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B-2016-1820 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1820 11063 FIRETHORNE DR CUPERTINO,CA 95014-0456(323 45 059) JEMICO LLC HAYWARD,CA 94544 OWNER'S NAME: JANSON RAGNAR F AND ANNIKA BIRGITTA S DATE ISSUED:04/22/2016 OWNER'S PHONE:408-507-2494 PHONE NO:(866)420-4109 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B.C-17 Lic.#972702 Contractor JEMICO LLC Date 05/31/2016 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE 1 PATIO DOOR AND REPLACE 2 WINDOWS(RETROFIT)- I hereby affirm under penalty of perjury one of the following two declarations: LIKE FOR LIKE r. I have and will maintain a certificate of consent to self-insure for Worker's ALL WINDOWS WILL MEET EGRESS AND BE TEMPERED WHERE Compensation,as provided for by Section 3700 of the Labor Code,for the REQUIRED BY BUILDING CODE. Ajerformance of the work for which this permit is issued. 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 permit is issued. Sq.Ft Floor Area: Valuation:$10106.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 32345 059 and state laws relating to building construction,and hereby authorize 323 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulation r the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LASh CALL D �PECTION. Sl n,a u.r . Date 4/22/2016 Issued by:Alex Vallelunea -� Date:04/22/2016 NER-B LDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/22/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu ertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code a ions 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ,` ,e a, t l; etldtt 6t � APPLICANT CERTIFICATION Date:4/22/2016 I certify that I have read this application and state that the above information is TR Ti LE DI AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/22/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMIENT- BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C C1 P E RT[H O (408) 777-3228 • FAX(408)77 333 • buildina(5cupertino,org ❑?� �%1 CONSTRUCTION ❑ ADDITION ALTER4TI01\T/Ti ❑ REVISION/DEFERRED ORIGT?a,L PERMIT T PROJECT.ADDRESS , - I AP>,T h1 40 xojc a m 0\wNER NAI✓E PHONE E-1��i.AIL I 1 tJAJkt&✓A S�n� I �0%– STREETADDRESSCITY, STATE,ZIP q FAX [� CONTACT TAME PH01\E I E-MAIL )J.f ti L'j 93- 12(-3 STREET ADDRESS CITY,STATE, ZIP I F?X ❑ OI NER ❑ OP,�i.R-BLS DER ❑ ONTtR AGEI T J21 CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ENG .ER ❑ DEVELOPER ❑ TENINT CONTRACTORNAI�4E. I LICENSENLTBER 72 Z I LICENSE TYPE ` I Bus.LICn q q � / Ao�SL� o "Z Re4,et✓w� f COAZP.ANY N.AI En ,G n,}fE-b AIL FP- -- �"1 t o i IOU S'F C 0.r' STREET ADDRESS CITY,STATE,ZIP PHONE :30-RUO sA-�J l✓-,JA 5t lac��.rj ,e, ,q Lt 5Ltq 263--3193 a.RCHITECTlENGL\~ER Nfh4E LICENSE NUUABER BUS.LIC f COhdFANY NAME E-1✓iAEL FA-X STREET ADDP.ESS I CITY,STATE,ZIP DESCRIPTION 01\\'OR?: ce fl, Q 7co opt- 2 2e�-off�v,s�r� �,Ji��oL✓S Llk� JCOA, c.L��— (�'� el,t v�ti l� c: rte' a f��✓i�c- man- �enc✓ �.�. ALU W'ntq()w3 t44- P " T (�6- ytc—S EXISTF.G USE I PROPOSED L'SE CONSTR.TYPE _STORIES USE TYPE OCC. SQ.FT. VA-LUATION(S) FXISTG NEW FLOOR DEb40 TOTAL ?.R E.A AREA AREA NET?PFA BA i]HROOM KITCHEN OTFER RE'iODELAREA REMODEL AREA REMODELAREA i PORCI-]AREA DECK AR--A TOTA?DECK'PORCH AREA GA3 AGR AREA: Lj DETACH ❑ATTACH DY%ELLrN''G UNITS: I 1S A SECOND UNIT []YES SECOND STORY [])--ES EELNG.-_DDED'. []NO ADDITION' ❑NO PP`-A—PPLIC.ATION ❑YES r)-S.PROVIDE COPY OF IS THE BLDG AN ❑YES R_CEI\tD B} TOTAL\:A LUATIO:N: PL.A1,:'\ING APPL ❑?;0 PLAT,TTKG APPROVAL LETTER EICHLER HOME? ❑?:•O z J u t By niy signature below,I certify to each ofthe folio\\ing: I am the property o\ ner or authorized 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. I agree to comply witla all applicable local ordinances and state laws relating to ilding conSTUCtion. I authorize representatives of Cupel tizo to enter the above-identined property for inspection purposes. Signature of Applicant/Agent: Date: S Z- Ib S17TPLEMENTAL INTOP&fATION REQUIRED I L TJ\_G Ne\\-SFD Of 1\iL'Itlian711y d7ve11±P.°S: .Apply for delrolition penllit:OI r w r r > r ❑ Oti ERT E COII\TFR ? �tILDI\G PLA\REghE\3 exist DL1Id1P.tr�S). Deinol_1tion per_.it is requiied prior t0 issuance 011Ju11d111� f 1 < t u f+ 'r R t 1 pe:-,-n it for new building. L pr�1NL\G Pr 4� _E\IEji _Comninercial Bidgs: Provide a completed Hazardous Materials Disclosure I STA\D4RDF J:PGFLIC 1CRl.�s.. for_n ii any Hazardous are be__g::sed as Dart o:th-s;ro;ect. LAFGE –d PIREDEPT Copy Of P1aP17i:lg Appro\al Letter or?\Feetlrg w`h PIann:rg prior to '. ' 4�: ❑ k --- � ±4LaJOR LSA\IT RY�r\j ER DI�TRIC7 SLl-mittal Of BL1Id±na Permit app! Cation. v a IRO\\iE\I:1L HL.,LTH Bldg_'pp_?011.doc nevi_ed 05./21/11 _Project_n_a_me: _; Jan, r_ir,Annik_a Renewal byAndersen .-- I 11063FireThorne Dr _ Cupertino �_ I .. '� ' --, u r /iia etblack� - -- �i--' —h� —I-- -- ��e�� i �® 1 1 I v' I ' --{- WINDOW REPLACEMENT .. I I I I I — � ___ —I I — 1-- -- I _— 8417 TENT :.. �� —_J__— —_�—' '---- --- —I—I — — _ 2nd level l n tib.. :V9i ',:if. �r?sl I�L '..�itl,i, 4 fltll iG fil .L'.iil , UY�lfJ-UG -air'• ...___{ ---,_. _ ._ i_ .,�_. _L_.—.__.._._.-. __ '. -- �—�------- J I I 1 rr�aster,be�l1 0'J=I-,ir3rtl-th 13k N=fi1g.0 tick I - l i parr)u10 01 LhI pAn ,nil-so ifidc rim�'� - -� " uwAl Ut t i "'",`LPA7 I I_ -r--—i-- -of-any_provislG X10 +lily _— IBY I — D,r,7� T N CHECK Y- PEF�MITINO.I Pt.::ANNING-DEP-T —r-----__-- � �--;�IIJPERTINQ- , - I --- -- I I#101 -- �ntry I I ' I #102 living I --'— I 1 - ---- 1 - ---I �._..� = - ---- - — 1 _I —I- - — fi I -- _I.Entry _ 101 —GL_AP-CEO _�_J_—I—L— :_ I-312—_i__-1441/8 IT — _ -1- -- I I --I-- �;01/�2 79 1/2 i 102; P,SGD STOCK I �.—�_-' '-- ��y _ +. � I R92 Masteyn bed �_L`2011 !GTI CEO, I_ L �_. _ �_ I i I I I i—I I � � 1— I •; � � � ! I I I I � 1 ! i Scope of work: 1It Replacing 1 Patio Door and 2 Retrofit-insert windows like for like.Same size and locatic �_V�I-_I -� -AI _I_-� uH-ding-De I I I I -, part, t-_ �'e, _ 1-1-1 _17 ! I ! I l l l l l R CODE COMPLIANCE Reviewed By: - M"I �S 'K 1,CARBION -MONOXIDE ALARM$ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION r~1iF�Tfi�N 10300 TORRE AVENUE•CUPERTINO,.CA 95014-3255 b (408)777-3228*i-AX(408)777-3333 M;buildingC@cuUertino.org z 2 Cv,cL ' r Wkk 06N.,.4,,11"', RM PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for inspections are required. GEN.MUL IN,PORMATION-1 Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carboni Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1000.00;CIBC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AR-9A SMOKE ALARM CO ALA Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling,unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not Have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Sectioin 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelli nig units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units; alarms are permitted to be solely battery operated where repairs or alterations do not result iii,the,removal of wall and ceiling finishes or there is no access by means of attic,basement or, crawl space.Refer. to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is,required for alarms which must be co uzected to the building wiring. As owner of the above-referenced property,I hereby certify, that the alarm(s)referenced ahcve'has/have been installed in accordance with the manufacturer's instructions and in compliance with the Cahfornia Building and California Residential Codes.The al'arrnshave been tested and are operational, as of the date signed below. t haves read and a nee to coirply,with,the terms and,conditions of this.statement 4 .......... .......: ......... ........: ......... Signature ......... ......Lica.. ....... ..........Date :....... WATER-CONSERVING PLUMBING FIXTURES its OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION GUPERTINt} 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 408)747-3228•FAX(408)777-3333•building(�!)cupertino.org Owner Name ��' Permit N of) ( � Address i S 2 tei2Tt-16e1\JE- 0 i- Co V 1 i t (\J 1. Is your real property a registered historical site? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the.rest.of the form and sign bottom of form. c) 1f No Go to Question 2: 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. LF No Go to Question 3. 3. Is water service permanently disconnected for your building? 11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? El No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8,do,not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). El My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless,of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's. installation requirements,and that theter-conserving lumbing fixtures comply with the requirements as.indicated in the table on the following page. Owner or Owner Agent's Signature; ! Date:, Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. ,SB4072015.doc revised 08126115