B-2016-2204 I
CITY OFC PERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2204
10705 TRESSLER CT CUPERTINO,CA 95014-4038(356 07 078) THD AT-HOME
SERVICES INC
ATLANTA,GA 30339
OWNER'S NAME: PEDDADA TARAKAM AND SUHASINI TRU TEE DATE ISSUED:06/23/2016
OWNER'S PHONE:408-393-3316 PHONE NO:(770)779-1423
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-39,C-13.C-17 Lic.#836021
Contractor THD AT-HOME SERVICES INC Date 04/30/2018 X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Cod and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE PATIO DOOR(1)-SAME LOCATION(LIVING ROOM)
I hereby affirm under penalty of perjury one of the following twodeclarations:
t. I-have and will maintain a certificate of consent to self-inswe 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.
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. Sq.Ft Floor Area: Valuation:$2677.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby auth rize 356 07 078
representatives of this city to enter upon the above mentioned p operty for
inspection purposes. (We)agree to save indemnify and keep h rmless the
City of Cupertino against liabilities,judgments,costs,and expen 3es which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of I his permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all rim-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS C4 SPE TION.
Signature Date 2 /2016 Issued by:Alex Vallelunga
Date:06/23/2016
OWNER-BUILD E
I hereby affirm that I am exempt from the Contractor's License L tw for one of the RF ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not in nded or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-inswe for Worker's
Compensation,as provided for by Section 3700 of the Laber Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become i subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation)provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized age t
APPLICANT CERTIFICATION Date:6/23/2016
I certify that I have read this application and state that the above 4 information is C STR CTIO LE Cy
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constru n ng agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issue (Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purp ses. (Vile)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino agai st liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cu ertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed
Si
9 Professional
CONSTRUCTIO PERMIT APPLICATION
im COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
0119' RT1N4 (408)777-3228•FAX(408)777-3333•building(EDcupertino.orq
❑NEW CONSTRUCTION ❑ ADDITION ❑ AL RATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS JD � rl� � S �' —( APN#
OWNERN K
?K-PRA-DA%ePHONE
H�o
STREET ADDRESS jO X70,�; /�r� � ��7} C2,TA, f�O �� r
CONTACT NAME JEFF RAINEY 1� I PHONE 510-427-4260 E-MAILJEFFREY.RAINEY@ATT.NET
STREETADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 94545 FAX 510-783-1041
❑OWNER ❑ OWNER-Bun DER ❑ OWNERAGENT ❑ CON'T'RACTOR `I CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER. ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ICENSE NUMBER LICENSE TYPE BUS.LIC#
836021 B,C39,C13,C17
COMPANY NAME E-MAIL FAX
THD AT HOME SERVICES 510-357-3750
STREET ADDRESS CITY,STATE,ZIP PHONE
2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4�5n50
ARCHITECT/ENGINEER NAME ICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK P�,- - -, �� P D I
V Iry C,-- c1UJk-A
EXISTINGUSE PROPOSED USE CONSTR. E #STORIES
Z USE TYPE OCC. SQ.FT. VALUATION
EXISTG NEWFLOOR DEMO 'DOTAL
AREA AREA AREA 74ET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODE AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA G GE AREA LIDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECO STORY []YES
BEING ADDED? []NO ADDTTI N? []NO AV' IJ
PRE-APPLICATION [3 YES IF YES,PROVIDE COPY OF IS THE LDG AN ❑YES RECEIV f �,` /h^' TOTAL VALUATION:
PLANNING APPL# E]NO PLANNING APPROVAL LETTER EICHLE HOME? []NO n t)C7
Z
By my signature below,I certify to each of the following: I am th�property owner or authorized a nt to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have r ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cresentatives of Cupertino to enter the ab ve-identified property for inspection purposes.
onstruction. I e r p
Signature of Applicant/Agent: Date: 2
SUPPLE NT ORMATION REQUtRa PLhTcHECK4TXPE � �{
ROUTAYG SI IP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ BIIII DING PLAN REvMw -
R THE COUNTER
existing building(s). Demolition permit is required prior to ssuance of building t ,
permit for new building. EDPLANNING rLnNv>Ew`
_Commercial Bldgs: Provide a completed Hazardous M terials Disclosure0 1'USLIG woRxs
form if any Hazardous Materials are being used as part of th s project. x'`r °r s
��x LARGE �? � +«l� � � ❑ FIRE DEPT f •r,� ,
_Copy of Planning Approval Letter or Meeting with Plan ing prior to "` {
submittal of Building Permit application. rltirATOR. sANnrARYSEwERursrRlcT
ENVIROIVMENTAUREALTH
BldgApp 201 Ldoc revised 06121/11
LEGEND: SCOPE OF WORK;INSTALL(1)RETROFIT VINYL,DUAL
® = RETROFIT WINDOW/PATIO DOOR/ENTRY DOOR LOCATION GLAZED,LOW E,PATIO DOOR.NO(N)CONSTRUCTION,
FRAME WILL NOT BE DISTURBED. pdeft Lo
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NOTE: r
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 BATE 06.16.16
BEDROOMS,(c)ON EACH ADDITIONAL STORY OF THE DWELLING,INCLUDING BASEMENTS AND HABITABLE ATTICS BUT NOT INCLUDING CRAWL SPACES AND UNINHABITABLE ATTICS.(CRC 314)
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 DRAWN By 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
EVERY LEVEL OF A DWELLING UNIT INCLUDING BASEMENTS.(CBC 420.4,CRC R315). 0B 9315003
SHEET
(HOME OWNER TO PROVIDE BEFORE FINAL INSPECTION). A_1
WATER-CONSERVING PLUMBING FIXTURES IFIR,
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUP RT NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
408)777-3228•FAX(408)777-3333.building(alcupertino.org
Owner Name ( Pe it No. r '� C p- ►`�
Address '? �� 9
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Q-Ro Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Vi ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
L✓1 1V o Go to Question 3.
.3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Imo Go to Question 4.
a
4. Is,y/our real property built and available for use or occupancy on or before January 1, 1994?
P No My real property is built and available for use or occupancy after January 1, 1994.
- Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
❑ Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of forin..
5. Please check ONE of the following:
0:1� My property is a single-family residential real property. See Civil Code Section 1101,4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether properly undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.,
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 110 1.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page. f
Owner or Owner Agent's Signature: yJ Date: k, 26 6
Upon completing and signing this C rtificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26115
FE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
Iss Ct1p �T' �tt 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(�cupertino.org
_ Permit No.
HZCAddress � C 0— t #of Alarms Smoke: Carbon Monoxide:f
rm ...
? jERMIT CANNOT BIALED ANTI COMPLETED UNTIL THIS CERTIFICATE
BEESTHEBUDIAS NTRlS
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
_ AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each slue ging room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907:2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to ccApty with the terms and-conditions of this statement
Owner(or Owner Agent's)Name:
Si nature..... ... ............ ........ ...............................Date:
Contractor Name:
Sinature.........................................'..........................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03118114
4 R1 9
7� rE
WATER-CONSERVING PLUMBING FIXTURES q �
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)
-- 777-322 •F (408)777-3333.building(tupertino.org
Owner Name'( a Permit No:� 6
Address V t
a -
_
1. Is your real property a registered historical site?
❑- es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
-qN6 Go to Question 2.
2. Does your real propertyhave a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
- ❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
ly-
No Go to Question 3.
3. Is water service permanently disconnected for your building?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
NJ�No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
�U/No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
1.0,-Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Pie,se check ONE of the following:
-' My property is a single family residential real property. See Civil Code Section 1101.4,
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following age. _ e' 1
Owner or Owner Agent's Signature: y I,I ' Date: vol
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15