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B-2017-0398CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0398 21929 OAKDELL PL CUPERTINO, CA 95014-1104 (326 39 001) THD AT - HOME SERVICES INC ATLANTA, GA 30339 OWNER'S NAME: CHANDLER TIMOTHY R F AND ZAMOONNA DATE ISSUED: 03/10/2017 OWNER'S PHONE: 408-705-3363 PHONE NO: (770) 779-1423 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B C39 C13 C17 Lic.#B31021 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: REPLACE (1) WINDOW, (1) PATIO DOOR - (LIKE FOR LIKE, WILL I hereby affirm under penalty of perjury one of the following two declarations: MEET EGRESS & BE TEMPERED WHERE REQUIRED BY 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: Valuation: $5447.00 APPLICANT CERTIFICATION 1 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 326 39 001 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 against said City in consequence of the granting of this permit. 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. 3 Signature Date �r��l Issued by: MELISSA NAMES Date: 03/10/2017 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 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) z. 1, as owner ofthe property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 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, asprovided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSUR 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the the for this I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will of performance of work which permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the handle s. 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 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 i 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 9.1 d exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505,2555an Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Ownerorauthorized agent: ' APPLICANT CERTIFICATION Date: > / {D j f l I certify that I have read this application and state that the above information is 14STRUCTION-6,NDEVIGACY N CY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a const6icUerrlending 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. 1 understand my plans shall be used as public records. Licensed Signature Date Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 CUPER7'llNO I (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or 13 ®W, _i, 3 99 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS -Z 2_C I N # 3 ^ w 39_00) OWNERNAME ,0d1,4 (L_4_ A PHONE gol --os / 36 J E-MAIL// STREET ADDRESS z� o ti i 1 CI STATE, , � ;ZI�ZIP 1 J C)A FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAlLJEFFREY.RAINEY@ATT.NET STREETADDRESS 1069 EDGEMERE LANE CITY, STATE, ZIP HAYWARD, CA 94545 FAX 510-783-1041 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR I CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 836021 LICENSE TYPE 13,C39,C13,C17 BUS. LIC # 29818 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 DESCRIPTION OF WORK I <AJ -(Ar i I ® ja6 -,,e Fr -T 1J (,) 1:)o &J r,J 3)w //J 7x-71 i Z C�^C tit �J 6 � EXISTINGUSE PROPOSED USE CONSTRTYPE 1 11 STORIES USE TYPE OCC. SQ.FT. - VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA EIDETACH Lj ATTACH I #DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? [:]NO ADDITION? ❑ NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESED-_ - - --- TO AL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOME? ❑ NO [ 7 O� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 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. I a sentatives of Cupertino to enter the 4hDve-identified property for inspection purposes. Signature of ApplicanVAgent: Date: SUPPL2��MORMATION REQ PLATY CHECI x1FE xalrralcs lk v T1,COUNTER Ch stJILDIlVG.PI AN R7 VII w New SFD or Multifamily dwellings: Apply for de on permit for existing building(s). Demolition permit is require for to issuance of building permit for new building. LJ EXFPXSS Q )?LANN1NgPLAN vl�v Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fl SANna�tD L PIIBLIC R<iRKS _ To—nn if any Hazardous Materials are being used as part of this project. L7 ©,'I1RED" f.ARGE-.. _ Copy of Planning Approval Letter or Meeting with Planning prior to MAaoit" L� SnNrrA1 swv pisr�[t ; submittal of Building Permit application. L�°'.E1VY[RONMENTA3�-1�AL`I� _. BIdgApp 2011.doc revised 06/21111 '; F:` "-LGF'".1 N 1' l::)E Af�TNIE=NT TY ELJii_l)it,' , ?'VitiI��N is )r EwR-f INO APPROVED :.,i5 ,F•t of pians "�! 5;�ecmcaticns Pali ST be kept at the .c ,te S:,rir.:; '-r ction. 4t is unia.-fvl to make any ,n nn nr �11,,er_3tions on san,f;, or to deviate e rcrn. �° it t ji pfcval from t`+�� wilding Official, e S: i^1F ll�p an aha sped'ca::nnS H LL NOT_ -- i:e to l?e an aper„ aal of the violation City (�rc±irvan�e or State Law. ; 'any any` ��, +,�5 y_ .®tiAT E Cv,vpo-e6 f~ OFFICE DOPY g4mwz Cis ) to+9 -i { II°I SI 1wJj ' 0 :Wi': If"D f:Ul CODE CWMIIL.O N E Revw eweJ ByAbby Ayeinde n r ke_t, i PdmetL D flpr Eiis W44 Kemovek 61� - \w f 111111 w�rt.s� This set of pkws and sprwdfic atkms MUST be kept at the: jcf.l site ¢' wing consfi .+cfioni rr is unlawful to make any chain:^s or slfm'aa'flons on same, or to deviate therefrom, wntlanut sprarovsl wm, from the Building Official. .FFFst cernjpin, of this GG i p"¢J'dJr ,'-IAI I I�0T has Id to Pei nt a,i° Qi���(��i1 a arbvc 0P t re, Waticn er wi iy ,; Larwvision or any Gil r"PPfRPR arjtl aw,. 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