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B-2016-1971 1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1971 21865 EATON PL CUPERTINO,CA 95014-1180(326 19 13 1) JEMICO LLC HAYWARD,CA 94544 OWNER'S NAME: RUSSELL SCOTT WAND LISA B DATE ISSUED:05/18/2016 OWNER'S PHONE:408-490-4963 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: REPLACING I PATIO DOOR(LIKE FOR LIKE) I hereby affirm under penalty of perjury one of the following two declarations: 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$4581.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 19 131 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 regulatio s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED MPECTION. / Signature Date 5/18/2016 Issued by:Alex Vallelunea Date:05/18/2016 OWNER-BUILDER 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) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sce.7044,Business&Professions Code). Date:5/18/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 3. 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 Cod ,Se tions 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:5/18/2016 1 certify that I have read this application and state that the above information is CON TRUCT14N LENDING EN Y 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 5/18/2016 professional V CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO 1 (408)777-3228•FAX(408)777-3333•building a.cupertino.ora t9- 2,01� �I(or i c11'i ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS b.ry Z/b�5 ✓LQ� PI�G� APN# 52(12 r 131 . OWNER NAME C C okiz,+S S p✓T`� PHONE q96- '(9631 EMAIL STREET ADDRESS �l p r_ [ CITY,'STATE,ZIo �fl C O i y FAX CONTACT NAME 1 O O 11 J s I% PHONE 510 - 2,0-3-I JZi6 3 E4 STREET ADDRESS J2�� `7A N)rA NA [-I/ C,�TY,STATE,JZ &g Li L L f a j FAX ❑OWNER ❑ OWNER-BUILDER? ❑ OWNERAGE(NJT _F& cONTRACTORI` ❑CONrRACTORAGENT J❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME re�et�J �t n p LICENSE NUMBERgT,2- sn LICENSE TYPE US.LIC# ` ( �(� COMPANY NAME ,Itievjd ;/tluu^ E-MAIL �� r��(J��-6 FAX I 1 STREET ADDRESS 3 0 4 .�G �'EJ y✓a i�1 CITY STATE �o`� �l'�5`�K,ZI PHONE�I —26 3-30�3 UU CTS �V t Gr J V ARCIBTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# ' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK PA fto bo-0 n, LI ILe, r-O�L til Ic,e EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA ARBA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ❑ATTACH A DWELLING UNITS: ISA SECOND UNIT []YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITTON' [:]NO i PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: OTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER ETCHLERHOME? []NO oo By my signature below,I certify to each of the following: I am the property owner or authorized agen o a n the brSperly 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 with all applicable local ordinances and state laws relating to Iding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: t SUPPLEMENTAL FORMATION REQUIRED PLANCHECKTYPE T ROUIINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ RUMDINGPLANREVIEW 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 ElSTANDARD ElPUBLIC WORKS Form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWERDISTRICT submittal of Building Permit application. ❑ ENMONMENTAL HEALTH BIdgApp_2011.doc revised 06/21/11 Project name: I Russell Scott _ I I Renewal 21865 Eaton PL —� ^� b1'Andersen. Cupertino — I Backyard/Rear Setb�ackl •�• WllIOOM R i _ �_ I I _GF1 '. ,� .F 1 9I _ I _ dining I 60X68-P/D - - -- - :3 2 I I I entry I 11 '-j Dining('- �(— 1101 TPSGD -CUSTQM SR 657/8 817/8 I 651/2 `-,813/8 I i I I P �.V:PEIR1 [tlAJ �uiLdng Depattme Ay1 6 2016 1 — ' R V1E� FOR�OT!�-E�CIVI�LTANCE� I ie_�!ed s_y.�— I_ I ' - I -P,LANS-G?HECKD- DA' L- -H Scope of work: Replace 1 Patio Door like for like 11 ----- -L�AIV IN 11 DEPS' j I - CUPRTIfUC�11 11 11 11 H 'I I I, I I I I '