B-2017-1873 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1873
1375 PRIMROSE WAY CUPERTINO;CA 95014-5229(366 17 047) JEMICO LLC
HAYWARD,CA 94544
OWNER'S NAME: APT VIRGINIA E TRUSTEE DATE ISSUED: 11/01/2017
OWNER'S PHONE:408-253-5407 PHONE NO:(866)420-4109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 13:C-17 Lic.#972702
Contractor JEMICO LLC Date 05/31/2018 `X BLDG _ELECT _PLUMB
"`i 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 Sr Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WINDOW(3)-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
rfomiance of the work for which this permit is issued.
I{.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
permit is issued. Sq.Ft Floor Area: Valuation:$6530.00
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 366 17 047
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 Cupertinopieipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ignature dc" Date 11/1/2017 Issued by:AbbyAyende
Date: 11/01/2017
OWNER-BUILDE 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 roofmg 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:11/1/2017 •
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
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 rtino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co a Se do s 25505 25533 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall • 1,4
'
be deemed revoked. er or authorized agent:
APPLICANT CERTIFICATION ate:11/1
I certify that I have read this application and state that the above information is CONSTRUC ION 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 11/1/2017 Professional
13_7o R— N1-3
\ / CONSTRUCTION PERMIT APPLICATION
/' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4:,-c.19f� 1. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingcuperti
na, no.orq
CUPERTINO
❑NEW CONSTRUCTION El ADDITION El ALTERATION/TI ElREVISION//DEFERRED ORIGINALPERMIT#
PROJECT ADDRESS ) ,3-7. ^,.Alms APN# /ter_(0 ^ I _ ® �
OWNERNAME /' A ( T PHONEPs.jpp 2,5-3 `5-L(JO� E-MAIL
STREET ADDRESS f' CI ESTATE,ZIP FAX
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CONTACT NAME I i �' PHONE SZ
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` E-MAIL
JO' A
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
Ander LICENS ER LICENSE TYPE' BUS:LIC#
CONTRACTOR NAME
�i�v1P.t✓ 5� X 27 o - P — 1 1
COMPANY NAME E-SAIL FAX
5 fpe-r reAr. 1wl eArect:Go M
STREET ADDRESS i CITY STATE,ZIP PHONE
3o S!-4n11k�✓A S't 1 cz-d 1 � ) 1H s;�/N s,._263- 3176
ARCHITECT/BNGINEERNRME •
LICENSE NUMBER BUS.LIC'#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
a- 3 („/t,M- -LY 1 A) I rt,.JCe 2a�o61 ' 16 I%LlfO,J) .1-41'.0/1'
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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 -
REMODELAREA REMODEL AREA REMODEL AREA
i'.PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH
❑ATTACH
I
I#DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES -BEING ADDED? ❑NO ADDITION? ONO
PRE-APPLICATION "❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC Y -- r TOTAL.VALUATION:
1.PLANNING APDL# 0 NO PLANNING APPROVAL LETTER EICFILER HOME? 0NO �Y ( 3,0 - so p
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to a on the operty owner's behalf. I have 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 allapplicable local
ordinances and state laws relating to ding construction. I authorize representatives ofCupertino to enter the above-identified property foriiispection purposes. -
Signature of Applicant/Agent: Date: ��J 1 J /
SUPPLEMENT INFORMATION REQUIRED . PLAiv caECxTx''''.1 w .. k Roil TNG SI IP - ,,,..,
New SFD or Multifamily dwellings: Apply for demolition permit for
❑`=OVER TIE COUNTER ❑ BIIIL.DING PLAN REVJEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. t ❑ 'EXPREssx .,,,:;,.0,----,„.!.;
❑ PLANNING"Pi AN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑,STANDARD ,.-:,,,,,,,:y:PUIILIC WORKS
form if any Hazardous Materials are being used as part of this project. ` =
❑ LARGE FIRE DI PT s 14
Copy of Planning Approval Letter or Meeting with Planning prior to
❑,-.104.4;,,.,,,,,a - ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application. ;€
. _ ' .< . ' .._ _...m . .❑ ENVIRONMENTALh EALT11 ...w .:,
. BldgApp_2011.doc revised 06/21/11
,\ , , SMOKE / CARBON MONOXIDE ALARMS
y x OWNER CERTIFICATE OF COMPLIANCE
; w,, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildincic cupertino.ora
PERMIT CANNOT •BE FINALED UNTIL THIS CERTIFICATE HAS BEEF
€t�£,,���way i ,& '�� £�t� �' '� �"`r� x -4 x `'�',,„�a z`�m�`� ro�` ��, �,e+ hx��u A
,'COMPLETE i SIGNED, D R'ETURINED TO THE,, 0 }I�NG DIVISI(tqfON ��
£ ,.6 ''rte', ,Sia £ -ii-i . a �'a..� ..:x.✓e,a,:e'ti'� aa. '4'
PURPOSE
This affidavit is a self-certification.for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314,R315, 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:
AREA SMOKE ALARM CO ALARM
Outside of each•separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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 Section 420.6 and'shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling 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 in 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 connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance' the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the .
date signed below.
• Address: 137.5- p riPv)Jr'OS'e-, ?N I C[�c1�4 v-`I'"Ii 0 Permit No. 8-7,O 17 -4 x,73
Specify Number of Alarms: #Smoke Alarms: I #Carbon Monoxide Detectors: 12. I
, • I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:,
°Ft
V r F n f of ' , pi: ; . Signature... Date: .r/../.. Z,l. l
ContraObr Name:
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017
I