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12020101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10279 BYRNE AVE CONTRACTOR:THD AT-HOME SERVICES, PERNIIT NO: 12020101 INC. OWNER'S NAME: JUDITH STARK-MODLIN TRUSTEE 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:02/22/2012 OWNER'S PHONE: 4084101434 ATLANTA,GA 30339-3913 PFIONE NO:(510)731-1004 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License ClassC Lic. ��z iLIEC;H RESIDENTIAL COMMERCIAL ContractorTOP A'T At �7�� ate � Z�-I �Z.— I hereby affiriu that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL 3 WINDOWS AND I PATIO DOOR. NO BEDROOMS. (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$4313 Section 3700 of the Labor Code,for the performance of the work for which this pennii:is issued. APN Number:35711018.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon(lie above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Z"Z 9.18. Issued bye Date: Signatur Date 2-:2- 0 'Z❑ `NE LDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my ernployees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I liercby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSCIRE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 695 of the Compensation,as provided for by Section 3 700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work lir which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the perfortuance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or autho become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY a construction lending agency for the performance of work's APPLICANT CERTIFICATION I hereby affirm that there is I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: TraciC COPY # Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35711018 - 00 DATE ISSUED. . . . . . . : 02/22/2012 RECEIPT # . . . . . . . . . : BS000016084 REFERENCE ID # . . . : 12020101 SITE ADDRESS . . . . . : 10279 BYRNE AVE SUBDIVISION . . . . . . : CITY . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . JUDITH STARK-MODLIN TRUSTEE ADDRESS . . . . . . . . . . 22448 ST ANDREWS AVE CITY/STATE/ZIP . . . CUPERTINO, CA 95014 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- IBCBSC VALUATION 4 , 313 .00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 4 , 313 .00 0 . 50 0 . 00 0 .50 0 . 00 1WINREP EACH 8 4 .00 392 . 00 0 .00 392 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 393 .50 0 . 00 393 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 589 .00 43147 --------------- TOTAL RECEIPT 589 .00 D' Q� CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10279 byrne Ave. DATE: 02/22/2012 REVIEWED BY: gs APN: 15 BP#: VALUATION: 1$4,313 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex PENTAMATION 1GENRES USE: P PERMIT TYPE: WORK Install 3 window and 1 patio door. No bedrooms. SCOPE NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on therelinina information available and are o!!!E an estimate. Contact the De t Lor addh I info. FEE ITEMS (, 1`1 FEE 1_'-t15 ':'�. i% FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 4 # Window/Sliding Glass Dour Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $392.00 1 t,INREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT O,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? j Yes G No $0.00 G _?b;r= t, =r;; r 1- $0.00 Select a.Non-Residential Building or Structure 0 5 tufo t l,o Fere: 1BSEISAECR $0.50 Select an Administrative Item I I t d s_Co ii—in_ssi—o 'fie; IBCBSC $1.00 SUBTOTALS: $1.50 $392.00 TOTAL FEE: $393.50 Revised: 1/19/2012 Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10 c3 PERMIT# OWNER'S NAME: t7 0140DvJ PHONE# GENERAL CONTRACTOR:TH D z hr BUSINESS LICENSE# ADDRESS: 2--f56 L- L?, CITY/ZIPCODE: S �✓ G-c�.cJ,� 9 77 *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: 4 y `�— Si a Date Please check applicable subcontractors and ete the following information: V 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 Ow for Signature Date RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. J Project address. I 0Z 7 9 YZA /w F Contact person. 5 c/z)e� t�E Y CS l 1� Phone. S 1 ` 7 S ' 63 40 Fax. S 7113 -to 41 Net square footage of lot. Existing Frowsed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spco� siclt � gate Y;' 1V V I�' 611 Is privacy protection planting requiredfo�project?; Build it Green Total Points :i 11 ti ^" � � � On what floor(s) is work being done? Brief description of work. I/J 5-TA-1 I -TH2e'-C t" t�17 Ct-t�h�� E, 1�ti i n1 !I i'►ld �z�t2S ��� ��h213o,,� Code editions: 2010 CBC . (IFY—)N)2010 CFC (Y- N) C (Y-N) 2010 CPC (Y-N)2010 NEC (Y-N) California Green Building Standards Code 2010 doo 301iio Effective 1/01/11 ,r Plan Review Process Work Book Page-8- Revised 12/21/10 1 CONSTRUCTION PERMIT APPLICATION (�N COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ') Y 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n �/ (408)777-3228•FAX(408)777-3333•buildin @cup_01in0.0rg LI (/ CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# E _PROJECT ADDRESS 1 APN# Oz� � t PHONE E-MAIL OWNER NAME �'/ 1/ /' 1 ✓ + ^l 401? D I CITY, STAT IP r FAX STREET ADDRESS 02 �'1Z�.it Gt2�r�J C> C A _ �j�G l'� E-MAIL CONTACT NAME L Z r j t T_ STREET ADDRESS• 7 AlJ CITY,STATE,ZIP �L J(-7 FAX11 /D 3, 1 0 q Z�1 SCo l�ci�.j A_ 5 E'7 14�; L_c^�P�� �h I 7 ❑OWNER ❑ OWNER-BUILDER OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT \ CONTRACTOR NAME ^ LICENSE NUMBER LICENSE TYPE BUS.LIC# J ij rT�.� L� 836021 B,1239,C13,C17 E-MAIL FAX COMPANY NAME 510-783-1041 THD @ HOME SERVICES CITY,STATE,ZIP PHONE STREET ADDRESS SAN LEANDRO,CA 94577 510-877-4550 2456 VERNA STREET [COMPANY CHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# NAME E-MAIL FAX CITY,STATE,ZIP PHONE REET ADDRESS DESCRIPTION OF WORK c T �il —7 AJ r7 1 U r 7�;Z CFF A-AJ&e S . EXISTtNQ USE PROPOSED USE CONSTR.TYPE #STORIES N Y 1 CTYPE DESCRIPTION so, VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA A NET AREA BATHROOM KITCH i I OTHER REMODEL AREA REMOD A A REMODEL AREA PORCH AREA DECK AREA TAL DE K/PORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? MNO J V LUATION: PRF:-APPLICA'nON ❑ YES IF YES,PROVtDF:COPY OF PLANNER'S NAME RECEIVED BY: ToBkLPLANNING APDL b NO PLANNING APPROVAL LF."ITER By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac 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 . n. I authorize represen of Cupertino to enter the above-identifiedproperty for inspection purposes. Date: Signature of Applicam/Agent: SUPPLEMENTAL INFO TI _ D PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwell "Apply for demolition permit for ❑ OVER-THF COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building ❑ EXPRESS ❑ PLANNING PLAN REVIEW permit for new building. _ ardous Materials Disclosure ❑ STANDARD E] PUBLIC WORKS Commercial Bldgs: Provide a completed Haz 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_201 1.doc revised 03/16/11