B-2018-0030CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0030
10381 RIVERCREST CT CUPERTINO, CA 95014-1027 (326 37 006) JEMICO LLC
OWNER'S NAME: BYLIN ROBERT E AND SEVERENE
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class J3: C-17 Lic. #912M
Contractor JEMICO LLC Date 05/31/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Date 1151201_$
HAYWARD, CA 94544
ISSUED: 01/05/2018
NO: (866) 420-4109
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE WINDOWS (8); PATIO DOORS (3) - LIKE FOR LIKE
Sq. Ft Floor Area: Valuation: $33650.00
APN Number: Occupancy Type:
32637 006
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aygnde
Date: 01/05/2018
I hereby affirm thaiI aro 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
t. 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: 1/5/2018
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 1/5/2018
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S tons 25505, 25533, and 25534.
Owner or authorized agent:
Date: 115/2018
I hereby affirm that there s a nstru io ending agency for the performance
of work's for which this pe it is issue Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255 �}
(408) 777-3228 • building@culpertino.org PEMIT #B - � � � " 0
REV # DEF#—
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NEW CONSTRUCTION n ADDITION F1 ALTERATION n T.I. MEP nRE-ROOF SWIMMING POOL/SPA
PROJECT ADDRESS
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APN # 3Z&
O R NAME PHONE
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E-MAIL
STREET ADDRESS
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CITY, STATE, ZIP C,N 1 -
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CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
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STREET ADDRESS
CITY, STATE, ZIP
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L .i✓c,rC� C S
g_MAIL
PHONE BUS. LIC I
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CONTRACTOR AGENT E3 ENGINEER ❑ DEVELOPER ❑ TENANT
COJACT NAME
E-MAIL
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STREET ADDRESS
CITY, STATt ZIP PHONE
00 —S
A cOH'LASlo c. try
DESCRIPTON
pct
INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
I PORCH SF
I DECK SF
DEMO SF
STORIES # I
TOTAL NET SF
REMODEL.
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EMSING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING SECOND DWELLING [3 YES ❑ ATTACHED ❑DETACHED OTHER
UNITS # UNIT ADDITON: ❑ NO SF
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNTTE ❑ PREFABRICATED
POOL - SF SPA. SFSPA ATTACHED YES Q NO TOTAL - 5F
RE EIVED BY:
TOTAL VALUATION:
Commercial or Multi Fmnily Buildings with Public Sraimming Pods reiires Department of Ennimnnimtal Heath tmnrmW
3 IvS
RE -ROOF
EXISTING ROOF TYPE: C]BUILT-UPROOF ❑ ASPHALT SHINGLES[] WOOD SHAKES [:]'
OOD SHI GLES TILE OTHER (SPECIFY)
REMOVE /REPLACE[] NO
IF NOPLYWOOD
❑„ ❑ 3/8"
PLYWOOD TYPE:
PITCH:
12
ROOF CLASS
YES
I # OF LAYERS
THICKNESS C]5/8" OTHER_
❑ OSB ❑ CDX OTHER
'
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
By my signature below I certify to each of the following: I am the property owner 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 with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above -identified property for ' on purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record. /
Date: '
Signature of Applicant/Agent / ,S t�
SUPPLEMENTAL INFORMA N
*New SFD/Second Dwelling lings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provi Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owners Association
B1dgApp_2017.doc revised 08/01/17
•
SMOKE /` CARBON MONOXIDE ALARMS .
OWNER CERTIFICATE OF COMPLIANCE
Y ¢¢ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTENO
(408)777-3228•FAX(408)777-3333•buildino cupertino.orq
'ER11T C OT BE EAEE7ITIL T� CEITIF'ICATEA i3EEl�
b COMPLETE+D,SIQNE AND 11 t » +D TCS 1 E B ILDTNG DIVISIONk
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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 SectionR314and 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 with 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: .49- 3-1 �f Lr 6.76;::S?' C 0 X)O( £.41 Permit No. /3 -,-2 oi _ci "jc
Specify Number of Alarms: