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15030182CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1007 SEPTEMBER DR CONTRACTOR: JEMICO LLC DBA PERMIT NO: 15030182 RENEWAL BY ANDERSEN OWNER'S NAME: HAYWARD, CA 94544 PHONE NO: (510) 263-3178 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL p LICENSED CONTRACTOR'S DECLARATION REPLACE 6 (E) WINDOWS, LIKE FOR LIKE. (WILL MEET I EGRESS & BE TEMPERED WHERE REQUIRED BY CODE) License Class Lic. # t_ 1-7 Contractor Date I hereby affirm that I am license nder 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 C mpensation, as provided for by Section 3700 of the Labor Code, for the onnance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $15881 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36215016.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work fpr 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 WITIIIN 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 FROM ED 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 ill I granting of this permit. Additionally, the applicant understands and will com with all non -point Municipal Code, Section 9 18. �j Date " � RE -ROOFS: be inspected to any roofing material being installed. If a roof is Signature All roofs shall prior 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 1, 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, pter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sections 25505, 255 and 25 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 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 CITY OF CUPERTINO Ti Ti Ti Ti CTTM A TnR _ RTTTT .11INf DIVISION Wa� JI, Plan Check 7!!!,!777 Elco t'lan C her;kMeeh. Permit F'ee; PcrmtJ he<;: I lec. Per"zit Fee, Other.i,kch. Irap 01hef� Llec. Imp. Li1$ecla. hasp. dee: I�lec. lila. tee: NOTE: This estimate does not include fees due to other uepartmems (r.e. r/anning, runuc rrurna, rsre, oure-u.y .,crvc• �•�•• ��••��• _ z _ _.• _ .•_ _ _ a:...a_,.� ..t .. ..A.,..... ..:1..67., and nrn nnhr n» octimnta_ Cnntart the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711/132 ADDRESS: 1007 SEPTEMBER DR DATE: 03/30/2015 REVIEWED BY: MELISSA APN: 362 15 016 BP#: *VALUATION: $15,881 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du 12X p Suppl. PC Fee: (E) Reg. ® OT PENTAMATION 1GENRES PERMIT TYPE: i USE: $0.00 PME Plan Check: WORK REPLACE 6 E WINDOWS LIKE FOR LIKE. WILL MEET EGRESS & BE TEMPERED WHERE SCOPE I REQUIRED BY CODE) Wa� JI, Plan Check 7!!!,!777 Elco t'lan C her;kMeeh. Permit F'ee; PcrmtJ he<;: I lec. Per"zit Fee, Other.i,kch. Irap 01hef� Llec. Imp. Li1$ecla. hasp. dee: I�lec. lila. tee: NOTE: This estimate does not include fees due to other uepartmems (r.e. r/anning, runuc rrurna, rsre, oure-u.y .,crvc• �•�•• ��••��• _ z _ _.• _ .•_ _ _ a:...a_,.� ..t .. ..A.,..... ..:1..67., and nrn nnhr n» octimnta_ Cnntart the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 © # $431.00 Window / Sliding Glass Door 1 wINREP Replacement Suppl. PC Fee: (E) Reg. ® OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: F Administrative t f ee : E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 A Trai,el Documentation Fees: Strong Motion Fee: IBSEISMICR $2.06 Select an Administrative Item BldP, Stds Commission Fee: IBCBSC $1.00 ti _ $3.06 $431.00 FEE $434.06 Revised: 02/14/2015