15010132 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10117 LAMPLIGHTER SQ CONTRACTOR:JEMICO LLC DBA PERMIT NO: 15010132
RENEWAL BY ANDERSEN
OWNER'S NAME: DOBYNS JOHN F AND WYNNE M 30800 SANTANA ST DATE ISSUED:01/23/2015
OWNER'S PHONE: 4084464117 HAYWARD,CA 94544 PHONE NO:(510)263-3178
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE 5 WINDOWS LIKE FOR LIKE,TO
License Class C ' Lic.# �� 7 c MEET EGREES IN BEDROOMS
Contractor 1--614w 41 V NJ A-01krI&
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:$11682
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:34242005 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXP + ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHINS OF P RMIT 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 DAY F LAST ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, j
costs,and expenses which may accrue against said City in consequence of the Issued b
granting of this permit. Additionally,the applicant understands and will comply Y Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
n RE-ROOFS:
Signature Date i 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. 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 ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 550 ,25533, 5534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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
918.
Signature Date
V
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(ftuaerlino.otg
NEW CONSTRUCTION ❑ ADDrfiON fgA=Amown ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ' /h I'1 L O� 1,( APN B �)
OWNERNAME )�+ PHONE E-MA& C/
STREET ADDRESSCrfY,STATE,ZIP FAX
h-7 (1 rr.r S t. C� ✓�1Ma (A 45"14
CONTACT NAME �` C/ PHONESI'o 2 E 3 3 '7 e� B-MAII,
• STREET ADDRESS r 0 FAX
G1/� CITY,STATE,ZIP r t G J y�J
s �) I
M OWNER ❑OWNER
-SU1LDER 13 OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENr 12 Axct=CT 13ENGINEER [3DEVELOPER ❑TENANT
CONTRACTOR NA:'"- +lam O3l nr�'� iCBNSE NUMBER LICENSETYPE ` BUS.LI jq q
COMPANY NAME?-,-y 1, &TWT, C E-MAIL,
AI `'I l FAX cb)U. vs` " 7
STREET ADDRESS V Y,SFATB,ZIP O rK PHONE
ARCHITECT/ENGMEER NAME LICENSE NUMBER BUS.LIC 0 '
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKVr
I_CP /
(90 M 5 b U
EXISTING USE PROPOSED USE CONSTR.TYPE I ASTORIES
U36 TYPE UCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEO TOTAL
AREA AREA AREA NETAREA
BATHROOM FUTCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREAA: DETACH
ATTACH
U DWELLING UNns IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE.APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED TOT VALUATION:
PLANNING APPL A [3 NO PLANNING APPIWVAL LEITER EICHLER HOME? ❑NO
r
By my signature below,I certify to each of the followiDg: I am the property owner or authorized agent to acfonN property owner's behalf. I have read this
application information I have provided is correct. I have read the Description of Work and verify it is aMrate. I agree to comply with all applicable local
ordinances and state laws relatin building constru�ct`ion.� authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: �V �' Cate;
SUPPLEMENTAL INFORMATION REQUIRID PLANCHECK ROUTINGSLIP
New SFD or Multifamily dwellings: Apply for demolition permit for THFrCOVNTER D]NaPLANREVIEW
existing building(S). Demolition permit is required prior to issuance of building,
permit for new building. ❑ ERPRE93 NG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD ElIC PUBLwoEES
Form if any Hazardous Materials are being used as part of this project, ❑ LARGE ❑ PIREDEPT
_Copy of Planning Approval.Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR NARY BErvEREzsTRtcr
❑
❑ ENVMOPOUNTAL HEALTH
BldgRpp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10117 DATE: 01/22/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$11,682
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE: A
WORK remove and replace 5 windows like for like to meet agrees in bedrooms
SCOPE
"MMU
:Luck t hwr h. Pkiir€hcc it
bt P .rrra
Fee: }'r: fir. Pefart
3t rc,. t pec°k,. F-10,
1he'*"h"",7rasrr. Ll oiheo,1 ic(c h:'sk:".
12110. Irzsp. [ee
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These _f
fiees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Window/Sliding Glass Door
Suppl. PC Fee: Reg. 0 OTJ
Rol hr's $0.00 $431.00 1WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee: Reg. 0 OT Fo,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? ® Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
,J,-£�tt'ei l>i`t,11Y1 c'.?1ttt7f'Y7 Fees. /
Strong Motion Fee: IBSEISMICR $1.52 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$2.52 $431.00 TOTAL FEE: $433.52
Revised: 01/06/2015
Project name: Dobyns,John
Renewal
10117 LamplighterSquare b'Andersen.
Cupertino Ca;,95014 Backyard/Rear Setback 19'
' WINOOM R tI.ClYCNT
. .
MAL
203 204 205
4
Bedroom 2 Master bed
jogs
Second floor
Setback Zero/ Setback 15' ,
common wall
COMMUNtTy
D LOPrStairs/hal 1NGpMSfOM
A EdTN RTIpPL®T +CTU
" �gIet of plans ands >fl
CHECKED. Job site during construction.� ��ons MUST be kept at the
chaps unlawful to make any
�' thejefr changes or alterations on same, or to deviate
ATE Street/Front Set ac
approval from the Building 1110 Mm in g Official.
p g of this plan andspecifications
Go h ;• �. SMALL NOT
- «� permit or to be an approval of the violation
nY City Ordinance or State Law.
PLANN-INC DEPT'
IPS
CU P1ERT1 ICU
Stair/hall way 201 GL-AP NF 461/2 451/8
Bed 1€ 202'_ GLmAP_NF 701/4 451/4
Bed 2€Office -- -203; GL-=-AP NF 701/8 335/8
Mstr Bed€ '204` GL-AP NF 701/8 335/8
MstrBed€ 205 GL-AP NF 345/8 335/8
fork: ; IJPERTIt�LC�►
S ailment.
r,, %iitg Dep
_`M� „OMPLIAW-E—,
NEL0 Y- a.•t
c7.E'VIE:weo Y �
b i
i7
A-
{
�1._ �
ra
F
{
S
I
kt