B-2018-0382 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0382
10394 COLBY AVE CUPERTINO,CA 95014-2401(316 29 04 1) PETER
CONSTRUCTION
SUNNYVALE,CA
94089
OWNER'S NAME: DATE ISSUED:03/15/2019
OWNER'S PHONE: PHONE NO:(408)529-2787
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#87AB8Z
Contractor PETER CONSTRUCTION Date 03/31/2020 X BLDG _ELECT _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:
(N)SIDE KITCHEN ADDITION AND REAR BEDROOM ADDITION
I hereby affirm under penalty of perjury one of the following two declarations: (515 SF);(N)FRONT PORCH(32 SF);REMODEL OTHER(1,406 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL BATHROOMS(98 SF);FULLY SPRINKLER BLDG;(N)
Compensation,as provided for by Section 3700 of the Labor Code,for the FURANCE;(N)A/C;POOL TO BE INFILLED;RE-ROOF(1,173 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:515 Valuation:$180000.00
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 16 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 316 29 041 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 Musical Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
-�-' Date 3/ 5 19 Issued by:Haley M, cKee
Date:03/15/2019
OWNER-BIALDER DECLARAhION
I
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:3/15/19
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(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& 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ' `
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION
Date:3/15/19
I certify that I have read this application and state that the above information is CONSTRUC2 ION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a donstruction 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. I understand my plans shall be used as public records.
Signature Date 3/15/19 Licensed
Professional
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS:
10394 COLBY AVE CUPERTINO, CA 95014-2401 CUPERTINO APN: 316 29 041 PERMIT NO: B-2018-0382
OWNER'S NAME: Not provided OWNER'S PHONE: Not Provided
CONTRACTOR:
PETER CONSTRUCTION, 690 E PERSIAN DR #3 SUNNYVALE CONTRACTOR PHONE:
DATE ISSUED 12/11/2019 12:20:24 PM ISSUED BY: HALEYM VALUATION: $180000
JOB DESCRIPTION
(N) SIDE KITCHEN ADDITION AND REAR BEDROOM ADDITION (515 SF); (N) FRONT PORCH (32 SF); REMODEL OTHER (1,406 SF); REMODEL BATHROOMS (98 SF); FULLY SPRINKLER BLDG;
(N) FURNACE; (N) A/C; POOL TO BE INFILLED; RE-ROOF (1,173 SF) REV#1 - HEADER CALCULATION CHANGES - ISSUED 12/11/19 REV#2 - MOVE ELECTRICAL PANEL; UPDATE LAYOUT
LICENSED CONTRACTOR DECLARATION
CONTRACTOR:
PETER CONSTRUCTION
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR, C33 PAINTING AND DECORATING, C39 ROOFING
LICENSED NO:
874887
EXP DATE:
03/31/2020
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.
I hereby affirm under penatly of perjury one of the following three declarations:
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.
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.
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534.
An EPA Lead-Safe Certified Renovator will be responsible for this project.
Certified Firm Name:
No EPA Lead-Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes No
Lender's Name:
APPLICATION 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 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 and keep
harmless the City of Cupertino against liabilities, judgements, 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 regulations per the Cupertino Municipal Code, Section 9.18.
Signature:
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
Firm Certification No:
Lender's Address:
of 365 days after the time the work is commenced.