B-2016-1972 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1972
10816 LINDA VISTA DR CUPERTINO,CA 95014-4749(356 14 052) JEMICO LLC
HAYWARD,CA 94544
OWNER'S NAME: MILLER PAUL V AND FUNARO GINA M DATE ISSUED:05/18/2016
OWNER'S PHONE:408-781-8433 PHONE NO:(866)420-4109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C-1 7 Lic.#972702
Contractor JEMICO LLC Date 05/31/2016 X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
REPLACE 10 WINDOWS(LIKE FOR LIKE);ALL WINDOWS ARE
I hereby affirm under penalty of perjury one of the following two declarations: INSERTS
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.
2. 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:$23189.00
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 356 14 052
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 er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CA PECTION.
Signature Date 5/18/2016 Issued by:Alex Vallelunga
Date:05/18/2016 r
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. 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: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
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
z. 1 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(x)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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 Curti Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code ec ions 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 4 Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/18/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING 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 5/18/2016 Professional
V
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildincgncuaertino.orq
❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS i O (0 Lux 1c, Vi
+ b(L APN# .5 5 L t q-
6 7/_
OWNER NAME �l�fa f �Ap-0 qv ` -1 g 1 + q 3 EMAB 1 C
STREET ADDRESS1_ CITY STATE,ZIP FAX
9�$1lo LDn�e- v s�c- ►�rt .o CJA 95 0 til
CONTACT NAME Q i f f� PHONE
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STREET ADDRESS3 0%0!3 '5A O 7A-,,,)A cin CITY, TATE,ZIP CA1 L 5I K FAX
E3 OWNER 11OWNER-BUILDER1:1OWNERAGENTO CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME yleVWCA ^ '� LICENSENUMBER�� ---Yu? LI ENSETYPE BUS.LIC {/A G
1111 I�lxtl SPr� Lr2� t v` l
COMPANY NAME ILk ^ 1 e'-15 e_,
E M�}fL��,� r��� Il a/ FAX
STREET ADDRESS O4 A^_ '7 {/� !J A 5(-,
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J'QI•' �aW Q (_U5 51�J-L63�31gJ
ARCMTECT/ENGTNEER NAME LICENSE NUMBER BUS.LIC N '.
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Revic-clr-5 1 fl U,jmxot.f5 7.Z11-. (-o:R, LI1c.2. }4-1--(. Liwl) pos '
pis C.,rL-r 5
EXISTING OSE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQFT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCHAREA GARAGE AREA rJDLFrAcH
❑ATTACH
A DWELLING UNITS: 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 RECEIV TOTAL VALUATION:
PLANNING ADPL N ❑NO PLANNING APPROVAL LETTER ETCHLER HOME? []NO ij 2-3
By my signature below,I certify to each of the following: I am the property owner or authorize a e o ct the erty 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 it ng construction. I authorize representatives of Cupertino to enter the above-i entified property for inspection purposes.
Signature of Applicant/AgeDate: < <b
SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUIIAINGPLANREVWW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ waumss ❑ PLANMNGPLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD El PUBLICWORKS
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 11 SANITARY$EWERDISTRICT
submittal of Building Permit application. ❑
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
Project name: I 44_16_10265-FUN ARO, Gina Renewal
10816 Lind VV to -I_ by/kndersen.
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Scope of work: Replacing 10 windows like for like. All windows are inserts FF �j
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WATER-CONSERVING PLUMBING FIXTURES FILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION,
CuPERTINO 10,500 TORRE AVENUE-CUPERTINO,CA 95014-3255
Al 777-3228•FAX(408)777-3333•building(c�cupertino.org
Owner Name O� ° l Eo Permit No
Address � � Ejy_% I')� , IDA ,12Jfo/y
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
[A, 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.
KI No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ 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 110 1.1 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).
❑ 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 the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: r Date: .� 0A
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15