14080058 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10962 WILKINSON AVE CONTRACTOR:THD AT-HOME SERVICES, PERMIT NO: 14080058
INC.
OWNER'S NAME:
ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
Pr LICENSED CONTRACTOR'S DECLARATION (� � (-
2 ('� , BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class— Lic.# Z5 36(:92-
t l�z� � � MECH � RESIDENTIAL � COMMERCIAL F
Contractor TfAD '7 ('1 -im r Date `b/
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION' INSTALL TWO RETROFIT WINDOWS FIBRIX NO SIZE
(commencing with Section 7000)of Division 3 of the Business&Professions CHANGE.WILL MEET EGRESS
C de a d that my license is in full force and effect.
affirm under penalty of perjury one of the following two declarations:
I c i will maintain a certificate of consent to self-insure for Worker's
ompensa on,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:$2088
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35613055 00 Occupancy Type:
APPLICANT CERTIFICATION
1 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 L ST CALLED NSPECTION.
granting of this permit. Additionally,the applicant understands and wli ply
with all non-point source regulations per the Cupertino Municipa e,Section
9 18.;x, Issued by: ` Date:
Signature Date
❑ OWNE - 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 n aterials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation,
will
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date
BLISmess&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL 1200E COVERL S 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 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. I 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 or authorized. t: �/ f
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: `6
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
indemnity and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHIT'ECT'S DECLARATION
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
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10962 wilkinson ave DATE: 08/08/2014 REVIEWED BY: larrys
APN: BP#: *VALUATION: 1$2,088
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1GENRE
WORK install two retrofit windows"Fibrix" no size change. Will meet egress.
SCOPE
.. IN
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is ;.1:-_1'_3T11i1 Fee'
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NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Lr(f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 # Window/Sliding Glass Door
Suppl. PC Fee: (F) Reg. ® OT FO.OTh7rs $0.00 $431.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. C) OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? ® Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
'�'L's':
1T Building or Structure 0
�f"cIk t t)t1 ftt'r'2/.217r1rt �
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.00
;rte M � yT'OTALS $1.50 $431.00 TOTAL FEE: $432.50
Revised: 07/10/2014