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11080162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21074 GARDENA DR CONTRACTOR:THD AT-HOME SERVICES, PERMIT NO: 11080162 INC. OWNER'S NAME: BARCLAY SCOTT AND SUSAN 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:08/22/2011 C 7R'S PHONE: 4084463953 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004 LICENSED CONTRACTOR'S DECLARATION // BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G .7 Lic.# 9 360? Ir C, -IC-cs MECH RESIDENTIAL COMMERCIAL Contractor I tAT-> /tJ f40pir �K Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL FIVE(5)NEW RETROFIT (commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS,NON-STRUCTURAL,FOR SINGLE FAMILY DWELLING 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:$11016 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32608011.00 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 the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 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 9.18• Issued "�� Dater 2-2 `4( Signature Date L O - UILDER 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. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for 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. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air 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 performance 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 o 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 APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 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.I 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 it' •inify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gi„wing 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 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32608011. 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014520 REFERENCE ID # . . . 11080162 SITE ADDRESS . . . . . : 21074 GARDENA DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BARCLAY SCOTT AND SUSAN ADDRESS . . . . . . . . . . : 21074 GARDENA DR 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 016 . 00 1. 00 0 . 00 1 .00 0 . 00 1BSEISMICR VALUATION 11, 016 .00 1. 10 0 . 00 1 .10 0 . 00 1WINREP EACH 8 1 . 00 392 . 00 0 . 00 392 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 394 .10 0. 00 394 .10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 394 .10 #42413 --------------- TOTAL RECEIPT 394 . 10 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION its ADDRESS: 21074 gardena dr. DATE: 08/22/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$11,016-� °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK install new five new retrofit windows non structural for sfd. SCOPE F-1 _L_ NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addh 7 info. FEE ITEMS (fee Resolution 1l-053 fj FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $392.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 i Strom Motion Fee: IBSEISMICR $1.10 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 _71 SUBTOTALS: $2.10 $392.00 TOTAL FEE: $394.10 Revised: 07/04/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building Okupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ffALTERATION/TI ❑ REVISION/DEFERRED //O'��RIGINAL PERMIT# ,p PROJECT ADDRESS Z'O , 6 A �r I ^ _ # /!� APN t y(" C) OWNER NAME 5�� A) d gC (('4t PHONE �r y7 t ,I/ q MAIL STREET ADDRESS /`7 LI ( C[TY;STATE,ZIPv�f C`lA`wCl 4 FAX I ' 7f (� �L n1/� P/Z -,t ,s -r t.J u rl CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# 836021 B,C39,C13,C17 COMPANY NAME E-MAIL FAX THD @ HOME SERVICES 510-783-1041 STREET ADDRESS CITY,STATE,ZIP PHONE 2456 VERNA STREET 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 � 5.1 A'1 ( F 1 J� iZ�I� i�'J r,J r� ��,)� l..,' i� ►r1 J . fv� �►Z-t 16 EXISTING USE _ PROPOSED USE CON1STR,.JE #STORIES NLY v�l Y TYPE DESCRIPTION SO.FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA-1 GARAGE AREA: ❑ DETACH ❑ ATTACH F IriVI:I1,IN6l\I'FS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? NO ADDITION? NO I'KI�V'PI.1c'A'IION ❑ YL'S 11;YES,PROVIDE COPY OF PLANNER'S NAME'. RECEIVED BY; AL �UATIOC� PLANNING APDL# ❑NO PLANNING APPROVAL LETTER " I By my signature below,I certify to each of the following: I am the property owner or authorized agent to ct on the property owner's behalfI 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: �/ 2-2—/ / SUPPLEMENTAL INFORMATION D PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: or demolition permit for VER-THE-COUNTER If-BUILDING PLAN REVIEW 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 03/16111 LLS-V6 VO `oapuea-� ueS ��056 dO `ONll�l3d(10 '10 euaan 99trZ 'iia `dN3(RJV0 tILMZ 04JON) SGOINOS GWOH Ib - aHl AV-1MAV9 Nvsns a i Q �N Wz �o r`N Q k,�- NQ 3 p W w� Z �- W� �c� E- F- 7�5 J • w WWd) WQ� v z W W Z �tl =m o W<a . W W Z-1 J LLJ J ~LL LL, Lu Q zz �n D- 3 �- Q W zz = m IFS oma° I) 6 N N J Q W Z K Q W 0�`" gClw 0 ,n m v _ Wn LL = W F=LU JHJ O �-- W W Q I I I LL A W Z J z • • • _ Z Z D- CL [n p zm Nz 0 W JJ J c kD m m - o oW _ Z � � if1 LU O 0 ,� G� W Lf) Q) — Z N N f(1 Q d m U- p # # �fir: O � � dlrr- � W voZ � oL c d F- < <(f) o ? N -1 m m m c v Lu v U- t- O O � wrin m � ) Nu 3 O LU z O o04 CLIL w a z z z r- � Q3 � o � oL o0 v q) ct W _ W I N � z Z z � � q) CL m uv Q Q < - - - - - W Q vuj 0 = N � 9 o m Z W Z Q QO v � � " 3 O p O U m0 � LLr) c: — a w 6 XQ 7 W z � w_ a - — w � Z LU Q W H H N LL 0 6 () L � � z � p � � v � � Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 'ZI0241 G,/r izDE-.J A IZ PERMIT# b / 2 OWNER'S NAME: 5L)5A-^) , 'Z `t. PHONE # 6q• L4q 6 i 3 S -3 GENERAL CONTRACTOR: 'TH(: 7 Ho C 42✓sir BUSINESS LICENSE # ADDRESS: 2-Lf 00R,-J,+ CITY/ZIPCODE: G Say *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. ?� Q/ I am not using any subcontractors: i re Date Please check applicable subcontracto omplete 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 O r/Co ctor Signature Date