15100155I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20954 PEPPER TREE LN
OWNER'S NAME: DAVIDMURATA /+A * 5v,[ & 0 .—RA3j+
OWNER'S PHONE: 4083130588
CONTRACTOR: THD AT-HOMEI PERMIT NO: 15100155
SERVICES, INC.
2690 CUMBERLAND PKWY STE 300 1 DATE ISSUED: 10/20/2015
ATLANTA, GA 30339-3913 1 PHONE NO: (510) 731-1004
IQ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE (E) SIDING 3 SIDES OF (E) SFD, & REPLACE
License Class C 17 Lic. # 5 36e2– I WITH (N) HARDIE FIBER CEMENT SIDING (800 S.F.)
Contractor 7-12 -+1 (f-'Wf- Date
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
t
sation, as provided for by Section 3700 of the Labor Code, for the
ance of the work for which this permit is issued.
nd will maintain Worker's Compensation Insurance, as provided for by
3700 of the Labor Code, for the performance of the work for which this
s 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 relatin
to building construction, and hereby authorize representativesof this city t
upon the above mentioned property for inspection purposes. (We) a save
indemnify and keep harmless the City of Cupertino against liabilities, judgrnet�
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 upert!:7=1
18.
Signature
I hereby affirm that I am dstrmpt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three 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
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
Sq. Ft Floor Area: I Valuation: $11368
APN Number: 35913046.00 1 Occupancy "Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180
180 D�
ISSUANCE OR
1 INSPECTION.
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
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. 1 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, Sections 25505, 25533, and
Owner or author' gent:
Date: 1 � ��, S
ONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � r /0 61 (408) 777-3228 • FAX (408) 777-3333 • building(d�cupertino.org .`i
SB
s
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS O C 1�- A�
APN # C C� — t -:3, O -6
UW NER NAME`,, P ��., A?,
���
PFI
'3' • .99
I.-�1;�II
'1
o ! .
STREET ADDRESS
Z o c�2 /r2 L�1
CITY, STATE, ZIP
r��►,�D
FAX
CONTACT NAME JEFF RAINEY
PHONH510-427-4260
E-MAILJEFFREY. RAINEY@ATT. NET
STREET ADDRESS 1069 EDGEMERE LANE
_7
CITY, STATE, ZIP HAYWARD, CA 94545
FAX 510-783-1041
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR -11 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
'
836021
B,C39,C13,C17
COMPANYNAME THD AT HOME SERVICES
E-MAIL
FAX 510-783-1041
STREET ADDRESS 2456 VERNA COURT
CITY, STATE, ZIP SAN LEANDRO , CA 94577
PHONE 510 - 7 8 5 - 6 3 4 0
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
r2 (=�6_ r AJ -7 S1D/
11 z�Z /I — G U v ► V-- AAI 121 6 h
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE TYPE OCC.
I
SQ.FT.
VALUATION ($)
EXISTG
NEIN FLOOR
DEMO.
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UMTS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION?
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES BY:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME?
/ ( -3 6
By my signature below, I certify to each of the following: I am the property owner or authorize a 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 an 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 inspection purposes.
Signature of Applicant/Agent: Date: ?-c9 /l S
SUPPLEMMTAL INFORMATION ED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: A or demolition permit for
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
❑
❑
submittal of Building Permit application.
MAJOR
SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
CITY OF CUPERTINO
R�� FEE ESTIMATOR -BUILDING DIVISION
19ADDRESS:
20954 PEPPER TREE LN
DATE: 10/20/2015
REVIEWED BY: MELISSA
a
APN: 35913 046
BP#:
*VALUATION: 1$11,368
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
''himb. Insp. Fee
PENTAMATION 1GENRE
PERMIT TYPE:
WORK
REMOVE E SIDING 3 SIDES OF E SFD & REPLACE WITH N HARDIE SIDING 800 S.F.
SCOPE
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the DeDI for addn'l info.
FEE ITEMS (Fee Resolution I1-053 Eff. 7/1/13,
A.lech. Plan Check71-
-co,
Plumb. Purr Check
Flee. Plan Check
Permit Fee:
Fl
Plumb, Perinit Fee:
Islet. Permit Fee:
Ot/rcr Aaech. Insp' L_
),her Plumb Insl>
Other Elee. Insp.
A1ech. Insi, �� .'
''himb. Insp. Fee
Flea Insp. Fee. -
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the DeDI for addn'l info.
FEE ITEMS (Fee Resolution I1-053 Eff. 7/1/13,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
800 s.£
$646.00
Siding
1SIDEOTHER All Other
Suppl. PC Fee: E) Reg. Q OT
Q.Q
I hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OTTO-01hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
r�ttstr 2rt•'t= e .
t chl�inislr afire Fee:
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
O
i
""I'rxvel Doettinenlalion Fec �
Strong Motion Fee: IBSEISMICR
$1.48
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$2.48
$646.00
TOTAL FEE:
$648.48
Revised: 10/01/2015
y,Wv f. HLAiVS CH
DATE----�---
COMUNITY BUILDNG DIVISION ECU ERTINO NT EIV t �_tli��!{'
APPROVED CUP E�T DE
RTINO
This set of plans and specifications MUST be kA
lob site during construction. It is unlavfful to r�. t at��e
ct7ar ss or alter�,tiorts on same, or to d:�iz.'e
t�hor,:frc:;n, 'v�lfi,;?%l;t u-.-_1 t.
m
the Building Gi ,cis'
^ificatiors
-oval of ib < ci(
Zz- C)//
J
m
M
o
� z
m n
m o
D
Z
m
C-) o CO
CD T n
r- = O
3J W m
II Q:) CD
rn
n „ �
C W o
rrt 77
C"7 —
m Z
m
Z �
ci) co
m C/-)
F- O
rn C
C/) rn
K T
O o
O o
m
NO
DAVID MURATA NORTH SAY soul
10 THD - AT HOME SERVICES (NORTH)
20954 PEPPER TREE LANE (p VLYq+/H N MI(NEEU9 2456 VERNA COURT
m U CUPERTINO, CA. 95014 �„ ,, ; SAN LEANDRO, CA. 94577
0