14050151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7638 KIRWIN LN CONTRACTOR:THD AT-HOME PERMIT NO: 14050151
SERVICES,INC.
OWNER'S NAME: PURCELL GEORGYNE M 2690 CUMBERLAND PKWY STE 300 DATE ISSUED:05/27/2014
OWNER'S PHONE: 4082535578 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE AND REPLACE 600 SQ FT OF SIDING TO FRONT
License Class G? 63 Lic.# �I>b�Z OF
Contractor TFf D Iq-'I S�GMI=�2�-date 27 SFDWL
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 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:$13186
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:35922013 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 DAY ROM LAS `77D INS ECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the=Date
,Section
9 18.
RE-ROOFS:
Signatu e 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.
ElOWN DER 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
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(Sec.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 District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9. 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: Z7 f
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 CONSTR ION 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 rr 1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
191 �l
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 r�O
C U PERT t N C3 .
(408)777-3228•FAX(408)777-3333•building cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS �/ 2 'F 1 + I /` ^ AJ 6—
APN#
OWNER NAMEDn (S L(,�S) C i Cfp- —/Ff PHON�,Z 3' SS ' E-MAIL �J
STRE T ADD ESS G• CITY,STATE,ZIP FAX
7A 3
CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAILJEFFREY.RAINEYQATT.NET
STREET ADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 94545 FIA. 510-783-1041
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR n CONTRACTOR AGENT ❑ (A�RCC,HHIIT�ECRT,� 11ENGINEER 11DEVELOPER 1:1TENANT
CONTRACTOR NAME LICENSE NUMBER 836021 t ISEl.:S7 3,C17 BUS.LIC#
COMPANY NAME THD AT HOME' SERVICES E-MAIL FAX 510-783-1041
STREETADDRESS 2456 VERNAI,COURT CITY,STATE,ZIP SAN LEANDRO,CA 94577 PHONE510-785-6340
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Aj 5^ _t f AJ / \� r '
15
EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES
d111) 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 I GARAGE AREA: DDETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES .;,ItECE• y;' TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or authorize agent to act on the propetao�:tce.,.n
nr's behalf/I have read this
application and the information I have provided is correct. I have read the Description of� enfy itis accurate. I plywith all applicable local
ordinances and state laws relating to',building construction. I authorize re resen LEves oaf Cupertino to enter the abovve-idenrty for inspection purposes.
Signature of Applicant/Agent: Date: J 27
SUPPLE MOR;py
TI D Pini ca>Cid TYrE Rournm G SLIP
_New SFD or Multifamily dwellings: for demolifion permit for ❑ OVER THE=COUNTER ❑ BunmiNG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building ,
permit for new building. ❑ EXPRESS ❑' PLANNING PLAN REVIEW
_Commercial Bldgs: Provideia completed Hazardous Materials Disclosure sTANDaxu ❑ 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 0 MAJOR ElSANITARY SEWER DISTRICT
submittal of Building Permit application.
,..... ,. 0 >'NYIRONMENTALHEALTH
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7638 kirwin In DATE: 05/27/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$13,186
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 GENRE;
WORK remove and replace 600 sq ft of siding to front of sfdwl
SCOPE
W.y
3lcci; r'4z-'r C trfrc-,
Nan;"), Non Chec' htee. 1`' r
Fee: c«: .cc .,.
Orwr 1 <. ? y�Yr�if 11SiiLj
Ccu:'a t,ralz Vcce Phanri3, Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS (I ee Resolution 11-053 Eff 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 600 s.f. Siding
Suppl. PC Fee: Reg. 0 OTT 0.0hrs $0.00 $627.00 ISIDEOTHER I All Other
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.(F) Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Plannin&Fee: $0.00 Select a Non-Residential G
7, , �{.z E'rc' Fd J Dees_ I
Building or Structure
i
Strong Motion Fee: 1BSEISMICR $1.32 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
R' S J'OTALS $2.32 $627.00 TOTAL FEE: $629.32
Revised: 04/01/2014
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