B-2017-1073 CITY OF CUPERTINO BUILDING PERMIT
MAZZONI
CONSTRUCTION
PLEASANTON,CA
94588
OWNER'S NAME:SUN JASON TAI AND NOZAWA MIE DATE ISSUED:12/14/2017
OWNER'S PHONE: PHONE NO:(925)236-0818
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#1 00 934
Contractor MAZZONI CONSTRUCTION Date 06/3 012 01 9 JX BLDG ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professlons Code and that my
license is in full farce and effect. JOB DESCRIPTION:
IST FLOOR ADDITION GUEST ROOM/KITCHEN(332 SF);
I hereby affirm under penalty ofperjury one of the following two declarations: REMODEL BEDROOMS/BATHROOMS/KITCHEN/LIVING
r. I have and will maintain a certificate of consent to self-insure far Worker's RM/DINING RM(1950 SF);
Compensation,as provided for by Section 3700 of the Labor Cade,for the (N)ROOF COMP SHINGLE(1950 SF)
performance of the work for which this permit is issued. DEF#1-TRUSSES-ISSUES 7-13-2018
z. I have and will maintain Worker's Compensation Insurance,as provided for by REV#I REPLACE EXTERIOR WALLS DUE TO TERMITE-ISSUED
Section 3700 of the Labor Code,for the performance of die work for which this 1/25/20 t8
ex
erm
pit is issued.
Sq.Ft Floor Arca:332 Valuation:$150000,00
APPLICANT CEHTIFICATION
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: Occupitney'I•ype:
and state laws relating to building construction,and hereby authorize 316 29 070 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
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatu��'� Date 7-13-2018 Issued by:Abby Avende
//
I hereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOF'S:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner of the property,or my employee with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do die work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z, 1,as owner o£the property,am exclusively contracting with licensed Signature of Applicant
convectors to construct the project(Sec.7044,Business&Professions Code). Data 7-13-2018
I hereby affirm under penalty of perjury one ol'the following three declarations;
i. I 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
a I have and will maintain Win ter'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 25534.1 will
permit is issued. nr aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I. I 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 hamt-dous
shall not employ any person in any m m
sas to become subject to the aterial.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California.If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,1 became subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertine Municipal Code,Chapter 9.12 and
Labor Code,I neat forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
Owner or authorized age
APPLICANT CERTIFICATION Date:7-13-2018
I certify that I have read this application and state that the above Information is C NSTRUCTION
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 7-13-2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
MAZZONI
CONSTRUCTION
PLEASANTON,CA
94588
OWNER'S NAME: SUN JASON TAI AND NOZAWA MIE DATE ISSUED• 12/14/2017
OWNER'S PHONE: PHONE NO:(925)236-0818
LICENSED CONT ACTOR'S DECT AR ATION BUILDING PERMIT INFO
License Class a Lic.#1004434
Contractor MAZZONI CONSTRUCTION Date 06/30/2019 2i BLDG ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH Y 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
1ST FLOOR ADDITION GUEST ROOM/KITCHEN(332 SF);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL BEDROOMS/BATHROOMS/KITCHEN/LIVING
1. I have and will maintain a certificate of consent to self-insure for Worker's RM/DINING RM(1950 SF);
a r ¢„�-- Compensation,as provided for by Section 3700 of the Labor Code,for the (N)ROOF COMP SHINGLE(1950 SF)
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. Sq.Ft Floor Area:332 Valuation:$150000.00
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 29 070 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
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue the against said City in consequence of the grhg othis WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Addit(onally,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.
Signae_w Date 12/14/2017 Issued by AbbyAyende
Date: 12/14/2017
OWNER-BUILDER 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 roofmg material being installed.If a roof is
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)
2. 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:12/14/2017
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
a. 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
material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the , the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
�,'��' ---
APPLICANT CERTIFICATION Date:12/14/2017 f, `
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 12/14/2017
LicenseProfessionald