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B-2017-0101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0101 10464 DEMPSTER AVE CUPERTINO,CA 95014-1225(326 48 026) THD AT-HOME SERVICES INC ATLANTA,GA 30339 OWNER'S NAME. PAYER JEANNE TRUSTEE DATE ISSUED:01/19/2017 OWNER'S PHONE:408-257-1140 PHONE NO:(770)779-1423 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 8:C-39:C-13:C-17 Lic.#8_36D21 Contractor THD AT-HOME SERVICES INC Date 04130/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MEECH 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 WINDOW(2}-LIKE FOR LIKE TO MEET EGRESS I hereby affirm under penalty of perjury one of the following two declarations: 11 1 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 ':p6rformance 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. , Sq.Fit Floor Area: Valuation.$1668.00 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 326 48 026 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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature �n.,.1119/2017 Issued by:AhbyA_ygride X Date:0119Z2017 I Thereby affirm that I am a in t from the Contractor's License Law for one of the RF ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: 1. L 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. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(Sco.7044,Business&Professions Code). Date:1/19/2017 1 hereby affirm under penalty of perjury one of the following three declarations, ALL ROOF COVERINGS TO BE CLASS"All OR BETTER 1. 1 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 I Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. owner or authorizedagent* APPLICANT CERTIFICATION 'bate:1/1 912 01 7 d"ING AANCY I certify that I have read this application and state that the above information is CON�1 RUCTION I hereby affirm that there is a constructidn' ung agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(See.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal -- 1 understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 1119/2017 Professional III 'Mot ,gni. 1 0 l CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ig10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPER T;#NO (408)777-3228•FAX(408)777-3333•buildingecupertino org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 1 J ` JAPNff j 02(o OWNER NAME v )r Cr. �ll(1 (awry Jd ��imp �� PHONE R 2-5 7' I/-T 0 &MAIL STREETAD®DRESS ��/A� �y s CITY,STATE,ZIP B �7 G� ® YJ Dc 14{ TER C- CITY, e-/t / ®/ FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAIL JEFFREY. STREETADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP FAX � HAYWARD, CA 94545 510-783-1041 y ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ` 1 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 1:1 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# 2q 1 836021 B,C39,C13,C17 COMPANY NAME E-MAIL FAX THD AT HOME SERVICES 510-357-3750 STREET ADDRESS CITY,STATE,ZIP PHONE 2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4550 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK J(,J_1)aJ 5 —,L)o 5f2-45— C EXISTINGUSE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG 7AREA OR DEMO TOTAL AREA AREA NET AREA BATHROOMTCHEN OTHER REMODEL AREAEMODEL AREA REMODEL AREA PORCH AREA DTOTALDECK/PORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: A SECOND UNIT ❑YES SECONDSTORY ❑YES ING ADDED? ❑NO ADDITION? [:]NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NOv. 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 cons ' orize representatives of Cupe#il 01V-e—nter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ( tel SUPPLE AL INFORMATIO D I'urtcHl crcxrE xiuTlivc stirn _New SFD or Multifamily dwellings: A or demolition permit for x ovvrrRR�t GozIN BT[LDII� PLANItEYIE�v existing building(s). Demolition permit is required prior to issuance of building permit for new building. ©` $ p rz aIG rI�nsl Rvvv . _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Cl SIANDAIID Q rul3Mc wos form if any Hazardous Materials are being used as part of this project. ' r {:�'LAR�R II"Ji7R�DEPT' _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ' submittal of Building Permit application )°R sANi? ?sl t &Dts'rMG, CI=ENVRn1�IWIT NTAI IUA7.'�H B1dgApp_2011.doc revised 06/21111