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12040030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10195 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12040030 CONSTRUCTION OWNER'SNAME: AVERY GLENBROOKLP 528 S h1ATHILDA AVE STE 2 DATE ISSUED:04/05/2012 OWNER'S PHONE: 6509618330 SUNNYVALE.CA 94086 PHONE.NO:(408)80&9145 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class I,ie.k MECH r RESIDENTIAL r COMMERCIAL Contractor 0V,[vtc,L Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 2.DECK RAILING AND POST REPLACEMENT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.FI Floor Area: Valuation:$6000 1 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(his permit is issued. APN Number:32627037.10195 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply ` 'ry with all non-point source rc ulalions per the Cupertino Municipal d Section Issued by: �� / JE/q/J Date: L 9.18, C —� Signature ` Dale ✓ �� RF.-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penally of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE: declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and wi11 maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will Permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I eerily that in the performance of the work for which This permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Ow r au mrfzed agent: Compensation laws of Cal ifomia. If,after making this certificate of exemption,I Dale: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) 1 cenify that 1 have read this application and state that the above information is Lender's Name correct. I agree to complywith all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address 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 may acerae against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally;the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY'DEVEL'OPMENT DEPARTIVIENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)T77-3333• building(a cuoer4no.ora E]NEW CONSTRUCTION ❑ ADDITION �TERATION/Ti. ❑ REVISION/DEFFRRID ORIGINAL PERMIT p PROJECT ADDRESS O 1NU APNa -7 — 032 [ I OWNERNAME vinY GC r�ao-0oi L /0 1 FHONE6j-0-96/-k EMALAVeytysp SIXEST 3 055 /�a/A s+. CITY. ®.14.� I"j C4`1 CONTACT NAME PryONE E-��AI, /� 51-(='✓i CYAAc,C. YOFs-frob7 41- STS rA LL t) l9 rtta- Gv STR=ADDRESS i-I CTrY,STATE ZIP F 13oWNER 13OWNER-BUILDER ❑ OWNERACENr �S-C/MTRAeroR ❑COe CTDB.Acxr ❑ Aacarn= ❑ENGw= ❑ DEYELoFFR ❑TENANT CONTRAC[OR NAME [..V ✓LCA �`_ [1CFNSE NUME I // <76;1LICENSE TYPE,5 BUR.t1C p COMPANY NAME C- EMAIL �-(1Q F1,7f0a-73�^ f Q rC n v S Qu EV Mai I.CC>>N STRFBr ADDRE! A y1 ,STATE,IIP G le u ONE - 6— ARCHIIECrrENOINEER NAME , ) T LICENSE NUMBER BUS.LIC 9 COMPANY NAME 'v E-MAB. FAX STREET ADDRESS CRY,STATE,IIP PHONE DESCRIPTION OF WORK e EXISTING USE PROPOSED USE CONSTR.TYPE OSTORIFS USE TYPE OCC. SQFr. VALUATION(3) AREA NEW FLOOR DEMO TOTAL �O 5 AREA AREA AREA NET.AREA "+j`, !O/ BATHROOM KITCHEN DTHER REMODELAREA RENODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH ATTACH R DWELLING UNITS: rs A s,112"UPtLT VES SECOND DRY YES - BRNGADD®r ❑NO ADDm,O ❑NO PRE-APPLICATION OYES IF YES,PROVmE COPY OF tMTBRBLOGAN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNINGAPPLS ❑NO PLANNING APPROVAL LETTERCmER BOp@T ❑NO By my sigaanae below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty oWnees behalf. I have read tbis application and the information I ha 'tied 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 lava relating ding tion. I authorize representatives of Cupertino to enter the above-identi5le�d property Por inspection purposes. Sigaamm ofApplieam(Agent Date: 77 / SUPPLEMENTALINFORMAnONREQUIRID PLANCBECKTYre RODTmcsLIP New SFD or Multifamily dwellings: Apply for demolition permit for oesTXx �PCAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ BIORE.ss ❑ PLANNING PLAN RXVWW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ SCANDARD ❑ PUBLIC WORKS rm foif any Hazardous Materials are being used as part of this project ❑ r.eGg ❑ FinaDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DLsrnrer submittal of Building Permit application. ❑ RSNVIRONWPNTAL UEA TH BldgApp 2011.doc revised 06/21/11