B-2017-1485 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1485
10404 MELISSA CT CUPERTINO,CA 95014-2620(342 45 020) RICHARD HARO
SAN JOSE,CA 95148
OWNER'S NAME: DATE ISSUED:06/21/2018
OWNER'S PHONE: PHONE NO:(408)532-1755
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.# 04 79
Contractor RICHARD HARD Date 03/31/2019 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:
ADDITION-(1110 SF);REMODEL KITCHEN(140 SF);REMODEL(2)
I her by affirm under penalty of perjury one of the following two declarations: BATHROOMS(212 SF);REMODEL OTHER(842 SF);UPGRADE
I have and will maintain Workers Compensation Insurance,as provided for by REV#1-REMOVE FRONT PORCH FROM SCOPE OF WORK-ISSUED
Section 3700 of the Labor Code for theh f erforman e
p c o the work for which this 12/18/2018
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area: 1110 Valuation:$400000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 45 020 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 Cupertinoagains liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue again t sai, City in consequence of the granting of this permit.
Additionally,thea plic t understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulatio per he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM O LAST CALLED INSPECTION.
Signature Date 5/24/19 Issued by:Jasmine Archbold
OWNER-BUILDER D CLARATION Date:06/21/2018
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:5/24/19
I hereby affirm under penalty of perjury one of the following three declarations.-
1.
eclarations: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 Munici al 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)shou 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 me or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay reaiir Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cu rtino`Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code, "ctio 5505,25533,and 25534.
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/24/19 /`
I certify that I have read this application and state that the above information is CONSTRUCTION LEXDI2sqG AGENCY
correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructio nding agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued ec.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 /25 4/19 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1485
10404 MELISSA CT CUPERTINO, CA 95014-2620 (342 45 020) RICHARD HARO
SAN JOSE, CA 95148
OWNER'S NAME: DATE ISSUED: 06/21/2018
OWNER'S PHONE: PHONE NO: (408) 532-1.755
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #704179
Contractor RICHARD HARO Date 03/31/2019
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:
ADDITION - (1110 SF); REMODEL KITCHEN (140 SF); REMODEL (2)
I hereby affirm under penalty of perjury.one of the following two declarations: BATHROOMS (212 SF); REMODEL OTHER (842 SF); UPGRADE
1. I have and will maintain a certificate of consent to self-insure for Worker's PANEL (200 AMPS); REROOF (392 SF); FIRE SPRINKLER BLDG
Compensation, as provided for by Section 3700 of the Labor Code, For the REV#1- REMOVE FRONT PORCH FROM SCOPE OF WORK- ISSUED
performance of the work for which this permit is issued. 12/18/201.8
I have and will maintain Workers 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: 1110 Valuation: $400000.00
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 342 45 020 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.
,'1p
Date 12/18/2018 Issued by: Jasmine Archbold
_.._.
Date: 06/21/2018
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)
i. 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: 12/18/2018
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
3. 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 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, Owner or aut rized
APPLICANT CERTIFICATION Date: 12/18/2018 ----
1 certify that I have read this application and state that the above information is CONSTRUCTION LE IN GENCY
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 works 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 12/18/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1485
10404 MELISSA CT CUPERTINO,CA 95014-2620(342 45 020) RICHARD HARO
SAN JOSE,CA 95148
OWNER'S NAME: DATE ISSUED:0621/2018
OWNER'S PHONE: PHONE NO:(408)532-1755
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#704179 X BLDG X ELECT—PLUMB
ffrMECH X RESIDENTIAL COMMERCIAL
Contractor RICHARD HARD Date 03/31/2019 —
I hereby n
m that I am licensed under the provisions of Chapter 9(commencing — — —
with Section 7000)of Division 3 ofthe Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ADDITION-(I 110 SF);REMODEL KITCHEN(140 SF);REMODEL(2)
I hereby affirm under penalty of perjury one ofthe following two declarations: BATHROOMS(212 SF);REMODEL OTHER(842 SF);UPGRADE
Opfhave and will maintain a certificate of consent to self-insure for Worker's PANEL(200 AMPS);REROOF(392 SF);FIRE SPRINKLER BLDG
ompensation,as provided for by Section 3700 a£the Labor Code,far the
erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
action 3700 of the Labor Code,far the performance of the work for which this
ermit is issued. Sq.Ft Floor Area:1110 Valuation:$400000.00
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 slate laws relating to building construction,and hereby authorize 34245 020 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=,DE
Iiahilitles,judgments,costs,and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED
ons�uence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
s d a d will comply with all non-point
rain n !pal Code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Data 06/21/2018 Issued by:Jasmine Archbold
Date:06/21/2018
OWN �BIJ
I hereby affirm that I am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.II'a rootis
s. I,as owner of the property,or my employees with wages as their sole installed without first obtaining no inspection,Iagree to remove all new materials I'ar
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Cade)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code). Date:06/21/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
s. 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. 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 ofthe 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 ofthe work for which this permit is issued,I Health&Safely Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in avy manner so as to become subject to the material.Additionally,should[ se aqui rento •ylces which omit hazardous
ab•conta at ants as defined b tr@amlil nagement District l
Worker's Compensation laws of California.If,after making this certificate of will nrafi tai.compliance query unl ipnl hap[er 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health& ad
if OS 25 33, 534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized
APPLICANT CERTITTC TION Data::06 018
I certify that I have read this application and state thatthe above information is II T. Y
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 properly 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 ARCIHTECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06121/2018 professional