14090086 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21074 GARDENA DR CONTRACTOR:THD AT-HOME PERMIT NO: 14090086
SERVICES,INC
OWNER'S NAME:
ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REPLACE 7(E)WINDOWS WITH(N),LIKE FOR LIKE.
License Class G�7 Lic.# 1736,62-1 WILL MEET EGRESS&BE TEMPERED WHERE
^� ��[j C REQUIRED BY
Contractor !ff��f'/ /�12nME" �f�t�t ?i Date CODE
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
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4576
ave and will maintain Worker's Compensation hisurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32608011 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPI ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT O D 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 LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, .7Z/
costs,and expenses which may accrue against said City in consequence of /r
Ix
granting of this permit. Additionally,the applicant understands 1 omply ::ed by: Date:
with all non-point source regulations per the Cupertinolylumuipal Code,Section
9 18.
RE-ROOFS:
Signature Date 9 f 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.
❑ OW UILDER 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 9.12 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:
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 CONSTRUC 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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21074 GARDENA DR DATE: 09/15/2014 REVIEWED BY: MELISSA
APN: 326 08 011 TB--- P#: EVALUATION: J$4,576
-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: p PERMIT TYPE: i
WORK REPLACE 7 E WINDOWS WITH N LIKE FOR LIKE. WILL MEET EGRESS & BE TEMPERED
SCOPE WHERE REQUIRED BY CODE
f>.
11f>;'�L. l'c>rrtril Fee: 1'trh h I'ertnit Pee:
r, Ll rrs'r�. 01her1 . tT[i?c✓. frsn. (tlFr1iurrTl
O, Jlunuh.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the preliminarp information available and are onik an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 I ' # Window/Sliding Glass Door
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $431.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.(E) Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Co;Zvrtfc!,i n K,I.I.
ft Ir'tlfP1C/r"'fX1tL'c; 1"Ct': 0
Work Without Permit? ® Yes (E) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Truvel 1,u it,unwnlolion Fees:
Stroniz Motion Fee: IBSEISMICR $0.59 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC $1.00
$1.59 $431.00 . TOTAL FEE: : $432.59
Revised: 08/20/2014