11070045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7643 SHADOWHILL LN CONTRACTOR:THD AT-HOME PERMIT NO: 11070045
SERVICES,INC.
:-"VNER'S NAME: LYNN CHIEN 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:07/08/2011
iNER'S PHONE: 873-8888 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
NON-
License Class G"3� C i 7 Lic.# O�- INSTALL 10 WINDOWS AND 1 PATIO DOOR NON-
c- 7 STRUCTURAL
Contractor I Dates 1 ►/
I hereb rrm that _lieerised under the provisions of Chapter 9
(commencing ction 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:$7701
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. APN Number:36225013.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating `7tj7ITPIN-18e"DFAYSeF-p�RMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter =`t
upon the above mentioned property for inspection purposes. (We)agree to save 180 D �FROM LAST CALLED INSPE�7TON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,
costs,and expenses which may accrue against said City in consequence of the
Date: 1y1/1�
granting of this permit. Additionally,the applicant understands and will comply Issued by:7;
with all non-point source regulations per the Cupertino Municipal Code,Section /' y
9.18.
RE-ROOFS:
Signatur Date 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.
❑
OVi< LDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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. I will
I 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 I
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
Owner or authorized agent: Date:
permit is issued.
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 CONS CTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I 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 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
-non 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
_.,sts,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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36225013 . 00
DATE ISSUED. . . . . . . : 07/08/2011
RECEIPT # . . . . . . . . . BS000013994
REFERENCE ID # . . . : 11070045
SITE ADDRESS . . . . . : 7643 SHADOWHILL LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER LYNN CHIEN
ADDRESS . . . . . . . . . . : 7643 SHADOWHILL LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
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 7, 701 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 7, 701 . 00 0 . 77 0 . 00 0 . 77 0 . 00
1WINREP EACH 8 11 . 00 522 . 00 0 . 00 522 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 523 . 77 0 . 00 523 . 77 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 523 . 77 Visa
---------------
TOTAL RECEIPT 523 . 77
CA $�0 wo��®v MVS bek�a e any
nd sPec`ticatto onlao to d$�vate
s a n ,t oti��a1.
t of Pian o�stNt ons on C tre 0°i1d�n9 NST
V1s ss e dUCer9or altera ��horn
°b �ar`v t Soto tions S v\O anon
c mW�thou and SPec��a\oA ttre to�-aw' +
tneretr° of this Ptanbe an aPP. ancg or Stake
'tavloog o or to COM Ord\t\ ,
11'e v ed to P� of asl`1
be h Dov\sons
of any P G(
ON
00.
O �
-0
(- a
Z P
r .a'
t
W �
D
0 G
_
�= r
r <
r �
z �
O �<
i
p a
M 3
A ? N
x
N
O LO
0
$ a LYNN CHIEN THD - At Home Services (North)
a o N 7643 SHADOWHILL LANE `,Z 2456 Verna Ct.
W -
CUPERTINO, CA 95014 San Leandro, CA 94577
#
r U] 7� —n QJ U7 Q] 3 3 r n OZ � � Z Z
-i D =i� << D M M D 03 03 O N fl O -p N N -I M � Z ffl
r 1 2z3100 � yrnn M � _. _
z = = r ;u 73 = -+ 111 M fl -D (D fl -N
rn �► N Zni ni -< 1S M= Q -4X r rll fl Q � � U > —1D = —
_ 3 333cuN 3 � NiNi � � � � (D < � OI � OZrn
rn � Z
a � � oZ -o -oZZ T N ° n � O > O
z zrzrz r- r- M Arn rrn
J N cu -4 -4 UJ J J uJ uJ J Q 9 A N
r N N -A 6` 0` CP N N CP CP N = (0J Z Z
N
K' rn -d = p 11
Z M -0
ti CP C)1A �A -. N N -. L Z 0% Z Q M u
p p 3 z �- CPU' D
0 � -� _ /o
z o Zy p -i
0` �) N N 4 ud W CP CP UJ = O N 111 CP O fll Z
QP Qp _
= O J a` V 4 UJ N - # (J1 Z O J D r
E: p] 7� r_ r_ QJ Ql a) 3 3 r O N QPJ J r D
< D -i < < D M M y QJ N
Zrnzz � � � � � � n fl ODS
„ _
N ni Gl � 3 3 = -Di rn V' �' M %0
3 z 3 3 A ru
cu rp n p O (n
3 z > N
-_I O N
O
O z z z z z z z z z z Z =
rrrr rrr- r r rr- rnrn
ru
ooti � $ � JJUUQ
y
ul
rN -- A. � -A UJ UJ J J u9 Z Irjl
M Q r
i1 r Z
=ym- A 4 N 4 -4 -1 i r 0 M -11 :j O
rn OM. N 0
1Z
D �y T�1 N N N N p �p M
A . �_ z rn un
n rn m M O rn
rn
N
NA�� z z z z z z z SAM
R ZNA D D D D D D D Nrn A
p-i zrn NN
NA
A LYNN CHIEN THD - At Home Services (North)
P 7643 SHADOWHILL LANE 2456 Verna Ct.
w CUPERTINO, CA 95014 San Leandro, CA 94577
X..
-41
U, c
c
D m;0 14
--I rn
rn 42" TO SILL ,
3
D
M
M
� O �
.3 O rrn
N
M —-- o X_
Q N (Jl
3 z Q) rZ
� z
rn
O
3
UJ Y
i
ONINDaO Ol ONGcJ0 Ol
-1:j N0'6
b-b N`dHl SSA-1
$ LYNN CHIEN THD - At Home Services (North)
z
o 7643 SHADOWHILL LANER 2456 Verna Ct.
J CUPERTINO CA 95014 San Leandro, CA 94577
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(o)cugertino.org 1116700 /C�
CUPERT{NO `t,! (,Jv—!J
❑NEW CONSTRUCTION ❑ ADDITION TR ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 760
0 5�+A DO&i'ri l L-L L_,4.Jr APN# ' n
OWNERNAME I t� - I-1 /`, 1 'c,�I PHONE 04q . V73 W E-MAIL .
STREET ADDRESS -7I/ ,j C�t �' 1 l�I ' I G CITY, STATE,ZIP Peiz// 1 O C 0/ FAX
CONTACT NAME V L t/�L PHONE/O Z?. L1� O E-MAIL
STREET ADDRESS /06/ TI\`__MC9 L CITY,STATE,ZfP� CA
FAZ�2-P i `d 9 93, /O I
11 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR $'CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER�❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSEER (CENSE TYPE BUS.LIC#
6 C-3 c r c 17
COMPANY NAME AX
�nD Q� Om� E-MAIL FS/O ,
STREET ADDRESS L�� 2 CO
2', i /+` , 1 e ,J CITY,STAT ,ZIP PHONE J 7
/T — Si p 0
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
DM x, .
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES F
E D N SOFT. VALUATION
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODELAREA
PORCH AREA DECK AREATOTAL DECKTORCH AREA GARAGE AREA: ❑ DETACH
❑ ATTACH
#DWELLING LTITSIS A SECOND UNIT ❑YES SECOND STORY [3 YES
BEINGADDED? ❑NO ADDITION' ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE.COPY OF PLANNER'S NAME: RECEIVED BY: TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LErI'ER
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. 1 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 constr uthorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: r
SUPPLEMENTAL INFO N REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
❑ EXPRESS ❑ PLANNING PLAN REVIEW
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E] STANDARD ❑ PUBLIC WORKS
T—=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