B-2018-0970 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0970
942 ROSE BLOSSOM DR CUPERTINO,CA 95014(359 06 027)1940 ROSE BLOSSOM PEDRO PIAO
DR CUPERTINO,CA 95014-4216(359 06 027) 1858 E SAN
FERNANDO SAN
JOSE,CA 95116
OWNER'S NAME: DATE ISSUED:09/17/2018
OWNER'S PHONE: PHONE NO:(408)687-7607
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#853051
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 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:
(N)SECONDARY DWELLING UNIT-(433 SF);REMODEL OTHER-
I hereby affirm under penalty of perjury one of the following two declarations: (126 SF);ADDITION OF(2)BEDROOMS-(308 SF);REMODEL(2)
1. I have and will maintain a certificate of consent to self-insure for Worker's BATHROOMS-(115 SF);REMODEL KITCHEN-( 112 SF);(1)NEW
Compensation,as provided for by Section 3700 of the Labor Code,for the PORCH-(56 SF);RE-ROOF-(18 SQ);REPLACE WINDOWS(4)TO
performance of the work for which this permit is issued. MEET EGRESS;REPLACE(1)PATIO DOOR;(36)NEW RECESSED
I have and will maintain Worker's Compensation Insurance,as provided for by LIGHTS;(30)PLUGS AND SWITCHES;(4)NEW SKYLIGHTS
Section 3700 of the Labor Code,for the performance of the work for which this REV#1-RELOCATE SHEAR WALL-ISSUED 11/5/18
permit is issued. REV#2-REPLACE/UPGRADE TO 200 AMP ELECTRIC METER-
APPLICANT CERTIFICATION ISSUED 06/13/2019 IV �^_
I certify that I have read this application and state that the above Sq.Ft Floor Area:741 Valuation:$143178.00
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 APN Number: Occupancy Type:
inspection purposes. (We)agree to save indemnify and keep harmless the 359 06 027 R-3(Custom)
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 regula. per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
- Date 06/13/2019 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by:Kim Dunbar
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:09/17/2018
following two reasons:
1. I,as owner of the property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
2. I,as owner of the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:06/13/2019
Compensation,as provided for by 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
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 HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Worker's Compensation laws of California. If,after making this certificate of Health&Safety Code,Section 25532(a)should I store or handle hazardous
exemption,I become subject to the Worker's Compensation provisions of the material. Additionally,should I use equipment or devices which emit hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code 'ons 25505,25533,and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is Owner or authorized
to enter upon the above mentioned property for inspection purposes. (We)agree I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City in Lender's Name
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 06/13/2019 1 understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0970
942 ROSE BLOSSOM DR CUPERTINO, CA 95014 (359 06 027)1940 ROSE BLOSSOM PEDRO PIAO
DR CUPERTINO, CA 95014-4216 (359 06 027) 1858 E SAN
FERNANDO SAN
JOSE,-CA 95116
OWNER'S NAME: DATE ISSUED: 09/17/2018
OWNER'S PHONE: PHONE NO: (408) 687-7607
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #85305
Contractor PEDRO PIAO Date 01/31/2019 X BLDG X ELECT — PLUMB
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:
(N) SECONDARY DWELLING UNIT - ( 433 SF); REMODEL OTHER -
I hereby affirm under penalty of perjury one of the following two declarations: (126 SF); ADDITION OF (2) BEDROOMS - ( 308 SF); REMODEL (2)
1. I have and will maintain a certificate of consent to self-insure for Worker's BATHROOMS - (115 SF); REMODEL KITCHEN - ( 112 SF); (1) NEW
Compensation, as provided for by Section 3700 of the Labor Code, for the PORCH - (56 SF); RE-ROOF - (18 SQ); REPLACE WINDOWS (4) TO
performance of the work for which this permit is issued. MEET EGRESS; REPLACE (1) PATIO DOOR; (3 6) NEW RECESSED
I have and will maintain Worker's Compensation Insurance, as provided for by LIGHTS 3 0 PLUG AND IT
( ) S SWITCHES; (4) NEW SKYLIGHTS
Section 3700 of the Labor Code, for the performance of the work for which this REV #1 - RELOCATE SHEAR WALL - ISSUED 11/5/18
permit is issued.
Sq. Ft Floor Area: 741 Valuation: $143178.00
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 359 06 027 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
Date 11/5/18
Issued by: Kim Dunbar
Date: 09/17/2018
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 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: 11/5/18
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 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 -Seo s 25505, 25533, and 25534.
z
be deemed revoked. --
Owner or authorized agen • ���----��
APPLICANT CERTIFICATION Date: 11/5/18
I certify that I have read this application and state that the above information is CONSTRUCTI N 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 11/5/18 Licensed
Professional