B-2016-2400 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2400
19992 RODRIGUES AVE CUPERTINO,CA 95014-3197(369 04 045) JEMICO LLC
HAYWARD,CA 94544
OWNER'S NAME: SCHMIT MICHAEL LAND PHYLLIS S DATE ISSUED:07/28/2016
OWNER'S PHONE:408-239-3312 PHONE NO:(866)420-4109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GLAZING Lic:#972702 X BLDG ELECT —PLUMB
Contractor JEM ICO LLC Date 05/31/2018 —
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:
REPLACE WINDOWS(11) LIKE FOR LIKE TO MEET
I hereby affirm under penalty of perjury one of the following two declarations: EGRESS/TEMPERED 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
erformance of the work for which this permit is issued.
2.J 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:$21210.00
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 369 04 045
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 regulation er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LASTCA INSPECTION.
Signature Date 07/28/2016 Issued by:
Date:07/28/2016
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
i. 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(Scc.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:07/28/2016
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
2. 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. 1 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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod ctions 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:07/28/2016
1 certify that I have read this application and state that the above information is CO STM C&ON LENDING AGENCY
ect.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
ting to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
nter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
ave indemnify and keep harmless the City of Cupertino against liabilities,
[[and
ments,costs,and expenses which may accrue against said City in Lender's Address
sequence of the granting of this permit. Additionally,the applicant understands
will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
e,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
nature Date 07/28/2016 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN® (408)777-3228•FAX(408)777-3333•building(a)cupertino.orA r3— ?iori7 — 2 v o
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# /
PROJECT ADDRESS ( C ^ APN# O [/_
OWNER NAME �j �fJ / yz,, PHONEg0 -231 -33iZ EMAIL
STREET ADDRESS r I h CITY TATE,ZIP FAX
11992- ���-'cotes �vv. ffi.n950/Y
CONTACT NAME / , r/ PHONE [o _ n p 3 1.L�? EMAIL
STREET ADDRESS (^ CITY,STATE, ZIP L O J FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTRNAME e LICENSE NUMBER I ^I Z,7 0 Z LICENSE TYPE C BUS.LIC
COMPANY NAME 1 t E-MAIL / (/ / FAX
Co M
STREET ADDRESS %045�-[AAJ'� t_ CITY TATE,ZIP (/ �, y, I
'- 5y
A,c,/L/ PHto✓�.'�_L(.3
ARCHITECT/ENGINEERNAME G LICENSE NUMBER v1 G✓7 BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK rdli
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
j USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION [_I YES IF YES,PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ff NO
By my signature below,I certify to each of the following: I am the property owne orized agent to act on the property owner's behalf. I have read this
application and the information I have pro 'd 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 bu'din construction. I authorize representatives of Cupertino to enter the above-i entified roperty for inspection purposes.
Signature of Applicant/Agent: — ---- Date: Z g b
SUPPLEMENTAL IYFORMATION REQUIRED `" "
Q BLAN,CHECK TYPE, RO•TIlVC SLIP,
New SFD or Multifamily dwellings: Apply for demolition permit for VER THE coUNTER B IrrG PLAN REviEw' 4
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building. ❑ IWRESS G PLAN REVIEW.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �, sTAIVDaRD ❑ PtISLIc.woRxs
form if any Hazardous Materials are being used as part of this project. :3
❑, LARGE . ❑ FIRE DEPT'
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. MAaou' ❑ snIVITAiiY sEwERvtsTRlci'
❑,EN�IRONMENTAL.HEALTH
BldgApp_2011.doe revised 06121111
1 ' 1 i 1 l i l i w ' I
Project name: 44_16 1086� 0-SCHMIT, Phyllis] ; _,—, . E I_--; ' _1 i i Renewal
19992 Rodrigues byAndersen.
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! Cwper`tino CA 95014-} ! f I Backyard/lReal`r Setbaic3-
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-I�—�204
�! { Famll-y-{—�--Kitchen _; i____. -_-Master balth-'-Master-bed - - {—! --`
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Kitchen' 1051
I_ �_-I- ! � - _� l—' �---1—'
102 _-_I__-_ �__ _ -E Setback 12 1
1{ ' I + 1 i ( I Second floor 1--
�. (` Ground floor
203 Bedroom 2 i_ -_ i
1-I + {101 Guest bed �I Dihing room -106 1 , I E _I
Setback 6 �_,— L I i- ,_202-�_Bedroom_
1 -,
Hall bath
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u-Factor:0.32 i Garage ENTRY
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SHGC:0._25 I I ► ' 1 i -_, _i _ 1 I
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; Street/Front Setback 20
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I -Noor
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- - i —I i— FI'r -1 verfit,--kL-tr�m, I I- Current Current -- 1-----
Exact Order Exact Order
Room-Description--Plan--StyFe---I NF=FFrame;-or -Handing Opening Opening -j--;-- 1— -
i width � Height
1 { 1 E I____i� _----—1_-I_E—,g t
Stock Doo'r--{--;—; Width Height
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Guest 1bedjf..—_101 GL �_ CEO-..{ iJ_. I ., ,.__AP i_.___ 695/8 43 7/869.1/c4 p 431/2
Family,'room -I 102----D'B [ CEO; ? E ual, 21 45 205/8 44 5/8
Fami-I-y�room-� --103--DB-1-- -CEO,---;-.- - -- --,-Equall- 21 45 -?-205/8_x___1 445/8
I —+ --T--—i—I--L-1-1--j- - - I-- - - -�--?- _ i_�
Kitchen dining 104 GL _C'Edi 1 i l ( AP ; 695/8 437/8 ! 691/4,1 l 431/2 1
I -� -' t i 33 33 ; 32 5/8-LJ_; 32�5/8_4
Kitchen_-- - ._I _ 105 ADB I_ CEO.; } i Equal{._._
Formal din,ing, ..__I _ 106 GLI CEO; ; J AP 571/2 437/8 _� _571/8 431/2
'- -
--- .� L-1 1 - i -�- I -1/14—i
Halal-bathroom r 201—GL --CEO; -I - I AP-(- 45 5/8 19 7/8 , 451 19-1/2-
-!— -- '
-Be.dr-oom-1__-__� __-202__._.GLS--.CEO—{--__......__;___;__.-AP.I__ 575/8 437/8 _..__571/4_i___(_431/2
Bedroom 2 203 GL CEO, 4 AP 575/8 437/8 s 571/14' 431/2
-- - -
Master-bath----{- -204- --GL~{- C*EO,--;--;--; -}- -�AP-j-- 45 5/8 317/8 -1-45 1/,4
Master bead205 GLT (;,EO, AP j 695/8 437/8 171 69 1/;4
_T
(Scope of work: I Replacing 11 Retrofi Insert windows like for like
FT
OFFICL Copy . .
P T P S D BY
ATE
PLANNING DEPT
ER
COMMUNITY DEVELOPMENT DEPARTMENT cup TINO
BUILDING DIVISION-CUPERTINO
APPROVED CUPER r IN®
Thls set of plans and specifications MUST be kept at the
job sJ an site durinr_ construction. It is unlawful to make _ Building Department
Y i
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and snp^ia' Jtions SHALL NOT REVIEVVE[i F-OR CODE COMPLIANCE
be heid to permitapproval of the violation
of any prc+�%,.un. ��� ante ui 13"a ^� Reviewed By;
n
DATE _ �6
PERMIT NO.