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15040057
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10955 NORTHSEAL SQ CONTRACTOR:JEMICO LLC DBA PERMIT NO:15040057 RENEWAL BY ANDERSEN OWNER'S NAME: LYDIA BALANO TRUSTEE 30800 SANTANA ST DATE ISSUED:04/08/2015 OWNER'S PHONE: 4089731290 HAYWARD,CA 94544 PHONE NO:(510)263-3178 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL '70 REPLACE 2(E)SLIDING GLASS DOORS,LIKE FOR LIKE License Class (3C� Lic.# q 7 Contractor �C(/l."'Gl q�17 VW a ate 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 " a ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8452 ` \k ave 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:31640021 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 ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabili' ,Judgments, costs,and expenses which may accrue against said City in equence of the granting of this permit. Additionally,the applicant u tands and will comply ss a e: Xr with all non-point source r er t u mo Municipal Code,Section 9 18. Vk RE-ROOFS: Signature Date 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 Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,2553 ,and 255 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 o0 CONSTRUCTION PERMIT APPLICATION A COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 85014-3255 \ CUPERTINO (408)777-3228•FAX(408)777-3333•building0_cuAertina.oru NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS O S� bid ' .S Q ® APN B I O /1 OWNER NAME O r b �� PHONE L�aI© (/"?2 I�bn EMAIL C/ STREET ADDRESS r (T 1,rn! CITY,STATE,ZIP/ �7/� 19,914 9 Q1FAX CONTACT NAME YVC 7�� V I�VL A l lJ� PHONE'�•�1�12�� 2 `7�(/ E-MAIL lcl �d `� Jt r1 I 'Cul-j • STREET ADDRESS'7 G`n6k (�1 I CITY STATE,21P L �I/S/L FAX ❑OwNER ❑OWNER-BUILDER ❑ OWNER AGEN1 T `�]}CONTRACTOR ❑CONTRACTORAGENT ❑ ARCBIrBCjT ❑ENGIINEER ❑ DEVELOPER Cl TENANT CONTRACTOR NA:" ``� J1 eC-t6_`t {CENSE NUMBER Cj.+7�( /4, LICENSE TYPE i BUS.LIC 0 COMPANY NAME le b� 't1 I1 CE-MAIL, l / FAX G�)Ulsl ry, S'CREET ADDRESS Y,STATE,21P L o 1~ PHONE •nta r q ARCHTTECTIENGEJEBRNAME LICENSE NUMBER BUS.LIC 0 COMPANY NAME E-MALE. FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK L C "1 ® ',S ( f O i/ EXISTING USE PROPOSED USE CONSTRTYPE I 4STORIES USE TYPE OCC. SOFT. VALUATION($) EXISTG I NEW FLOOR DEMD TOTAL AREA AREA AREA NETAREA BATHROOM E'd'r(EM OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DBcmoRcm AREA NUN AREA EIDEFAcH ❑ATTACH #DWELLiNGUNITS: ISASECOND UNrr E3 Yes- SECONOSTDRY ❑YES BEING ADD&D? ❑NO ADDITION? ❑NO PRE-APPLICATION [I YES IP YES,PROVIDE COPY OF IS THE BERG AN ❑Y T ALV UAT[QN: PLANNING APPL 0 1❑NO PLANNING APPROVAL LETTER RICKLER HOME? ❑N By my signature below,I certify to each of the following: I am the property owner or prized agent to act on the 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 verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relator building constru�ct`ion.1 authorize representatives of Cupertino to enter the above-idealtifie(d�r eerrtty for inspection purposes. Signature of Applicant/Agentfif"v Date: [–"�KJf d 1.15 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTMGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ oVERTHE-COUNTER ❑ Bu nxNGPCANREvrEw existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑ EXPREBs ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PtMLICwoM43 Form if any Hazardous Materials are being used as part ofthis project, ❑ LARGE ❑-FIREDEPT —Copy of Planning,Approval Letter or Meeting with Planning prior to submittal of Building Permit application. D MAJOR ❑ SANITARY SEwERDISTRECT ❑ ENVIROMI[ENTAL HEALTH B/dgApp Z011.doc revised 06/21/11 19 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10955 NORTHSEAL SQ DATE: 04/08/2015 REVIEWED BY: MELISSA APN: 316 40 021 BP#: *VALUATION: 1$8,452 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex M PENTAATION 1GENRES USE: PERMIT TYPE: i WORK REPLACE 2 E SLIDING GLASS DOORS LIKE FOR LIKE SCOPE 71 I k- Y . : rte_ �� „ ,„" o '. s„n• 'r"s� S "",�,'?a .,�. i Meech. Plan Check � Phumb.Pluri C'hed Elec.Plan Check ;Leech.Permit Fee: Plumb.Peimit Fee: lik:c. Per-mi7 Fee. Other A,f ec�h.tnsp, Cltlier Plumh Insla. [IF Other•Elec_Fnsp. 111ech. E3 lrup.Few Plumb. hisp.Fee. Elec.Imp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: (D Reg. ® OT 0.0 hrs $0.00 $431.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. ® OT Fo,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('onstruclion Tax: Administrative Fee: Work Without Permit? ® Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 7r-uvel Doemnentution Fees: Stroniz Motion Fee: IBSEISMICR $1.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 - $2.10 $431.00 -AL--FEE. $433.10 r a Revised: 04/01/2015 NORTHPOINT HOMEOWNERS ASSOCIATION PROPERTY MODIFICATION NOTICE Please indicate below which modification(s) are planned for your property. Provide brochure(s) if possible and a copy of any proposal(s), including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval. Satellite Dish installation has a separate form to be completed and submitted for approval. Modification Restrictions and Requirements Air conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property. There will be no part of the unit visible to common areas. Installed by a licensed contractor. Replacement window/ Must be same size aperture and Sliding door location of existing window or sliding door. Any necessary touch-up <Spainting is the responsibility of the Homeowner. Installed by a license contractor. Garage door Must be windowless and in conformity with general architectural style of the complex. Repainting to conform to exterior color scheme is responsibility of the Homeowner. Installed by a licensed contractor. Any damages caused to property as a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association enumerated under Article V of the amended and restated Covenants, Conditions and Restrictions of the Northpoint Homeowners Association are applicable to modifications Contained herein. City permits may be required. Please Print Homeowners Name(s): Tom Ai'1 in& Lit &ioa �em ]t2 Property Address: , q 65 /VOY�SeG\ �QQO& Phone: 408- 913 - Ig90 Date of Notification: Date of Completion: Homeowner has 6 months to complete the designated modifications and is responsible for notifying management upon project completion. O "k�e,Use Only j Notification received by: rkn-1 L �V tVN►w?.�� Date: a(. ! I" Completion verified & approved by: fre.YQ Date: Form adopted 8/1011999 Revised 5/00 Project name: Kemnitz,Tom �pgH/gl d 10955 northseal Sq bYARdelSen Cupertino Backyard/RearSetback y 60X68 60X68 P/D P/D living dining; entry ENTRY Setback Street/Front Setback SetbackCOMIV�I�?'+i T Y ;EVP- _('tjRMENT DEPARTMENT BU;LJi�� ;``l�rC N - CUPERTINO APPROVED This set c71a n �I eclf catidns k'lUST be kept at the job site cilr,Inncq, >tr.jctlo It isun(�3wfui o make any changes or nl; :rAlions orrsartie, or to deviate therefrom, wlth,.,_t approv r from the Building Official. N The Stan ping or AS plan anti specifications SHALL NOT be held to permit �t � f the violation of an ns f_an, Ci r or State Law. Scope of work: F-FICE a 1� `s PLS N � 'E BY CUPERTINO tSr-ilding ( Snartrnent DATE SPR 0 8 2015 PLANNING DEPT REVIEVVED JZ OR �;Or� CUPERTINO Reviewed COMPLIANCECOMPLIANCEBy. �-