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11060217 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10640 JOHNSON AVE CONTRACTOR:THD AT-HOME SERVICES, PERMIT NO: 11060217 INC. OWNER'S NAME: KOH CHU KENG 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:06/28/2011 f ?R'S PHONE: 4085949834 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004 LICENSED CONTRACTOR'S DECLARATION F_ ELECT BUILDING PERMIT INFO: BLDG ELECT PLUMB License Classc 3� C 13 Lie.# j G 0 L GI / It MECH RESIDENTIAL COMMERCIAL Contractor Date (9 Z 1 hereby affirm t�etio, sed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL 9 RETROFIT REPLACEMENT WINDOWS. (commencing 0)of Division 3 of the Business&Professions BEDROOMS MEET EGRESS Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declA0 _ 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2535 permit is issued. APPLICANT CERTIFICATION APN Number:37528024.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS Or LAST CA ED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section / 9.18. 1� Issued Date: Signature Date LER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or aut i d agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: (O / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save ir' -nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g�, ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37528024 . 00 DATE ISSUED. . . . . . . : 06/28/2011 RECEIPT #. . . . . . . . . : BS000013910 REFERENCE ID # . . . : 11060217 SITE ADDRESS . . . . . : 10640 JOHNSON AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KOH CHU KENG ADDRESS . . . . . . . . . . : 10640 JOHNSON AVE 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 2, 535 .00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 2, 535. 00 0 .50 0. 00 0 .50 0. 00 1WINREP EACH 8 9. 00 506 . 00 0. 00 506 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 507.50 0. 00 507 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 507. 50 VISA --------------- TOTAL RECEIPT 507.50 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10640 johnson ave. DATE: 06/28/2011 REVIEWED BY: bobs. MIAPN: BP#: 'VALUATION: 1$2,535 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK install 9 window replacement non structural. SCOPE Lj I Li I NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 119-051 1.: ': T'[,"10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. 0 F0.0OThrs $0.00 $506.00 1 wINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.4@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (F) No $0.00 0 Work Without Permit? 0 Yes E) No $0.00 G PlanningFee. $0.00 Select a Non-Residential E) Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.50 $506.00 TOTAL FEE: $507.50 Revised: 04/29/2011 Z � 3 Q, \A -� G _d o � � � r TV r � z O n n D z L 2 z E Z D rn z o N N N PS 3 e�7 O V Y Th c cEat f rn rn 1 Cs tl%l as or alt6ratlilfly tri Sc." C1 rn therefrom,without appy oval frorrr tra The stamping of this plan and spec=fications SHALL i`,I':)T x ba held to permit or to be an app-oval of the Bio'-:tun of any provisions of any City Ordinance or State Law. BY Std C, DATE ' L PERMIT NO. (19 CHU KENG KOH = THD - At Home Services (North) o N N 10640 JOHNSON AVE. _ 2456 Verna Ct. CD n co M CUPERTINO, CA 95014 San Leandro, CA 94577 A vary - u N 0no00 r r < O N fl 0rn frTl 0 = 0Zyrn M � (D�� = ALM tTl 3 - 3 -1X oz — U' N tt3oN NQ) � � �� � (� OzQ) Z rn z � o rn � Nfl < _ � . 7 o O O rn - � Z � ^ � ADL 3 70 AZ = zz z rr r rnnl = Q ;u M n (D (D T Z Z -13 LC z � � 3 z 2d( 3 7�(I Z u _' O O =� u rn z h � � � � O �. nN n W DOzrn O Owl p ul Ml- (3U, z o --I (J) � yz sqµ MD � ` r0 rn :3 J � < p rn Z — 3 --i _� u1 ° ra �O r.#i 3 z n O N D D N N 31- — — — r- �rwcA - QM N DC zzz z � rnf=11 rn rn r° � Z UUj u� a -, � _ D o - - 4 rn z 3E-� ul r- irr- �Mzrn M = D rn c rn z g p N � -i � - rnp� NAp .. O � Jrn nl ��q M:K 20 N 0 -1 ON c Z N (D fl UZ fTl O -1 lP Z ADrn Arnrn f f Z rn rn rrNnO Z r N rn MZ N A rrnn rn r N Q c N N 0 3 Q O U-4 2M -C D D N rni /� �A NN KELLI WATSON THD - At Home Services (North) 246 PALMA ST. 2456 Verna Ct. I _ W ` J EL GRANADA, CA 94018 San Leandro, CA 94577 N Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: J0410 JopA50,jE PERMIT# OWNER'S NAME: C q CJ • EI.1� GH PHONE# 404� GENERAL CONTRACTOR: -T�,tT HOMC BUSINESS LICENSE# ADDRESS: 2,456 �'7z,J,+ �'1 CITY/ZIPCODE:.$ '� 457 *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: ature Date Please check applicable subcontractors and complete the following information: 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 tractor Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildincl a.cupertino.ora ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALryPErrr�RMIT# PROJECT ADDRESS I O6 �O �� .� � ppN# ��� �7 / ' OWNER NAME C HO KF1%36 <kN 0 + PHONE n I E-MAIL STREET ADDRESS ©/ j CITY, STATE,ZIP 5� FAX I ��FFn��rJ /�, L GL)?L9-71-)U GN,) - /p L 701 CONTACT NAME �� PHONE E-MAIL t AI^) Sio -422 4160 STREET ADDRESS 106e,- L 1 CITY,STATE,ZIPG 24545 F ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT cc--- e f ',2- � LIC SE NUMBER LICENSE T B US.LIC# TYPE IICIn COMPANY NAME E-MAIL -r o,ot F0E 3 0(41 STREET ADDRESSLE ( CITY,STATE,Zr►C I Zi G� 9q_5� PHONE10 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK (Zf � � � A ► 1 i ,C V - wl—rl7 tJ I til 17-bt . c 7i 04 LE `7 12 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES OFFICE USE N Y VALUATION AREAEXISTNEW FLOOR DEMO TOTAL AREA .n • �7 �� �� AREA AREA NET AREA BATHROOM KITCHEN OTHER / REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH t t- - - - - -- ❑ ATTACH #DWED-ING I'NITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEINGADDED7 ❑NO ADDITION ❑NO PRE-APPLICATION, ❑YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY: T TAL VALUATION: PI_A.NNING APPL# ❑ NO PI.A.NNING APPROVAL.LEITER 'Z C� 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. I have read the Description of Work and verify it is accurate. 1 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: t CLI 1/1 r SUPPLEMENTAL INFORMATI�demolition D PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: permit forVER-THREVIEW existing building(s). Demolition permit is required prior to issuance of building `E-COUNTER C�SL1iI-HitQGF�AN 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 Planting prior to 13 MAJOR ❑ SANTTARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 03/16/11