12040102 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 11612 SEVEN SPRINGS DR CON fRAcIOR:TFIDAT-HOME PERNDI'No: 12040102
SERVICES, INC.
OWNER'S N'ANIE: WEI TEK C AND SUSAN S 2690 CUMBERLAND PKWY STE 301 D:%rE ISSUED:04/18/2012
OWN'ER'S PUONE: 4084462967 ATLANTA, GA 30339-3913 PI ION NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PF:RNII'I'INFO: WAR; F-
PLu>ni
I.icense Class CI-7 Lic.N 3�� Z j r r-
-THD
r
\ 11 � C[ )IECII RES]DEN I IA 1. COMMERCIAL
Conlncclor �NL /}n I�ot'IF�L12�jciDa[e ��
:
I herrhy affirm That I am licensed under the provisions of Chapter 9 .IOB DESCRIPI IONINSTALL I REIROI'1'f WINDOW
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
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
Coin pen sat inn,as provided Ibr by Section 3700 of the Labor Code,for the
perlimnance of the work for which[his permit is issued. Sq.FI Floor Area: Valuation:S1230
I have and will maintain Worker's Compensation Insurance,as provided for by
tiection 3700 ol'Ihe labor Code,fix the perf"ormance of the w/(hitsCfty
this \pN Number:36654015.00 Occupancy I\'pe:
Permit is issued.
APPLICANT CERTIFICATION
I ccnify that I have read this application and state that the abois PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply'with all city and county ordinances s relating WITHIN I80 DAYS OF PERMIT ISSUANCE OR
to buil Jing construction,and hereby authorize representatives
.of
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS.FROM-LAST CALLED INSPECTION.
indemnity and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which mut'accrue against said City in consequence of the (i _
graming of this pemnit Additionally. !1',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 Dale ZS / All roofs shall be inspected prior to anyroofing material ligate installed. Ifa will is
installed without first obtaining an inspection. I agree to amore all new materials Ibr
inspection,
❑ OWNER-ISUILDEai DF:C,1..\RATION
Signature of Applicant: Dale:
hereby affirm that l am exempt from the Contractor's License Law'for one of
the following two reasons: ALL ROOF COVERINGS"1'0 BE CLASS"A"OR BE 1-1 ER
1,as owner of the propernl or m}employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044.
13usincss&Professions Code)
I,s owner of[he propen)',am exclusively contracting with licensed contractors to HAZARDOUS NIA'ERI.ALS DISCLOSURE;
construct the project(Sce.7044,Business&Professions Code), I have read the hazardous materials requirements under Chapter 695 of the
California Ileallh&Safety Code.Sections 25505,25533.tend 25534. 1 will
hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal(:ode,Chapter 9.12 and the
declarations: 11ealth&tiafet% Code,Section 25532(1)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally.should 1 use equipment or devices which emit hazardous
Compensation,as provided for b)'Section 3700 of the Labor Code,for the air contaminants as defined by the Ray Area Air Quatily Management District
performance of the work for which this permit is issued will maintain compliance with the Cupertino Municipal Code.( Ice 9.12 and
I have and ,ill maintain Worker's Connpnsation Insurance,as provided fur by the Ile:dth&Safety Code,Sections 25505,25533,an
Section 3700 of the Labor Code-for[he-performance oflhe work for which this
pernnil is issued. Owner or authorized age m, Date:u 10
2
I ccnify that in the pert'omance of[tic 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 ill'California. H- after making this eenificate of exemption,I CO.\ '""24 IN' LFXDIxf:%f: :NCI�
bee1111IC subject to the Worker's Connpensa[ion provisions of the labor Code,I must I herch)'affirm that there is a construction lending agency for the penimtlancc of
limhwith amlply with such provisions or this permit shall be deemed revoked work's for which[his permit is issued(Sec,3097.Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I cenil}'[hill I hacc read this application and stale that the above intbrmation is
correct. I agree to comply with all city and county ordinances and sate last's relating
to building construction,and hereby authorize representatives ol'[his city to oder
upon the above mentioned property for inspection purposes.(We)agree to save ;U1CI11'1'EC'I"S DF.CI„\It,\TION'
indemnify and keep harmless the City of Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall he used as public records.
granting otlhis permit,Additionally,the applicanl understands and will comply
with all non-point source regulations per the Cupertino Municipal Code.Section Licensed Professional
9.18,
Signature Dale
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN 36654015. 00
DATE ISSUED. . . . . . . : 04/18/2012
RECEIPT 4 . . . . . . . -. . : BS000016570
REFERENCE ID # 12040102
SITE ADDRESS . . . . . : 11612 SEVEN SPRINGS DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WEI TEK C AND SUSAN S
ADDRESS . . . . . . . . . . : 11612 SEVEN SPRING DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5125
RECEIVED FROM . . . . : PERMIT SERVICES INC
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, 230 .00 1 . 00 0 .00 1 . 00 0. 00
1BSEISMICR VALUATION 1, 230 . 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CU PERTINO (408)777-3228•FAX(408)777-3333•buildina(aDcuoeAino.orD /l/ / \ I
❑NEW CONSTRUCTION
� 1❑ ADDITION c ❑ ALTERATION/TI ❑ REVISION/DEFERRED
[.,[ORIGINAL ITRmi r 9
PRI lfT 1-2- 5CVCN s�l lA\ 6 J D2. AP+Ip /�w7 / I OI /'
D„',r.. /F`` /,.) �I 1 /}� 1/ ( I/"1409 -EI z-L '7-/7 CE.,,,\II. /
NINI:Er A[IIIROSIZ rtir-) -5 /`rN6I Prl CITW.-LIZ 7/�� C/Y / JOil4 1=A\
CONL\CT NAMME +� L/ PII NF 2? (-
1 16
_ ` /U O E-MAU.
STREET ADDRESS ` /r CITY,STATE. ZIP FAN
ro 9 e�G€fart c�J LJ t� CA
13 011\'1,.R ❑ OWNER.BUIWER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEYF'I.CWIE ❑ ml4\N1
CONTRACTORNAME LICENSE NUMBER LICENSETYPIBUS LIC-
836021 B,C39,C13,C17
COMPANY NAME E-MAIL FAN
THD B HOME SERVICES 510-783-1091
SIH EET ADDRESS CITY,STATE,ZIP PHONE
2956 VERNA STREET SAN LEANDRO,CA 99577 510-877-9550
ARC]IITECTIENGINEER NAME LICENSENUMBER BUS Lic-
('OMPANY SAME E-MAIL FAN
N I RRI:T ADDRESS CITY.STATE.ZIP PHONE
DESCRIPTION OF WORK
I �lit'C-L On�� 20 i—r7 IJ (A DIc n)0 rz-C—
4fiA ✓ E .
IAISTIN'C ISE PROVOS O/USE CONST R 'PE ii STORIES OFFICE USE N Y
F/7 r I OCCTYPE DESCRIPTION FT VALUATIONS)
:CISIG NE\t'FLO(]ft DEMO TOTAL
ARIA AREA AREA NET AREA
BATHROOM KITCHEN
RIiMODFL AR GI REMODE REMODELAREA
PDRCUAREA DECK TO TAL DECKrvORCH AREA GARAGEARFA' ❑ DETACH
_ ❑ ATTACH
\'1111\I:I\IIS IsASEC UNIT E]VI''X MODI.STnPY 01'1_
RCING AOOED' tI ADDITION' (1
Ili- Ill rnuo. ❑ vls ¢\I Px nll crlwv oP 1n.ANTI,x'FNn\II' RECE VEDBY: TOTAL } IqO _
I \ \I'I'I.e I'I, NI.'' INII\'r\I.II:I'IlN / ✓/i
Ily my sibmamre below.I certify to each of the following: I am the property owner or authorized agent In act on the property owner's behalf. I have mad thie
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 withal]Dpplicablc local
Ordinances and state laws relating to building eonstructi msentatives o'Cupertino bo\'aidcrili(fe proper) Ibr inspection punnlse..
Signature of Applicant/Agenu Date: —f I
SUPPLEMENTAL INFORM ATI D
PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: py for demolition permit for
OVER-THE-COUNTER ❑ BUILDING PLAN Rt:1'I E\\'
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. El EXPRESS ❑ PLANNING PLAN REVIEW
1
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '❑ STANDARD EI PUBLIC WORKS
form if any Hazardous Materials are being used as pan of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to 1:1 MAJOR El SANITARY SEWERDISTRICTsubmittal of Building Permit application.
❑ ENVIRON'MENTAL IIEAI.T It
BrrlgeIpp_20/I.doc Jet iscd 014//6//I
PROJECT INFORMATION TABLE OF CONTENTS
s
OWNER INFO PROJECT ADDRESS T-I TITLE SHEET
0
SUSAN WEI 11612 SEVEN SPRINGS DR. A-1 FOOTPRINT Z
11612 SEVEN SPRINGS DR. GUPERTINO, GA 85014 N
GUPERTINO, GA 85014 PHONE: 408-446-268_ v L0
CONTRACTOR PROJ. #: 6180688 LEGEND .0 rn
THD @ Home Services (North) (510) 8"11-4550 N Q
2456 Verna CA. Walls U) .- V
San Leandro, GA 8451-7 N V
Field Inspector - ERIK HERNANDEZ ® New Window F= O
Drawn b - 5uzy Raine (510) 185-6340 = C C
SCOPE OF WORK WINDOW STYLES Q N M
Installation of I retrofit replacement windows. > J
3PNL - 3 PANEL SLIDER 0 � C
�(SEE LIST BELOW (6 N fn
WINDOW SPECIFICATION SHEET
EXISTING T NEW « MEETS
#1 LOCATION WIDTH HEIGHT # LOCATION PLR. STYLE WIDTH HEIGHTEOPESS
I OININe. cl 58 1 11 DINING I I I 51-NL 94 55 Y Q'
COMMUNITY DEVELOPMENT DEPARTMENT _. Z
BUILDING DIVISION-CUPERTINO R LO
LO
APPROVED 1�CMV_RD U), Q.
This set of plans and specifications MUST be kept at the APR 18 2.012 ZU
Job site during construction. It is unlawful to make any W 0
changes or alterations on same,or to deviate �Y j w Z
therefrom,without approval from the Building Official. BY: �
The stamping of this plan and specifications SHALL NOT N
be held to permit or to be an approval of the violation lf� CorAtr dof CD
any provisions of any City Ordinance or State Law. PEKE If my
BY �AN �DSLLLL (�
DA T .. 4-14-12
PERMIT NO. O
^ S.rial
TITLE SHEET 61
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N WEI THD - At Home Services (North)
D SEVEN SPRINGS DR. 2456'Verna Ct.
RTINO, CA 95014 San Leandro. CAI 94577
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