B-2016-2203 �II
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;4-3447-4,
August 24,2016
To Whom It May Concern: City Of Cupertino
RE:Permit Cancellation
Job#9329757
Name:Bernice Tsai
Address: 10410 Stokes Ave
Permit#B-2016-2203
Please cancel permit and issue a refund.The homeowner has cancelled their contract with Home Depot.
No work has been performed on this project. If you have any questions,feel free to contact me at the
number below.
Thank you,
Alicia Adams
;PermitServices.on Behalf of Home Depot.
980 Hopper Avenue l `
41 5 Lig 3:
800-627-3764
f
Toll-Free 1-855-621-8199 0 510.357.3589
Tit At-Horne Services,Inc.2456 Verna Ct,San Leandro CA 94577
I I
1
CITY OF CUPERTINO BUILDING PERMIT
BUIL.DINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2203
10410 STOKES AVE CUPERTINO,CA 95014-1247(326 47 019) THD AT-HOME '
SERVICES INC
' ATLANTA,GA 30339
1
i OWNER'S NAME: TSAI DAVID T AND BERNICE JOU DATE ISSUED:06/23/2016
OWNER'S PHONE:408-253-8668 PHONE NO:(770)779-1423
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5.0-39.C-13.C-17 Lic.#836021 X BLDG _ELECT _PLUMS
Contractor THD AT-HOME SERVICES INC Date 04/30/2018
MM X _RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter f y(commencing — r
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WINDOW(1)LIKE FOR LIKE- i G OOM
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-ins le for Worker's
Compensation,as provided for by Section 3700 of the Labo Code,for the 0
performance of the work for which this permit is issued.
I have and willmaintain Worker's Compensation Insu ance as provided for by
j/" Section 3700 of the Labor Code,for the performance of the work for which this --
permit
permit is issued. Sq.Ft Floor Area: :Iuation:$1464.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Occupancy Number:
APN
information is correct.I agree to comply with all city and county •rdinances Type:
and state laws relating to building construction,and hereby authfrize 326 47 019
representatives of this city to enter upon the above mentioned p operty for
! inspection purposes. (We)agree to save indemnify and keep harmless the
! City of Cupertino against liabilities,judgments,costs,and expen es which P? ' I T EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of is permit. THIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS E t I SPECTION.
r f.:
Signature �', Date 6/23/2016 Issued by:Alex Vallelunga t, ajla
_ 1
Date:06/23/2016 4
OWNER-BUILDER DELLA; "..� ` 1
..--
I
I hereby affirm that I am exempt from the Contractor's License for one of the RE-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 w. es 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>not int- .ed or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively c c tracting wi °licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business& rofessions Code). 6/23/2016
I hereby affirm under penalty of perjury one,4f the following thre declarations: Date: AL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-ins a for Worker's
Compensation,as provided for-by Section 3700 of the Lab r Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insuranc ,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 th work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit i issued. ,' maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this emit 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 becom 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 Makin this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensatio4provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions r this permit shall
be deemed revoked. . Owner or authorized agent:
APPLICANT CERTIFICATION Date:6/23/2016 /
I certify that I have read this application and state that the abov information is s R TIO L, °nA�6'A(�lvL
correct.I agree to comply with all city and county ordinances an state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize represent,�etives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
jto enter upon the above mentioned property for inspection purp¢ses. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
- judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the apj�licant understands ,
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECTS DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 6/23/2016 Professional