13120157 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10376 AMISTAD CT CONTRACTOR:JEMICO LLC DBA PERMIT NO:13120157
RENEWAL BY ANDERSEN
OWNER'S NAME: RAVIN CHECKER 30800 SANTANA ST DATE ISSUED: 12/19/2013
O ER'S PHONE: 4082532564 HAYWARD,CA 94544 PHONE NO:(510)263-3178
ICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
7 7a -7Q REPLACE 3(E)WINDOWS,LIKE FOR LIKE.WINDOWS
License Class Lic.# / WILL
fj, / MEET EGRESS&BE TEMPERED WHERE REQUIRED BY
Contractor I t/ `F= / 3 CODE
I hereby affirm that I am license 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:$5832
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 APN Number:34245014 00 Occupancy Type:
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 DAYS F T ALLED 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 Is Date: /2 I /
granting of this permit. Additionally,the applicant understands and will comply
with all non-
918.
on-918.
/ RE-ROOFS:
Signature ate ! 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-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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)
I,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,Ch ter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 05,25533,and 34. /Q
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:
permit is issued. J
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 RUCTION LENDING AGE CY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that re 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buiiding@cuDertino.o[g
❑NEW CONSTRUCTION ADDITION ALTERATION/TI ❑ REVISION I DEFERRED ORIGINAL PERMIT#
PROIECT ADDRESS +-q1 CA APN# Z 7 s o
l
OWNER NAME - � 7PHONE 408-
D8w w L -2�/ �f E-MAIL lJ
STREET ADDRESS 05-7
� CIt CITY,STATE,ZIP C�(
CONTACT NAME
1 "5101-t-53(76
HONESl° 1-633176 cllc�ik@cY.wN•d ac�a�c
STREET ADDRESS 3agod r FAX
ICITRZ�� Qft�`tY
❑OWNER ❑ OWNER-BUILDER ❑owNERAGENT MCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER-Q n 7�2 LICENSE TYPE �^ BUS.LIC#
COMPANY NAME E-MAIL
h ff ! FAX
STREET ADDRESS 4kC;A,Ls\_., CITY TATE, gYS�`1 PHONE r/u2-(? 1J/7,4
ARCHITECT/ENO ,v INEFR NAME A/ LICENSE NUMBER l HUS.LICJ#` 7
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NEPAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA DETACH
[]ATTACK
it DWELLING UNrTS: ISA SECOND uNrr [3 YES SECONDSTORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE TOTAL VALUATION:
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLERBOME? ❑
By my signature below,I certify to each of the following: I am the property owner or authoriz ent to ct on t property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verift it is pecurate. I agree to comply with all applicable local
ordinances and state laws relating t ilding cons ctio I authorize epr ntatives of Cupertino toe to a above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: � ��
SUPPLEMEN L INFORMATIM REQ PLAN CHECKTYPE ROUTING SLIP
_New SFD or Multifam' dwellings: Apply for demoliti permit for THE•COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Dem t'on permit is required prior to issuance of building
permit for new building. ❑ EXPRESS PLANNING PLANREVTEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD ❑ PUBLIC WORK$
Form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fm DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR El SANITARY$EWERDI$TRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10376 AMISTAD DATE: 12/19/2013 REVIEWED BY: MELISSA
APN: 342 45.014 BP#: *VALUATION: $5,832
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PENTAMATION 1GENRES
PRIMARY SFD or Duplex PERMIT TYPE:
USE:
wORK REPLACE 3 E WINDOWS LIKE FOR LIKE. WINDOWS WILL MEET EGRESS & BE TEMPERED
SCOPE WHERE REQUIRED BY CODE
Nfech.flan(,'heck. Plumb.flan Check Elec: Plan(.heck
Me&Pertssit Fee: Plumb.Permit Fee: Elec.Permit fee:
Other;Meeh.Insp, Other Plumb Insp. Other Elec.Insp.
Pluttab. fits Fee: Elec.Insp. Fee:
11ech,Insp..f'ee: 1
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These info.
ees are based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn'l
FEE ITEMS (Fee Resolution 11-053 E 7ff 11113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3 # Window/Sliding Glass Door
Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $418.00FiiiiEj
Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Supp/. Insp.Fee-.0 Reg. 0 OT 0,0 hrs $0.00
T=PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conslr-ttction Tax:
rlcltninh,arative.Fee:
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
Travel Docutnentation Fees: �
Strong Motion Feer IBSEISMICR $0.58 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
µa40 n $1.58 $418.00 - 'Td AEE: $419.58
Revised: 10/01/2013
Proiect:
Ravin Checker
10376 Amistad Ct 48x48 XO
Cupertino 72x48 XO slider Slider
(Egress)
M.Bath
M.BedRoom
Bath
38x18 XO
Slider
2nd Floor
I Swim 7--
'PILOT
PLOT PLANS a Ca �
CHECKED BY 1 O C 01 CVS
UAWR -� 3
$L DEPT,
DATE
p r^
Fit,9Ef:, Dir Front Street
s �tti ,Tr
c^fi.Of n'2lS an � )
= This r � _
job
CE Co
�• W,7l%0;,52." t }j
Scope of work:
o. _
Replace 3 windows like for like
BY
DEC 19 2013 pa ,,°tT No.