B-2017-0046 CITY OF CUPERTINO BUILDING PE ' IIT
BUILDING ADDRESS: CONTRACTOR: P 1 RMTT NO:B-2017-0046
955 VERNIE CT CUPERTINO,CA 95014-4346(359 22 051) THD AT-HOME
SERVICES INC
ATLANTA,GA 30339
•
OWNER'S NAME:
P•ONE NO:(770)779-1423
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT I FO:
License Class B.C39.C13,C17 Lic.#836021
Contractor THD AT-HOME SERVICES INC Date 04/30/2018 X BLDG _ELECT _ 'LUMB
MECH X RESIDENT 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 Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 13 WINDOW'/1 PATIO DOOR,LIKE FOR LIKE(WILL
I hereby affirm under penalty of perjury one of the following two declarations: MEET EGRESS&BE MI 'ERED PER CODE)
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
permit is issued. Sq.Ft Floor Area: V. uation:$16310.00
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: O cupancy Type:
and state laws relating to building construction,and hereby authorize 359 22 051
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 EXPI' I S IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. 'WITHIN 180 D YS 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 FRO I LAST CALL I I SPECTION.
Signature . Date 01/09/2017 Issued by:MEL ��- � � `.
Date:01/09/2017
NER-BUILDER D ^'ARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS;
following two reasons: All roofs shall be inspected.,rior 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 obtain' g 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:01/09/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF CO I RINGS 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. HAZARD•US MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardou•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&Saf i ty Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with t e 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 8z Safety Code,5:ction 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,sho d I use equipment or devices which emit hazardous
air contaminants as define, by the Bay Area Air Quality Management District I
Worker's Compensation laws of California, If,after making this certificate of will maintain compliance w th the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe 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:01/09/2017
I certify that I have read this application and state that the above information is s I' - t l
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructi•a I • agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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 ' NHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shal be used as public records.
SiSignature Date 01/09/2017 Licensed
g Professional