FOOD MART AND GAS PUMPS - (2487 SF) PERMIT APPLICATION EXPIRES ON 7.1.2020 - SEE ENTRY IN COMMENTS.
76 GAS STATION - CONSTRUCT
LICENSED CONTRACTOR DECLARATION
CONTRACTOR
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
ARMER/NORMAN &
CLASS: B GENERAL BUILDING
NO: 256896
DATE: 12/31/2021
affirm that I am licensed
and effect.
affirm under penatly of
I have and will maintain a
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California.
with such provisions or
ASSOCIATES INC
CONTRACTOR, A GENERAL ENGINEERING
under the provisions of Chapter
perjury one of the following three
certificate of consent to self -insure
Compensation Insurance,
of the work for which this permit
If, after making this certificate
this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
le
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
representatives of this city to
against liabilities, judgements, costs,
will comply with all non -point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this
construction, and hereby
harmless the City of Cupertino
the applicant understands
Signature:
application
authorize
and
/
.