15100152CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21921 ALCAZAR AVE
OWNER'S NAME: HESHAM IBRAHIM
OWNER'S PHONE: 4082097476
10 LICENSED CONTRACTOR'S DECLARATION
License Class G 1?Lic. # q 3 Go -2., f /
Contractor 7 /'�� A-7 ►'` « C Date / ID -o 1
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:
1. 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
erformance 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
it is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in co Bence of the
granting of this permit. Additionally, the applicant un st'aiid5and will comply with
all non -point source regulations per the C inicipal CSection 9.18.
Signature Date 20 S
L■I
I hereby affirm that m e t from the Contractor's License Law for one of
the following two r s•
i 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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
permit is issued.
3. 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
CONTRACTOR: THD AT-HOMEI PERMIT NO: 15100152
SERVICES, INC.
2690 CUMBERLAND PKWY STE 300 1 DATE ISSUED: 10/20/2015
ATLANTA, GA 30339-3913 I PHONE NO: (510) 731-1004
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE 2 (E) PATIO DOORS, LIKE FOR LIKE
Sq. Ft Floor Area: I Valuation: $3332
CPN Number: 35715099.00 OCCupaoCN "I'ypc:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D LLED INSPECTION.
Date: M/ 7,6
RE -ROOFS:
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.
Signature of Applicant: Date: _ _
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533,gnd 25534.
Owner or
Date: %6 2-e, 1
I hereby ajkTrrn Aatffiere is a construction lending agency for the performance of work's
for which is permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cunertino.ora e
CCUPERTINO I( V D/ SZ
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)NTRI ICTInM I^V
I AIl1TTnM I^ I AI TFR ATTnIQ / Ti F-1 RFVICI01J / DPFFRRFF) C)R1(',INAI. PERMIT #
PROJECT ADDRESS ✓� I I Z A Gc ^�
APN #
/
>WNER \AME J
r
PHONE �7 '7
• 2017 ' q 7e,
E-MAIL
STREET ADDRESS
Z ALG 2^-< /�ilE
CITY, STATE, ZIP I
Gr/ L9_ -71A)0 I G X , l
CONTACT NAME JEFF RAINEY
PHONE 510-427-4260 E-MAILJEFFREY. RAINEY@ATT. NET
STREET ADDRESS 1069 EDGEMERE LANE
CITY, STATE, ZIP HAYWARD, CA 94545
FAX 510-783-1041
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR T7CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME..
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
836021
B,C39,C13,C17
COMPANYNAME THD AT HOME SERVICES
E-MAIL
FAX 510-783-1041
STREET ADDRESS 2456 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
- �,-f /
7�J a , 2- - ,J0 12--C +,
EXISTING USE
PROPOSED USE
CONSTR. TYPE
# STORIES
USE TYPE
OCC
SQ.FT.
VALUATION I>�
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
11 BEING ADDED? ONO
ADDITION? ONO �—
PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YE TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? 0 V
By my signature below, I certify to each of the following: I am the property owner or au o ed agent a 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 It is accura . I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cu e r t e above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 7,0 ) J
SUPPL Al_ INFORMATION RE
PLAN CHECK TYPE
ROUTING SLIP
❑ FER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply fo e permit for
isting building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUN
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 Planning prior to
❑
❑ SANITARY SEWER
submittal of Building Permit application.
MAJOR
DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21///
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
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 preliminar information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 ETf. 7/1/13
ADDRESS: 21921 ALCAZAR AVE
DATE: 10/20/2015
REVIEWED BY: MELISSA
IF" _ . 1'errnil
APN: 35715 099
BP#:
*VALUATION: 1$3,332
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
?'h1mb. Insp. Fer
PENTAMATION 1GENRES
I PERMIT TYPE:
WORK
REPLACE 2 E PATIO DOORS LIKE FOR LIKE
SCOPE
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 preliminar information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 ETf. 7/1/13
lech. Plan Check
1'17imh. Plan Check
/;lee. I'lan Check
IF" _ . 1'errnil
1 :.. .
Flee_ P< snit Fee.
ther;14ech. Insp.
lther Pluinh Insp.
01her Llec. 111sp.
ilech. Insp. Fee:
?'h1mb. Insp. Fer
t•aec_ Insp. Fee,
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 preliminar information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 ETf. 7/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
�2 #
$431.00
Window / Sliding Glass Door
I WINREP Replacement
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
"construction 7'ax:
E)
Work Without Permit? O Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
O
i
IV/ Documentation I'ee.s.
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.501
$431.00
TOTAL FEE:
$432.50
Revised: 10/01/2015
CUPERTINO
^~ Building Department
I
1I ` �� OCT 2 0 2015
L.�
REVIEWED FOR CODE COMPLIANCE
Reviewed By
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LEGEND: SCOPE OF WORK: INSTALL (2) RETROFIT VINYL, DUAL
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® RETROFIT WINDOW/ PATIO DOOR LOCATION GLAZED, LOW E PATIO DOORS. NO (N) CONSTRUCTION,
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FRAMES WILL NOT BE DISTURBED.
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NOTE; WINDOWS / PATIO DOORS;
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SHGC = 0.25
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COMMUNITY DEVELOPMENT DEPARTMENT
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BUILDING DIVISION - CUPERTINO
APPROVED
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This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
11
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changes or alterations on same, or to deviate
therefrom, without approval from the Building Official?
^_.
W The stamping of this plan and specifications SHALL NOT
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be hald to f '.' t^ " the violation
of cr}, - r<...- or State Law.
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FIRST STORY (FRONT YARD)
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FLOOR PLAN �J�V ALCAZAR AVENUE
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NOTE:
1). SMOKE DETECTORS: WHEN A BUILDING PERMIT IS REQUIRED, SMOKE DETECTORS SHALL BE INSTALLED; (a) IN EACH SLEEPING ROOM, (b) OUTSIDE EACH SEPARATE SLEEPING AREA IN THE IMMEDIATE VICINITY OF THE
DATE
BEDROOMS, (c) ON EACH ADDITIONAL STORY OF THE DWELLING, INCLUDING BASEMENTS AND HABITABLE ATTICS BUT NOT INCLUDING CRAWL SPACES AND UNINHABITABLE ATTICS. (CRC 314)
10.15.15
SCALE NTS
2). CARBON MONOXIDE ALARMS: WHERE A PERMIT IS REQUIRED FOR ALTERATIONS, REPAIRS OR ADDITIONS EXCEEDING $1,000.00, EXISTING DWELLINGS OR SLEEPING UNITS THAT HAVE ATTACHED GARAGES OR FUEL BURNING
oaAwNBy DKW
APPLIANCES SHALL BE PROVIDED WITH A CARBON MONOXIDE ALARM IN THE FOLLOWING LOCATIONS; (a) OUTSIDE OF EACH SEPARATE DWELLING UNIT SLEEPING AREA IN THE IMMEDIATE VICINITY OF THE BEDROOM(S), (b) ON
JOB 8550070
EVERY LEVEL OF A DWELLING UNIT INCLUDING BASEMENTS. (CBC 420.4, CRC 13315).
(HOME OWNER TO PROVIDE BEFORE FINAL INSPECTION).
SHEET
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CUPERTINO
^~ Building Department
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1I ` �� OCT 2 0 2015
L.�
REVIEWED FOR CODE COMPLIANCE
Reviewed By
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OCT 2 0 2015
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