11070151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20200 PATRIC CT CONTRACTOR:THD AT-HOME PERMIT NO: 11070151
SERVICES, INC.
OWNER'S NAME: YOUNT ANNIE P AND JAMES R 2690 CUMBERLAND PKWY STE 30( DATE ISSUED:07/21/2011
'tVN'ER'S PHONE: 4089968710 ATLANTA, GA 30339-3913 PHONE NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION
�) BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class i �3 C t Lic.# `5 36 0�Z 1
�/ MF,CH RESIDENTIAL COMMERCIAL
Contractor`i ND R, rT-:aC 5c�2 :c -S Date
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL I VINYL REPLACEMENT WINDOW LIKE FOR
LIKE
(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:
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. Sq.Ft Floor Area: Valuation:$1016
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the workfor which APN Number:36935013.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above i rmation is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS O LAST CALLED INSPECTIO
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 Issued by: Date: / (/
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18,
RE-ROOFS:
Signature Date V2-1 1 J All roofs shall be inspected prior to any roofing material being installed. If a roof'is
IF installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
NER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this /21 1
permit is issued.
Owner or authorized agent: Date?
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 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
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
Lo 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Zp ZOO 1 C C-7, PERMIT#
OWNER'S NAME: -�Jyvl p VT PHONE# q01? 1 D
GENERAL CONTRACTOR: —rH r kE BUSINESS LICENSE#
ADDRESS: 2-454-j L;? � ,4 C,7. CITY/ZIPCODE: .Aj L^ 0 y4 2 7
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Date
Please check applicable subcontracto om a the following information:
%/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ownontractor Signature Date
1
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20200 Patriic Ct. DATE: 07/21/2011 REVIEWED BY: RDW
APN: BP#: ''VALUATION: 1$1,016
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK Install 1 vinyl replacement window like for like kitchen.
SCOPE
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 I f. "1.-11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Window/Sliding Glass Door
Suppl.PC Fee: 0 Reg. 0 OT 0.0 Fh,, $0.00 $392.00 1 wINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee42) Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes (E) No $0.00 O
Work Without Permit? Q Yes 0 No $0.00
Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
Strony,Motion Fee: IBSE1SNt1CR $0.50 Select an Administrative Item
B1d J Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $1.50 $392.00 TOTAL FEE: $393.50
Revised: 07/04/2011
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36935013 . 00
DATE ISSUED. . . . . . . : 07/21/2011
RECEIPT # . . . . . . . . . BS000014135
REFERENCE ID # . . . : 11070151
SITE ADDRESS . . . . . : 20200 PATRIC CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YOUNT ANNIE P AND JAMES R
ADDRESS . . . . . . . . . . : 20200 PATRIC CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4424
RECEIVED FROM . . . . : PERMIT SERVICES
CONTRACTOR . . . . . . . : FRANCES BLAKE LIC # 29818
COMPANY . . . . . . . . . . : THD AT-HOME SERVICES, INC.
ADDRESS . . . . . . . . . . : 2690 CUMBERLAND PKWY STE 300
CITY/STATE/ZIP . . . : ATLANTA, GA 30339-3913
TELEPHONE . . . . . . . . : (510) 731-1004
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 016 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 016 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1WINREP EACH 8 1 . 00 392 . 00 0 . 00 392 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 393 . 50 0 . 00 393 . 50 0 . 00
P&?,�,RTVIENT
)N-U7-th 11110
"VED
c-,,io,,2 MUST be kept at the
ton. it is unlawful to make any
t'i.ins on same,or to deviate
approval from the Building Official.
T! ; Ct this plan and specifications SHALL NOT
)er,nit or to be an approval of the violation
pt,vislons of any City Ordinance or State LaWi,
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1 JIM YOU NT THD - At Home Services (North)
20200 PATRIC CT. S,�K, 2456 Verna Ct.
CUPERTINO, CA 95014 San Leandro, CA 94577
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333-building@cupertino.org
❑ ❑ ADDITION ❑ ALTERATION/TI O�
NEW CONSTRUCTION
❑ REVISION/DEFERRED ORIGINAL PERMIT#tt
PROJECT ADDRESS Z0 7 oO !��?LI c APN#
OWNER NAME J 1✓� � Yo U)J � PHONE /O E-MAIL
STREET ADDRESSCITY, STATE,ZIP FAX
ZO .oG I>A-T tzt L �-7. GcJTPL�-L1Ti )U G A . C) S o iL
CONTACT NAME J J I ti PHONE
` E-MAIL
STREET ADDRESS CITY,STATE,ZIP (j FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 1a CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
g36o-Z1 �, 1 Cl
COMPANY NAME E-MAIL FA
—THD oim cp-oIGC ,0 35 3�So
STREET ADDRESS �- CITY TATE,ZIP
PHONE 7 �SSO
ARCHITECT/ENGINEER NAME LICENSE NUMBER `f > / BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK I I r I t-
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
OCC. TYPE DES N SOXT, VALUATION
EXISTG NEW FLOOR DEMO TOTAL / CTU
AREA AREA AREA NET AREA OIL ,-
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH
❑ ATTACH
#OWFILINO I:NITS IS A SECOND UNIT Yrs SECONDSTORY OYES
aEINGADDED^ ❑NO ADDITION' ❑NO
PRE.APPLICNI ION ❑YIa IP YI:S PROVIDIS COPY OI; PLANNER'S NAMr RECEIVED BY: TOTAL VALUATION:
PLAN'N'ING APPI,# [-] NO PLANNING APPROVAL LEATER
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 1 have provided is correct. t have rea cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructio orize lepre ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: I
SUPPLEMENTAL INFORM QUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwell il pply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_20/l.doc revised 03/16/11