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B-2016-3240
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3240 1464 JAMESTOWN DR CUPERTINO,CA 95014-5353(366 10 080) THD AT-HOME SERVICES INC ATLANTA,GA 30339 OWNER'S NAME: SARKAR DEEM AND UMA DATE ISSUED:12/09/2016 OWNER'S PHONE:408-647-3370 PHONE NO:(770)779-1423 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B:C-39: Lic.#836021 Contractor THD AT-HOME SERVICES INC Date 04/30/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL BLOW IN INSULATION(1,296 S.F.)-ATTIC 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 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 1 permit is issued. if? Sq.Ft Floor Area: Valuation:$2450.00 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 authorize 36610 080 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 PERMIT EXPIRES IF'WORK IS NOT STARTED may accrue againstsaidCity in stands and the hg this WITHIN 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 LAST CALLED INSPECTION. IIIIIIIIIP Signature Date 12/9/2016 Issued by:AbbyAyende Date: 12/09/2016 • .hi t-: ii r t,I • , .ARAI' e, I hereby affirm th, .,exempt from the Contractor's License Law 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 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 intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 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:12/9/2016 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-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. HAZARDOUS MATERIALS DISCLOSURE 2. 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 3. I 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 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. O . ddiallefLID wner or authorized agent: APPLICANT CERTIFICATION Date:12/9/2016 certify that I have read this application and state that the above information is s h Ali�i correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co, ending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name. to save indemnify and keep harmless the City of Cupertino against 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 Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 12/9/2016 Professional B z0t(o'' a V \\‘`I`' CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONB 4.,/9,\. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq{a.cupertino.orq CUPERTINO El NEW CONSTRUCTION El ADDITION El ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# r �` `f �'- 5 API.'# 31Ap- 10- NO PROJECT ADDRESS OWNER NAME '�j; �y �j J� I\ PHONE_e� -647,3570 E-MAIL STREET ADDRESS { 4)�/, r CITY STATE,ZIP P I*�L ,..1- J 63 ` Oj,J f)Z �` 9.5' FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAILJEFFREY.RAINEY@ATT.NET STREET ADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD eA 94545 FAX 510-783-1041 ❑OWNER 0 OWNER BUILDER 0 OWNER AGENT 0 CONTRACTOR ` I.CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC F 17 �� 836021 ,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 510-877-4550 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE � i � Z% -f . j aE.1 fns -t-Tic_ p, j(..) A fC)Ai DESCRIPTION OF WORK — 3C EXISTINGUSE PROPOSED USE CONSTR TYPE #STORIES 2 USE TYPE OCC. SQ.FT. VALUATION(S) 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: 0 DETACH 0 ATTACH it DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES - - - - - BEING ADDED? 0 NO ADDITION? ONO PRE-APPLICATION D YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES 'I E EDGY PLANNINGAPPL# 0N PLANNING APPROVAL LEIl>;R EICALERHOME? ❑NO Q ` + T/Q�o�7TALVALUATION: J By my signature below,I certify to each of the following: I am the property owner or authorized agent to ache 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 verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. a representatives of C i er e above-identified property for inspection purposes. Signature of Applicant/Agent: Date: r2-/ q /I b SUPPL AL INFORMATION • 5I�`i •y e ` EI-:-„,kECS'i"4F R(IO I q.." _New SFD or Multifamily dwellings: Appl. `• molition permit for ` existing building(s). Demolition permit is required prior to issuance of building 4'Is� TI± 9I.INPI,AN1tE �v , permit for new building. [ > © k z�+t +z�� z }t,OitO;..:",,,v::,,,, iat:ia_:.;2,c=:t1;ic",i._1?: _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1 saAtAttp [ ictI# form if any Hazardous Materials are being used as part of this project 1 AR�GR i)F _Copy of Planning Approval Letter or Meeting with Planning prior to CATORI 3ri � xr r submittal of Building Permit application. t)1V'1vI ENTA][3tE LlEr . _..,,'' BldgApp_2011.doc revised 06/21/11