13050150 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21821 WOODBURY DR CONTRACTOR:THD AT-HOME PERMIT NO: 13050150
SERVICES,INC.
OWNER'S NAME: TY BEMIS 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:05/21/2013
OWNER'S PHONE: 4082180224 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class G 17 Lic.# '?.390 - REPLACE 2(E)SLIDING GLASS DOORS,SAME
40141- Z 1 LOCATION&
Contractor I H� /+i ��1'Date S I SIZE
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of.the Business&Professions
Code and that my license is in full force and cffect
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:$3898
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 APN Number:32619121.00 Occupancy Type:
permit.is issued.
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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize.representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply by: 2/
with all non-point source regulations per the Cupertino roipal Code,Section
9.18.
RE-ROOFS:
Signature bate �) 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.
❑ OVKER-BUW6ER DECLARATION
Signature of Applicant: Date:
I hereby affir a 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
I,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(See.7044,
Business&Professions Code)
I,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 rict I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code rter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,an
Section 3700 of the Labor Code,for the performance of the work for which this /2
permit is issued. 1 l
Owner or authorized age t: Date: 5 l3
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 CONSTRUCTION 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
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 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
CONSTRUCTION PERMIT APPLICATION
01 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building a.cupertino.ord
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS I Q
��?jj I �� APN# 03� 2_1
a 19 '
OWNER NAME V r„�/� I PHONE - LI /9_o i,Z`r E-MAIL
STREET ADDRESS f c ,PI CITY, STATE,ZIP G� "r FAX
2 2 ► tJZ /2• C cJ ']'►�t7 CA- 75014
CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAILJEFFREY.RAINEY@ATT.NET
STREET ADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 94 5 4 5 FAX 510-783-1041
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR t]CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER g 3 6 0 21 LE Y13,C 17 BUS.LIC#
COMPANYNAME THD AT HOME SERVICES E-MAIL FAX 510-783-1041
STREET ADDRESS 2 4 5 6 VERNA COURT CITY,STATE,ZIP SAN LEANDRO,CA 94577 PHONE 510-7 8 5-6 3 4 0
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK i tj
�d 1 1Gftt4 Ad
l
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA [NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT E]YES SECOND STORY ❑YES
_T BEING ADDED? []NO ADDITION? [JNO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑❑YES R TOTAL L4TIOJ1j;
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NO �// �oJ
By my signature below,I certify to each of the following: I am the property owner or au nze to act on th operty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of k and verify it is urate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authadze r ves of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: /Z /13
SUPPLEM TAL INFO ATIO IRED
PLA7 CIIECTYPE" ROUTING SLIP
New SFD or Multifamily dw . Apps ly for demolition permit for OVER-TILE-COUNTER uILDIrrG PLANREVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS' LANNING PLAN REVIE
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure p sTAI�TDARD ,. UBLIC 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
submittal of Building Permit application. �7 El SANITARY sEwEi,D> TRICT
ENTAL M
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
{' ADDRESS: 21821 WOODBURY DR DATE: 05/21/2013 REVIEWED BY: MELISSA
APN: 32619121 BP#: `VALUATION: $3,898
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: p PERMIT TYPE: A
WORK REPLACE 2 E SLIDING GLASS DOORS SAME LOCATION & SIZE
SCOPE
n
Hach.Flan Check. Plzzrub.Plurr Check F.lec. Plan(.'heck
A1ech.Perrzzit Fee: Plumb.Permit Fee: I�ler. Permit tee:
[,I'f,,,'h.
Alech.Insp. Other Plumb Insp. Other Elec.Insp.
Insp.Fee: Plumb. Insp.Fee: lace.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prefindna information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl.PC Fee: (j) Reg. 0 OT r 0.0 hrs $0.00 $400.00 I WINREP 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
Construction ?'eta:;
A.drninistrative.Fee:
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel l�ocrrrnentation Fees: Building or Structure
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
VM $1.50 $400.00 Q $401.50
Revised: 04/29/2013
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/SUBCONTRACTO ,LIST .
JOB ADDRESS: Z1 g Z R., PERMIT#
OWNER'S NAME: FM) PHONE# 2-I Q`• O ZZ
GENERAL CONTRACTOR:. fit) T ROMC BUSINESS LICENSE
ADDRESS:2456 VC9,4A C-7, CITY/ZIPCODE n/ A-dbr1p 9 S7
*Our municipal code requires all businesses working:in the city to have.:a City of,Cupertino=business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL B $CHWDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS ED A CITY OF CUPERTINO
BUSINESS LICENSE. c ?�
I am not using any subcontractors:
Signa re Date
Please check applicable subcontracto s and e e following information:
SUBCONTRACTOR BUSINESS NAME 'BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing N Ah / /' Z111.
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
COMMUNITY DEVELOPMENT DEPARTMENT =
BUILDING DIVISION-CUPERTiNO
APPROVED
This set of plans and specifications MUST be kept at the ��LOrn
job site during construction. it is unlawful to mAka any CgEGKED BY w
changes or alterations on same,or to deviate U O Q
U
therefrom,without approval from the Building Official. Z
>I�T
The stamping of this plan , d spec) Ica Ions r. U =
Jroval of the violation w w
be held to permit �n�.p; PLANNING I� PT o z
of an Ordinance or State Law. Q
10 =I
MASTER BEDROOM �A� ~oo N Z cupE .
MASTER BEDROOM PATIO DOOR -�� ¢ Q �; R NO
DATE Zi -,��_ � 72x80 " '' auild,ng Depa
a
PERMIT NO. 00
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_ ::... MAY 2 1 2013
LIVING ROOM � `°" -==G
PATIO DOOR
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WOODBURY DRIVE c � T
FRONTYARD 00
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DArE 05.16.13 MAY 2 1 20.13
SCALE NTS y�
DRAWNBY DKW B i�p
FLOOR PLAN � I7 0�5 J0B 6881465��• r �O SHEET
IQ�E:PATIO DOOR REPLACEMENT ONLY. A-1