B-2018-0551 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0551
PEDRO PIAO
1858 E SAN
FERNANDO SAN
JOSE,CA 95116
OWNER'S NAME:Piao Julie Et AI DATE ISSUED:06/08/2018
OWNER'S PHONE: PHONE NO:(408)687-7607
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lie.#853061
Contractor PEDRO PIAO Date 01/31/2019 X BLDG x ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing x MECH$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:
ADDITION TO LIVING ROOM,MASTER BEDROOM;KITCHEN AND
I hereby affirm under penalty of perjury one of the following two declarations: FAMILY ROOM(688 S.F.);(N)ATTACHED 2ND UNIT(255 S.F.);
1. I have and will maintain a certificate of consent to self-inure for Worker's REMODEL(70 ST.);PANEL UPGRADE(200 AMPS);(N)
C Compensation,as provided for by Section 3700 of the Labor Code,for the CONDENSER;REROOF;TEAR OFF;INSTALL CDX;COMP
performance of the work for which this permit is issued. SHINGLES(31.35 SQ)
z. I have and will maintain Worker's Compensation Insurance,as provided for by REV#1-REVISE SCOPE OF WORK:ADDITION TO LIVING ROOM,
Section 3700 of the Labor Code,for the performance of the work for which this MASTER BEDROOM;KITCHEN AND FAMILY ROOM(688 S.F.);
permit is issued. ADDITION OF BEDROOM(255 S.F.);REMODEL(70 S.F.);PANEL
APPLICANT CERTIFICATION UPGRADE(200 AMPS);(N)CONDENSER;REROOF;TEAR OFF;
I certify that I have read this application and state that the above INSTALL CDX;COMP SHINGLES(31.35 SQ)-ISSUED 7/26/18
Information Is correct.I agree to comply with all city and county ordinances Sq.Ft Floor Area:689 Valuation:$256440.00
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 andkeep harmless the APN Number: Occupancy
City of Cupertino against liabilities,judgments,costs,and expenses which P y Type'
may accrue against said City In consequence of the granting of this permit. 36928 032 R-3(Custom)
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signal Date 07/26/1WITHIN 180 DAYS OF PERMIT ISSUANCE OR
8
180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:E int Dunbar
following two reasons: Date:06/08/2018
1. I,as owner of the property,or my employees with wages as thew sole
compensation,will do the work,and the structure is not intended or offered for RE-ROOFS:
sale(Sce.7044,Business&Professions Cade) All roofs shall be inspected prior to any roofing material being installed.If a roof is
z. I,as owner of the property,am exclusively contracting with licensed installed without fust 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. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicrm
Compensation,as provided for by Section 3700 of the Labor Code,for the Date:07/26/18
performance of the work for which this permit is issued.
z. 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
a. I certify that in the performance of the work for which this permit 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 25534.1 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 with the Cupertino Municipal Code,Chapter 9.12 and
APPLICANT CERTIFICATION the Health&.Safety C le,Sections 25505,25533,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 Owner or authorized agent
relating to building construction,and hereby authorize representatives of this city Date:07/26/18
to enter upon the above mentioned property for inspection purposes. (We)agree CONST G G E NCY
to save indemnify and keep harmless the City of Cupertino against liabilities, hereby affirm that there Is a construction lend
judgments,costs,and expenses which may accrue against said City In agency for the performance
of work's for which this permit Is issued(Sec.[ending ding 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 01J26LJ8 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0551
10426 LAS ONDAS WAY CUPERTINO,CA 95014-3130(369 28 032) PO WFUL
CONSTRUCTION
SAN JOSE,CA 95116
OWNER'S NAME:PIAO JULIE ETAL DATE ISSUED:06/08/2018
OWNER'S PHONE: PHONE NO;(408)687.7607
LICENSED T DECLARATION BUILDING PERMIT INFO:
License Class E Lic.11853051
Contractor POWFUL CONSTRUCTION Date 0113112019 2J BLDG XELECT_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:
ADDITION TO LIVING ROOM,MASTER BEDROOM;KITCHEN AND
I hereby affirm under penalty of perjury one of the following two declarations: FAMILY ROOM(688 S.F.);(N)ATTACHED 2ND UNIT(255 ST);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL(70 ST.);PANEL UPGRADE(200 AMPS);(N)
Compensation,as provided for by Section 3700 of the Labor Code,for the CONDENSER;REROOF;TEAR OFF;INSTALL CDX;COMP
1 have and will maintain Worker's Compensation Insurance,as In for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:943 Valuation:5256440.00
APPf.I('ANT 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 369 28 032 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,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.
Signatur --'� Date 0 610 012 01 8 Issued by:Kim Dunbar
Date:06/08/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following hvo reasons: All roofs shall be inspected prior to any roofing material being installed,If a roof'is
L 1,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(See,7044,Business&Professions Code)
1. 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:06/08/2018
I hereby affirm under penalty of perjury one of the fallowing threedeclarations:
s. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BE'T'TER
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. 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 ufthe Labor Code,for the performance of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,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 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 Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent cj
APPLICANT CERTIFICATION Date:06/08/2018
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 DF,CLAR_ATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06/08/2018
Professional