B-2016-1730CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; CONTRACTOR: PERMIT NO: B-2016-1730
10420 MANN DR CUPERTINO, CA 95014-1154 (326 45 012) RICHARD HARD
SAN JOSE, CA 95148
OWNER'S NAME:
I I PHONE NO: (408) 532-1755
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #704179
Contractor RICHARD HARO Date 03/31/2017
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.
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 for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
z. 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.
APPLICANT CERTHJCATIOiv
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 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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understan s and will comply with all non -point
source regulations per the CupertinpVunicipal Code, Section 9.18.
Signature ' ' Date 6/16/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
L 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
sale (Sce.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
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
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that.l 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
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 may accrue against said City in
consequence of the granting of this permit, Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal'
Code, Section 9.18.
Signature Date 6/16/2016
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
X MECH X RESIDENTIAL_ COMMERCIAL
JOB DESCRIPTION:
ADD 292 S.F. TO EXPAND BEDROOMS & DINING RM/FAMILYRNI.
RELOCATE/REMODEL KITCHEN/DINING AREA (500 S.F.). REPLACE
4 WINDOWS, REPLACE (E) WATER HEATER WITH 2 (N) TANKLESS
UNITS, RELOCATE FURNACE TO ATTIC. REPLACE DRIVEWAY
Ft Floor Area: 584 I Valuation: $175000:00
APN Number: Occupancy Type:
326 45 012 1 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abbyey nde
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed, If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:,
Date: 6/16/2016
"A"' OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal C de, Chapter 9.12 and
the Health & Safety C_Qder.$ections 25505,155331and 25534.
Owner or authorized agent:'
Date:. 6/16/2016
CONSTRUCTION LENDING AGENCYN
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10420 MANN CUPERTINO, 45
CONTRACTOR:
PERMIT NO: B-2016-1730
DR CA 95014-1154 (326 012)
RICHARD HARD
SAN JOSE, CA 95148
OWNER'S NAME:
DATE ISSUED: 06/16/2016
OWNER'S PHONE:
PHONE NO: (408) 532-1755
LICENSED CONTRACTOR'S RATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #704179
Contractor RICHARD HARO Date 03/31/2017
X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X RESIDENTIAL _ COMMERCIAL
_
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
ADD 292 S.F. TO EXPAND BEDROOMS & DINING RM/FAMILY RM.RELOCATE/REMODEL
J4wxeby affirm under penalty of perjury one of the following two declarations:
KITCHEN/DINING AREA (500 S.F.). REPLACE
I have and will maintain a certificate of consent to self-insure for Worker's
4 WINDOWS, REPLACE (E) WATER HEATER WITH 2 (I) TANKLESS
Compensation; as provided for by Section 3700 of the Labor Code, for the
UNITS, RELOCATE FURNACE TO ATTIC. REPLACE DRIVEWAY
erformance of the work for which this permit is issued.
haveand will maintain Worker's Compensation Insurance, as provided for by
REVISION #1 - STRUCTURAL SHEAR-WALLCHANGEAT
ection 3700 ofthe Labor Code, for the performance ofthe work for which this
W-PS
BEDROOM #2 / BEDROOM #3 - ISSUED 8/11/2016
ermit is issued.
REVISION #2 - REMODEL FRONT ENTRY; REMODEL BEDROOM #2
LAND
APPLICANT CERTIFICATION 1(_
BEDROOM #3; KITCHEN REMODEL; UPGRADE ELECTRICAL
1 certify that I have read this application and state that the above
PANEL 200 AMP; (N) AC UNIT; INFILL GARAGE WINDOW;
information is correct. I agree to comply with all city and county ordinances
RELOCATE SKYLIGHT AND PULL DOWN ATTIC STAIR - ISSUED
and state laws relating to building construction, and hereby authorize
12/6/16
representatives of this city to enter upon the above mentioned property for o
Sq. Ft Floor Area: 292
-
Valuation:. $175000.00
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabi' ' nts, costs, and expenses which
may accrue agai t in consequen a granting of this permit.
Additional! appli ant understands and will co ith all non-point
APN Number:
Occupancy Type:
sours er a Cupertino M nieipal tion 9.18.
326 45 012
Deferred Submittal (R-3),R-3 (Custom)
J
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LASTfC_ALLD INSPECTION.
I hereby affirm that I am exempt from. the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the'property, or my employees with wages as their sole
Issued by:I
compensation, will do the work, and the structure is not intended or offered for
Datet� ,C
sale (See.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm under penalty of perjury one of the following three declarations:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
inspection.
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature of Applicant:
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Date: 12/06/2016
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
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California. If, after making this certificate of
I have read the hazardous materials requirements under Chapter 6.95 of the
exemption, I become subject to the Worker's Compensation provisions of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Labor Code, I must forthwith comply with such provisions or this permit shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
be deemed revoked.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION
air contaminants as defined by the Ba Man ement District I
I certify that I have read this application and state that the above information is
will maintain compliance with 3 o Municipal o t , er 9.12 and
correct. I agree to comply with all city and county ordinances and state laws
the Health & Saf o ctto 255 5, 2 533 an 25
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,
Owner or authorizelkiacien
judgments, costs, and expenses which may accrue against said City in
Date: 12/06/2016 '
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
I hereby affirm that there is a construction lending agency for the performance
Code, Section 9.18.
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Signature Date 12/06/2016
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2'011-1710
10420 MANN DR CUPERTINO, CA 95014-1154 (326 45 012)
RICHARD HARO
SAN JOSE, CA 95148
OWNER'S NAME:
PHONE NO: (408)532-1755
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #704179
Contractor RICHARD HARO Date 03/31/2017
X BLDG _ ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X RESIDENTIAL — — — COMMMERC
AT i
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
ADD 292 S.F. TO EXPAND BEDROO
S &DRIVING RM/FAMILY RM.
I hereby affirm under penalty of perjury one of the following two declarations:
RELOCATE/REMODEL KITCHEN/D
ING AREA (500 S.F.). REPLACE
ave and will maintain a certificate of consent to self -insure for Worker's
4 WINDOWS, REPLACE (E) WATER HEATER
WITH 2 (N) TANKLESS
pensation, as provided for by Section 3700 of the Labor Code, for the
UNITS, RELOCATE FURNACE TO ATI'
IC. REPLACE DRIVEWAY
PC ncc of the work for which this permit is issued.
I v and will maintain Worker's Compensation Insurance, as provided for by
II
REVISION #1 -STRUCTURAL SHEAR
CHANGE AT
Sec ' n 3700 of the Labor Code, for the performance of the work for which this
BEDROOM #2 /BEDROOM #3 -ISSUED
-WALL
8/11/2016
t is issued.
APPLICANT CERTIFICATION
Sq. Ft Floor Area: 292
11
Valuation: $1750010.00
I certify that I have read this application and state that the above
it
APN Number:
Occupancy Type: i1
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building "construction, and 'hereby authorize
326 45 012
Deferred Submittal
(R -3),R-3 (Custom)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
j
City of Cupertino against liabilities, judgments, costs, and expenses which
'
PERMIT EXPIRES IF WOtK IS NOT STARTED
may ac ue against s i _' ence of the granting of this permit.
Addition t scant understan an v 'll comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source 13 - ' rrsgpe the Cupertino u cipa Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Sig a Date 08/11/2016{
Issued by: PAUL O'SUL LIVAN
Date: 06/16/2016 i}
OWNER- ION
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
i. 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
inspectio .
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 (Sce.7044, Business & Professions Code).
Date: 08/11/2016
I hereby affirm under penalty of perjury one of the following three declarations:
s. 1 have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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, Sectious 25505, 25533, and 25534. 1 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) �hould 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 equi devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by tray Aie4 Air Quail anagement District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with a Cuper ' o4YI mcipa o ' , apter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall
the Health & Safe
34.�
be deemed revoked.
Owner or authorized
APPLICANT CERTIFICATION
Date: 08111/2016
I certify that I have read this application and state that the above information is
N TR T3 - EN Y
correct. I agree to comply with all city and county ordinances and state laws
1 hereby affirm that there is a construction fending 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
ARCHITECT'S DECLARATION
Code, Section 9.18,
1 understand my plans shall be used as public records.
Signature Date 08/11/2016
Licensed
Professional