BLD-2025-0212_SignedPermit.pdfCITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS:20970 PEPPER TREE LN APN: 359 13 045
PERMIT NO: BLD-2025-0212
OWNER'S NAME: NGUYEN SHALT MYHANH AND HARRINGTON DYLAN C
OWNER'S PHONE:408-750-7096
CONTRACTOR: HILLS CONSTRUCTION INC
CONTRACTOR PHONE:
DATE ISSUED: Sep 24, 2025 ISSUED BY: Jasmine Archbold VALUATION: 1079142
JOB DESCRIPTION: 1ST FLOOR FRONT ADDITION (496 SF); 1ST FLOOR REAR ADDITION (384 SF); 1ST FLOOR REMODEL (895 SF) - NEW FLAT ROOF OVER GARAGE,
GUESTROOM REMODEL, NEW VAULTED CEILING IN LIVING ROOM WITH NEW WINDOWS; BATH 3 REMODEL (48 SF) - FOUNDATION WORK,
POCKET DOOR FOR ADJACENT NEW LAUNDRY CLOSET; NEW FRONT DOOR; NEW ATRIUM; NEW DRIVEWAY; NEW SIDING; NEW FRONT WOOD
TRELLIS OVER DRIVEWAY; NEW LEFT SIDE YARD FENCE AND GATE; NEW TILED WALL IN BACKYARD; NEW OUTDOOR SHOWER; LANDSCAPE
IMPROVEMENTS; LEGALIZE TANKLESS WATER HEATER; LEGALIZE HEAT PUMP AC UNIT IN RIGHT SIDE YARD; FIRE SPRINKLERS REQ'D.
LICENSED CONTRACTOR'S DECLARATION:
NO: 835064 EXP DATE: 03/31/2026
7000) of Division 3 of the Business & Professions
CONTRACTOR: HILLS CONSTRUCTION INC LICENSED CLASS: B GENERAL LICENSED
BUILDING
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section
Code and that my license is in full force and effect.
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury one of the following three declarations:
❑ I have and will maintain a certificate of consent to self -insure for Worker's Compensation,
Labor Code, for the performance of the work for which this permit is issued.
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
✓ I have and will maintain Worker's Compensation Insurance, as provided for by
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
become subject to the Worker's Compensation laws of California. If, after making
the Worker's Compensation provisions of the Labor Code, I must forthwith comply
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
V I have read the hazardous materials requirements under Chapter 6.95 of the California Health
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
No: NAT-108187-2
V An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Hills Construction Inc. Firm Certification
❑ No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
(Section AV7, Civil Code).
Yes ✓❑1 No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
2025
I certify that I have read this application and state that the above information is correct. I agree to comply
laws relating to building construction, and hereby authorize representatives of this city to enter upon
purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
accrue against said City in consequence of the granting of this permit. Additionally, the applicant
source regulations per the Cupertino Municipal Code, Section 9.18.
1-aSep 24,
Signature Date
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 OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.