Loading...
14060120 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10145 SCENIC BLVD CONTRACTOR:JEMICO LLC DBA PERMIT NO: 14060120 RENEWAL BY ANDERSEN OWNER'S NAME: TI KNO&ERNIE HARJONO 30800 SANTANA ST DATE ISSUED:06/18/2014 OWNER'S PHONE: 4083912204 HAYWARD,CA 94544 PHONE NO:(510)263-3178 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL ❑ lip REMOVE AND REPLACE 11 WINDOWS LIKE FOR LIKE; License Class Cn Lic.# q _Z� TO MEET EGRESS IN BEDROOMS Contractor �— Date 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 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:$17500 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:35709076.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 Ds6i-RERMIT 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 OM L CALLED 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 Date: Issued by: 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. f RE-ROOFS: Signature Date D 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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. 1 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 the Health&Safety Code, ections 25505,25533,and 25534, Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: l `� 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 CONSTRUCTION LENDING AGENCY 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 9 18. Signature Date d� CONSTRUCTION PERMIT APPLICATION r 1U 0 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION � 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333-buildingAcuoertino.orcl ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS t�\, 1 AEN# f 0-7&.60-7v OWNERNAME � PHONE"6 1is - 3qt E-MAIL STREET ADDRESS CITY,STATE,ZIP cACq!f I FAX CONTACT NAME PHONE31"�Lb E MA�nLJS •G STREETADDRES CITY,STATE,ZD' FAX51D-�5(_� l� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT (X-CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITHCr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAM LICENSE NUMBER-t LICENSE TYPE Q"E p BUS.LIC k COMPANY NAME ` E-MAII, l FAX5t0 �1c. cv I STREET ADDRESS �' CTfY,STATE,ZIP �l q� -` PHOJ'0 t/ ARCHITECT/ENGINEER NAME J J (A LICENSE NUMBER '\ Gl BUS.cLICC# COMPANY NAME fiE-MAILE-MAI, FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK El� w-1nd0A'0:s ";�C>-e- l EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT.7 VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA I GARAGE AREA DETACH []ATTACH ATTACH 9 DWELLING UNITS! ISASECONDUNIr ❑YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? [:]NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL 9 ❑ NI NO PLANNING APPROVAL LETTER EICHLER HOME? [3 NO t_71 1 5C�L>. vc> By my signature below,l certify to each of the following: I am the property owner or authorized agent to a on the r wner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to lding constructi I authorize entatives of Cupertino to enter the above-identifiedproperty for inspection purposes. Signature of Applicant/Agent: Date: H SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTINGSLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 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 ❑ MAJOR ❑ SANITARY SEWERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10145 SCENIC DATE: 06/18/2014 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: 1$17,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 GENRE; WORK REMOVE AND REPLACE 11 WINDOWS; TO MEET EGRESS IN BEDROOMS SCOPE tr;c;h,f'itzrt Check I'?urrtl:.I'?cars�;,rcu: s c.plr,r> . c-cit.Pe rn?it Fee: E'fwnb. Pers b Fee: ,};fech.fns;J. Orhel'P1ffmb.T't:4`t3. oiher l;Iez'.Mlv, 1er:l=.Isr.t"z'�. <"cc; i anFi..trrs 3. t'r>rr; Tec:. trrsp. Flee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminar information available and are only an estimate. Contact the Dept./or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 11 # Window/Sliding Glass Door Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $557.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'on rrmlvion :lax. _F Acl<nin,,strevi,e.Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Building or Structure 0 Strong Motion Fee: IBSEISMICR $1.75 Select an Administrative Item Bldiz Stds Commission Fee: 1BCBSC 1 $1.00 $2.751 $5 59.75 Revised: 04/01/2014 t ' Proiect: Setback ° Name Ernie Horjono Address 10145 Scenic Blvd City Cupertino 0 F F C 0 PY Setback Setback 21X57 DB 16X57 PW 69X57 PW master bath D.{-', -I_0,7"0,ZNT DEPAP,7VEN-7 i" .Z+Lai + ib�SdCN -CUPERTINO APPROVE® %s Sat Cf pigs and specifications MUST be kept at the job sate dur ir�g construction. It is unlawful to make any changes or alteraticns on same, or to deviate therefrom, without app,oval from the Building Official, dining \ T-9 Stamping e.4, tis plan and specifications SHALL NOT bed be heid to par ;it or to be an approval of the violation cf a Iy provisions of any City Ordinance or State Law, 4�62.33X57 CS 33X57 CS 2—40X52 CS 40X52 CS "P VI{mac 2 2 UT NO. CUPERTINO Front/Street f ` t,tJlt�iF�L1,g1VC� KE'VI�a1ft f7 ay. Scope of work: �Qdlrsov►.� � C��v� (,il��-ems� � �. �� �' S t 2 S tl t o'Ys F.: r5 i 6 s s j N r �� 4 �3 y:',: �- {. .::'.