BLD-2021-0007BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10475 BANDLEY DR Cupertino
APN: 326 33 1 1 1
PERMIT NO: BLD-2021-0007
OWNER'S NAME: DPT BANDLEY DRIVE LLC
OWNER'S PHONE: Not Provided
JOB DESCRIPTION
CABINETS AND WORK STATIONS; INSTALL (4) NEW IMMERSION TESTING CHAMBERS; CONVERTING (E) LAB #104 INTO AN IMMERSION TESTING LAB,
BOARD ON (E) WALLS
T.I. (1,000 SF) - REMOVAL OF SELECT
INSTALLING TILE OVER (N) SEMENTITIOUS
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
02/28/2023
I hereby
force
I hereby
DEVCON CONSTRUCTION
CLASS:
BUILDING CONTRACTOR,
NO: 399163
DATE:
affirm that I am licensed
and effect.
affirm under penatiy 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
INCORPORATED
A GENERAL ENGINEERING CONTRACTOR
under the provisions of Chapter
perjury one of the following
certificate of consent to self
Compensation Insurance,
of the work for which this
If, after making this certificate
this permit shall be deemed revoked.
three declarations:
-insure 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
permit 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
Chapter 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
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
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
representatives of this city
against liabilities, judgements,
will comply with all non -point
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application
construction, and hereby authorize
harmless the City of Cupertino
the applicant understands and
Signature:
L9—\A)
.