B-2018-0888PRIVACY PROTECTIONPLANTING AFFIDAVIT
Community Development Department
10300 Torre Avenue (408) 777-3308 / Fax (408) 777-3333
Cupertino, CA 95014 planning@cupertino.org
E'RV 9 http: / /www.cupertino.org/ planning
77,77
Purpose: To assure the decision -makers and neighbors that the privacy protection
planting has been installed' according to the planting plan.
Validation: An Internationally Certified Arborst or Licensed Landscape Architect
shall certify the design and accuracy of the privacy protection planting by signing this
form which is to be scanned or attached to a reduced 11x17 copy of the approved
planting plan. Submittal of this form shall be required prior to final inspection of the
residence. Failure to comply with these requirements may result in the delay of a
final inspection.
Planting Certification:
l -certif that the privacy protection planting and irrigations is installed ate
?1 e
r
address
and is consistent in design, height, and location with the landscape planting and
irrigation plans drawn by CA-1 A -�'j
dated (attached).
Name:
w
Title: �"
Professional License # : C,
Date: Q
Si ature:�
(Ord. 1868, (part), 2001; Ord. 1860, § 1 (part), 2000; Ord. 1834, (part), 1999)
revised 6116
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0888
10750 BROOKWELL DR CUPERTINO, CA 95014-4609 (369 21 038)
PEDRO PIAO
1858 E SAN
FERNANDO SAN
JOSE, CA 95116
OWNER'S NAME:
DATE ISSUED: 09/05/2018
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING P RMIT INFO-
License Class B Lic. #853051
Contractor PEDRO PIAO Date 01/31/2019
X BLDG X ELECT _ PLUMB
—
X MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
ADDITION (339 SF) OF (N) FRONT ENTRY, FRONT LIVING ROOM,
I hereby affirm under penalty of perjury one of the following two declarations:
AND FAMILY ROOM; REMODEL KITCHEN ( 189 SF); REMODEL (3)
t. I have and will maintain a certificate of consent to self-insure for Worker's
BATHROOMS ( 168 SF); REMODEL OTHER- SECOND FLOOR (607
Compensation, as provided for by Section 3700 of the Labor Code, for the
SF);
performance of the work for which this permit is issued.
(N) UPGRADE PANEL (200 AMPS); (N) AC UNIT
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
Sq. Ft Floor Area:
Valuation: $200000.00
permit is issued.
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
369 21 038
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.
Sigto Date 9-5-2018
Issued by: Kim Dunbar
Date: 09/05/2018
OWN - UILDER 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 roofing material being installed. If a roof is
t. 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)
z. 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: 9-5-2018
I hereby affirm under penalty of perjury one of the following'three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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
z. 1 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
3. 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
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 Code, I must forthwith comply with such provisions or this permit shall
-_
be deemed revoked.
Owner or authorized a ent:
APPLICANT CERTIFICATION
Date: 9-5-2018
I certify that I have read this application and state that the above information is
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.
1 understand my plans shall be used as public records.
Signature Date 9-5-2018
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0888
10750 BROOKWELL DR CUPERTINO,CA 95014-4609(369 21 038) PEDRO PIAO
1858 E SAN
95116
OWNER'S NAME: LAI JAMES S AND LI RUSTEE DATE ISSUED:09/05/2018
OWNER'S PHONE:408-893-0019 PHONE NO:(408)687-7607
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#853051
Contractor PEDRO PIAO Date 01/31/2019 X BLDG X ELECT _PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
ADDITION(339 SF)OF(N)FRONT ENTRY,FRONT LIVING ROOM,
I hereby affirm under penalty of perjury one of the following two declarations: AND FAMILY ROOM;REMODEL KITCHEN(189 SF);REMODEL(3)
1. I have and will maintain a certificate of consent to self-insure for Worker's BATHROOMS(168 SF);REMODEL OTHER-SECOND FLOOR(607
, Compensation,as provided for by Section 3700 of the Labor Code,fo the SF);
/performance of the work for which this permit is issued. (N)UPGRADE PANEL(200 AMPS);(N)AC UNIT
2.,/ I have and will maintain Worker's Compensation Insurance,as provided for by. DEF#1=STAIRCASE HANDRAIL AND GUARDRAIL-ISSUED
Section 3700 of the Labor Code,for the performance of the work for which this 02/27/2019
permit is issued.
Sq.Ft Floor Area: Valuation:$200000.00
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 369 21 038 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 THIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. .. 180 DAYS FROM LAST CALLED INSPECTION.
Signatu-e Fat- 02/27/2019 Issued by:Kim Dunbar
Date:09/05/2018
OWNER-BUILDER DECLARATIOIS
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
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:02/27/2019
I hereby affirm under penalty of perjury one of 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
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
3. 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
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
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,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Co ctions 25505,25533,and 25534.
be deemed revoked.
Owner or authorized age t:
APPLICANT CERTIFICATION \ Date:02/27/201
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 02/27/2019 Licensed
Professional