B-2016-3046 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3046
10269 CRESTON DR CUPERTINO,CA 95014-1013(326 37 032) JEMICO LLC
HAYWARD,CA 94544
OWNER'S NAME: DAVIS JAMES AND BARBARA R TRUSTEE DATE ISSUED:11/04/2016
OWNER'S PHONE:408-739-3968 PHONE NO:(866)420-4109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class$C17 Lic.#972702
Contractor JEMICO LLC Date 05/31/2018 X BLDG _ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
—MECH X RESIDENTIAL—
C 'MMERCIAL
with Section 7000)of Division 3 of the Business Sr Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 2 WINDOWS&1 SL ING GLASS DOOR IN BEDROOM 1
I hereby affirm under penalty of perjury one of the following two declarations: (WILL MEET EGRESS/TEMPE D PER CODE)
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.
j2. 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:$11129.00
T 11.1 sk
I certify that I have read this application and state that the above
information is correct.I agree to complywith all city and county ordinances APN Number: Occupancy Type:
and state laws relating to.building construction,and hereby authorize 326 37 032
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 regut ' per the Cupertino Municipal Code,Section 9.18. 180 DAYS FR t-1 SPECTION.
Signature- l� Date 11/04/2016 Issued by •MEL NAMES
Date: 11/04/2016
OWNER-B DER 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 inspdction,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:11/04/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGSO 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 Cuertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co , ections 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 C RTIFICATION Date:11/04/2016 u'
I certify that I have read this application and state that the above information is CONSTRUCT ON 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. I understand my plans shall be used as public records.
Licensed
Signature Date 11/04/2016 Professional
\L ,j CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
4.,,,,....... 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingna cupertino.orq
13-2.Aot6_ 0c..14
El NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS - t (77 Crha J1 D APN# 3 Z - rj ? — 03 2
r C 60„4•z - be-tint:$ PHO'401*- 13i -31'6 1,,
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CONTACT NAME 3d1,t PHONE ? E-MAIL-MALiRS-
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0 OWNER 0 OWNER-BUILDER 0 OWNER AGENT XoNTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE ER LICENSE TYPE BUS.LIC#
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COMPANY NAMEE_ FAX
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ARCHITECT/ENGINEER NAME 7 LICENSE NUMBER i d BUS.LIC#
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DESCRIPTION OF WORK ill51(.01:\-,0
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EXISTING USE PROPOSED USE CONSTR TYPE #STORIES --
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG - NEW FLOOR DEMO TOTAL
AREA AREA AREA. NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA ' GARAGE AREA: 0 DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? ❑NO
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES RECEIVE ® I : TOTAL VALUATION:,
PLANNINGAPPL# 0 N PLANNING APPROVAL LETTER EICHLER HOME? ❑NO #_�®y, I
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By my signature below,I certify to each of the following: I am the property owner or authorized.g-•. ...• • - ,.••T°ms's.e .4 , e read this
application and the information I have.rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all app"r-.1e local
ordinances and state laws relating to.A ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purp:es.
Signature of Applicant/Agent: , p
Date: [t/—(j /)
SUPPLEMENT'1 INFORMATION REQUIRED PLAN CHECK TYPE I ROUTING SLIP
-
New SFD or Multifamily dwellings: Apply for demolition permit for ovER-TxE=couxTER ID BUILDING
existing building(s). Demolition permit is required prior to issuance of building I
permit for new building. 0 EXPRESS 1I] PLANNESGELAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0 EUBLICWORKs
form if any Hazardous Materials are being used as part of this project. p LARGE`, FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR D.SANITARY SEWERDISTRTCT
submittal of Building Permit application.
0 ENVIRONMENTAL HEALTH_
BlclgApp_2011.doe revised 06/21/11
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