14010162CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7736 OBSIDIAN CT
CONTRACTOR: JEMICO LLC DBA
PERMIT NO: 14010162
RENEWAL BY ANDERSEN
OWNER'S NAME:
HAYWARD, CA 94544
PHONE NO: (510) 263-3178
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
REPLACE 2 (E) WINDOWS & 1 (E) SLIDING GLASS DOORS,
(�
License Class + G 1 Lic. # r� 7��0j `1
LIKE FOR LIKE, 1ST STORY ONLY
/
Contractor �l �5lmate � `� 0 / t/I
I hereby affirm that I am lice ed 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 penalty of perjury one of the following two 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.
Sq. Ft Floor Area:
Valuation: $13815
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36218025 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA NPBLYCALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ate: / 3
granting of this permit. Additionall , e applic nderstands and will com
s
with all non -point source
✓ (
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER-BUIL +RDsCLARATION
Signature of Applicant: Date:
I here affirm that I am exempt from the Contractor's License Law for one of
the lowing two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Labor Code, for the of the work for which this
the Health & Safety Code,
.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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making -this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
918.
Signature Date
�y
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W3
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j CITY OF CUPERTINO
1 ' FSI
IOV117 FCTTMATnR _ RITII,DINC DIVIRION
La,ADDRESS:
7736 OBSIDIAN CT
DATE: 01/30/2014
REVIEWED BY: MELISSA
APN: 362 18 025
BP#:
*VALUATION:
1$13,815
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or DuplexPENTAMATION
0.0
1GENRES
PERMIT TYPE:
USE:
PME Plan Check:
WORK
REPLACE 2 E WINDOWS & 1 E SLIDING GLASS DOORS LIKE FOR LIKE 1ST FLOOR ONLY
SCOPE
$0.00
:L1ech. Plan Check Plumb. Plan Check Elec. Plan Check
lylcch. Permit Fee: Plumb. Permit Fee: Elec. Permit Ice:
Ocher ,Wech. Insp. Other Plumb Imp. Li Other Elec. Insp. F-1
Alfech. Insp. Fee: Plumb. Insl). Fee: Elec, Insp. Fee:
NOTE: This estimate does not include -fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc These ees are based on the relimina information available and are only an estimate. contact the ue r or aaan t in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$418.00
Window / Sliding Glass Door
I WINREP Replacement
Suppl. PC Fee: 0 Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. ® OT
p,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ta —VIP
:L1ech. Plan Check Plumb. Plan Check Elec. Plan Check
lylcch. Permit Fee: Plumb. Permit Fee: Elec. Permit Ice:
Ocher ,Wech. Insp. Other Plumb Imp. Li Other Elec. Insp. F-1
Alfech. Insp. Fee: Plumb. Insl). Fee: Elec, Insp. Fee:
NOTE: This estimate does not include -fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc These ees are based on the relimina information available and are only an estimate. contact the ue r or aaan t in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$418.00
Window / Sliding Glass Door
I WINREP Replacement
Suppl. PC Fee: 0 Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. ® OT
p,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adlrnlnlstrative Fee:
1
E)
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$1.38
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$2.38
$418.00
= FE
$420.38
Revised: 01/15/2014