14010064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10344 DEMPSTER AVE CONTRACTOR:JEMICO LLC DBA PERMIT NO: 14010064
RENEWAL BY ANDERSEN
OWNER'S NAME: NYGAARD JON O AND MAXINE N 30800 SANTANA ST DATE ISSUED:01/09/2014
OWNER'S PHONE: 4084662062 HAYWARD,CA 94544 PHONE NO:(510)263-3178
4 LICENSED CONTRACTOR'S DECLARATION f— F 7
I`I BUILDING PERMIT INFO• BLDG ELECT PLUMB
License Class�� 1 1 Lic.# � �.'. r I" F
,,,, MECH RESIDENTIAL COMMERCIAL
ContractorW*T Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION.REPLACE 14(E)WINDOWS&2(E)SLIDING GLASS
(commencing with Section 7000)of Division 3 of the Business&Professions DOORS,LIKE FOR LIKE&SAME LOCATIONS(WILL MEET
Code and that my license is in full force and effect. EGRESS&TEMPERED WHERE REQUIRED BY CODE)
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.
1 h ve and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$35612
permit is issued.
APPLICANT CERTIFICATION APN Number:32647075 00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS O IT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 1 CALLED INSPECTION.
with all non-point source regulation er the Cu rtino Municipal Code,Section
918. q/
Issued by: Date:
Signature �, ate
❑ OWNER-BUILDER DE LARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(See.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9A2 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's health&Safety Code,Sections 25505,25533,and 25534.
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 Ow er or ar th rize
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION C STRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATION Q
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINa (408)777-3228•FAX(408)777-3333-buildinq@cupettino.ora \
❑NEW CONSTRUCTION ADDITION ❑ALTERATION I TI ❑ REVISION 1 DEF-EF RED ORIGINAL PERMIT#/
PROJECT ADDRESS 163
a3
I�M I" JTtj!✓ AV� APN# 3 'L C
OWNERNAME -�Y PHONE 0? �(IJ7'6 �E-MAIL
STREET ADDRESS I c?-5y STATE.ZIP 0 �FAX
CONTACT NAME u rtno 'f1
! J
1n� f
PHONE E MA I�,Q Y'Cl'►C WOI�
o
a
• STREET ADDRESS -4mum ,STATE,ZIP �y&ju FAX O � � S3q
❑OWNER ❑ OWNER-BUILDER
11 OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑1TTENANT
CONTRACTOR NAME LIC 3E'UMBER LI ENSE TYP BUS.LIC#
7
COMPANY NAME e�,5e EMAIL `J Oy j 1 �1 ��•� h 8Cv NFA�x '516 7451
STREET ADDRESS Nn �� STATE,ZIP �Jlr'GtI�VN PHONE L/O
ARCHITECT/ENGINEERNAME r!�" LICENSE `1 BUS.LIC_NJ` '
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKYe
, t j ^' ,C jl �/� �y I'y-� )^ C
w v -for/ I1k-,a. I (t.a
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODELARBA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DDCK/PORCH AREA GARAGE AREA DETACH
❑ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑YES SECONDSTORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF I3 THE BLDG AN ❑YES E TOTAL V ALUA
❑ TION: O
PLANNING APPLN LjNO PLANNING APPROVALLEITER EICHLERHOME? NO
By my signature below,I certify to each of the following: I am the property owner or uthorized agent to roperty owner's behalf. I have read this
application and-the information I have provided is correct. I have; the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to'bu construction. I aut riz re es matives pertino to enter the above-i entified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT FORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP
_New SFD or Multifami ellings: Apply for demolition permi for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demol ion permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
11 MAJOR 1:1 SANITARY SEWERDrsTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10344 DEMPSTER AVE DATE: 01/09/2014 REVIEWED BY: MELISSA
APN: 326 47 075 BP#: *VALUATION: 1$35,612 —�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: I PERMIT TYPE:
WORK REPLACE 14 E WINDOWS &2 E SLIDING GLASS DOORS LIKE FOR LIKE & SAME
SCOPE LOCATIONS (WILL MEET EGRESS &TEMPERED WHERE REQUIRED BY CODE)
aI hiu5 ,
Xfedi Plan Check Plulub. Plan Check Elec.Plan(.;heck
L1ech.Pc,>rntil Fee: Plumb.Permit Fey- Elec. Permit Fee:
01hcer;11ech. Insp. Other Plumb Insp. ELI-L- Other h.lec.Insp. Lj
Heck Insp,Fee: Plump.hap.Fee: Eley.Insp, Fee:
NOTE:This estimate does not include fees due to other Departments(1.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are only an estimate Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution]. E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F16 # Window/Sliding Glass Door
Suppl.PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $557.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ®OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction.Tax:
elrninistr ative.Fee: 0
Work Without Permit? ®Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Trcrved Documentation Fi Building or Structure
Strong Motion Fee: IBSEISMICR $3.56 Select an Administrative Item
Bldg._Stds Commission.Fee: 1BCBSC $2.00
c a ,
$5,56 $557.0011MINW $562.561101,
Revised: 01/01/2014
PROJECT NAME: Jon Nygaard. Rear elevation/Backyard Setback 25'
''
10344 Dempster Ave 21x42/46x42/21x42
Cupertino, Ca, 96x80 96x80 CSMT/Fixed/CSMT 69x45
Glass Door Glass Do XO Slider
Living nook kit dining
1st Floor
69X45
XO SliderJT C3FP �-'"SNT
Egress bed 3
J+ c-Nr CUP4my Set back 10'
ED ept at the
f33x. Ja o4 ►iy
t` r to
-n or � icia4. y
•_; XC�4��IQ�sr�;�^c4t1t3t�..t � ��il�t
a Jal'1rom rho
Garage iL;ioat app HAII NOT p
��ificatiai t f, t (
inn a.rd "ec i P violation l
Set back 10' ,;� of this rovai of t,�� --
Ji h �ta�a Law.
q t?f nYt ar to ,t r' a[1C6 or
�F�lr r,;1clnQ SRT//v pIj
,fit � nt
t�evation Fr and 25'
r, N :
%
� )j COMP 9X33 XO Slider E e
69X33 fid�r Egress ��
bed 1 bed 2
2nd floor stairs 22X11 '
Fixed
master bath bath
p
3 x21 JAN 0 9 2014
egress der (�
40X34 40X35 34X34
CSMT CSMT CSMT
Egress Egress
Scope of Work: Replace; �,J cVNOkQ [ ti
u
S f (,