07050146 CITY OF CUPERTINO
BUILD",G DIVISION PERMIT
PERMIT NO.
BUIIT61l116EYARKWOOD DR AVERY CONSTRUCTION 07050146
PERMIT ISSUE DATE
OWNER'S NAME:
GLENBROOK APTS 130 E1.ST DANA ST 05/16/2007
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH
i p C LICENSED CONTRACTOR'S DECLARATION _. T, _,T Job Description
v p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
o y in full force a ct ��_
License Class �•#
±Ftp Datc Contractor
Al
ARCHrrECrS DECLARATION
a< 1 understand my plans shall be used as public records
�qU
4 o H Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
COOfollowing reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 1q.Ft.Floor Area
rtx p (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
j? that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as thew sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[11.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a cone actor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workefs Compen-
sation,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 acquired by Section
3700 of the Labor Codc,fperformance of the work for which this permit is issued.
My Worker's Compensati n lnsutance carrier and Policy number arc:
Carrier. r_G4eA_4 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the Workcrs'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
fY the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
z Lcndees Address
U 0 I certify that I have read this application and state that the above information is
-i correct.I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned propert for inspection purposes.
(We)agree to e,indemnify and keep harmless the City of Cupertino against
liabilities,judgmcn toss and cxpengesav ich may in any way accrue against said City
U Z in consequence o c granlinguf IXis per '. Date
APPLICANT S 1ANDS A ILL COMPLY WITH ALL NON-POINT Issued by
S U
r /to y7 Re-roofs
Signature of Applicant/Conuactor —D T of]Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will a roof i;installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which -
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? '
❑Yes
1 have read the tors materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety ,Sections 25505.25533 and 25534.1 understand that if the building
does not c ntl atenank thatit' responsibility to notify the occupant of the
rgquirc must lx melpriorwissu ccnraccrti0cateerOccupancy. Signature of Applicant ate
.._-_.._.., a _o
All roof coverings to be Class "B"or better
Owner or authorized agent
CITY OF CUPERTINO
4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 32E27037.03
DATE ISSUED. . . . . . . : 05/16/2007
RECEIPT # . . . . . . . . . BSC00001350
REFERENCE ID # . . . : 07C50146
SITE ADDRESS . . . . . : 10150 PARKWOOD DR
SUBDIVISION . . . . . .
CITY CUEERTINO
IMPACT AREA . . . . . .
OWNER GLENBROOK APTS
ADDRESS 10100 MARY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1502
RECEIVED FROM . . . . : BRIAN AVERY/MATT
CONTRACTOR . . . . . . . : AVERY, BURT LIC # 12134
COMPANY AVERY CONSTRUCTION
ADDRESS 13C EAST DANA ST
CITY/STATE/ZIP . . . : MTY VIEW, CA 94041
TELEPHONE (9E0) 961-8330
FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BENERGY PERMIT FEE 147. 96 71. 02 0 .00 71 . 02 0. 00
BPERMFEE VALUATION 7, 785.00 147. 96 0 .00 147 . 96 0. 00
BPLANCHK PERMIT FEE 147 .96 197.45 0 .00 197.45 0. 00
BSEISMICRE VALUATION 7, 785 .00 0.80 0 . 00 0 . 80 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 417.23 0 . 00 417 .23 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 5, 841.22 VISA
---------------
TOTAL RECEIPT 5, 841.22
i
CI ' C�JL+ R'H'INO
'-
�,rYOF
PERMIT APPLItCA'I'IO�I �"®
CUPEkTINO
r- N # -. _ U Date:
Buildi g Ac1r1rPss: N ailing Address (if different from building address):
Owner's Name: Phone#:
L�_cense#:
Phone �~ Cupertin
Contact:
Business License
r
s,� ,r � Fax:
N u.
Building Permit Info:
Bldg ❑ Elect ❑ P1 zmb ❑ Mech ❑
Job Description: 7
Residential 19- .4// /3�"� J� b V 4 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Proje-* '" Occupancy Group:
� 7 ;5:
Type of Construction: Please check this box if theproject is a
second-story addition: El
coject Size: Standard ❑ Large ❑ Majcr ❑
Fee ID Fee Description Fee Group
Quantity Other Appliances PPliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boile-> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> lM to 1.75 M Btu MECHANICAL
BBOILER5 Bciler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind'Off/CommlQuasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Ifotel and Motel BUILDING
BCONSTAXR Constax-Resi/1V4obile BUILDING
BELEC1000 Elegy 600V <= 1000A ELECTRICAL
BELEC1001 Eli-.c 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD E Zergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 )f3
7
CITY OF CUPERTINO
CITY OF PERMIT' FORM
O
CUPEkTINO
Quantity Fee ID F€a Description Fee Group
BMISCELL Mi;;cellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
f BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMp New Comm Plumb PLUMBING
BOVERTIME Inst ection Overtime BUILDING
PLTA/1 1NG
BPBA C KFLOW ./'Jlll)spllel,(, �i acuum
- - -- -
- - BPC ESSPOOL _ cccsspool — ----- -- — -- -
BPERMFEE B1,I Permit Fees BUILDING
g
BPFIXTURE
?bl Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLA.NCHK P"'.an Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re ►i a Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawr. S rinkler/Backflo PLUMBING
BPSTORM St:)rm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Mzin Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMA]RIiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAppLI Appliance Install MECHANICAL
BREMBUSWAY Rt.-model Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL _
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc 11,Switch & Outlets ELECTRICAL
BREMRELOCA R,location of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
gREMRESApp Remodel Res Appliance ELECTRICAL
2 of 3
-rtk
CITY OF C TPERTINO
l-
CITYoF PERMIT APPLICATION FORM
LUPE INO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd: Signs Add Branch ELECTRICAL
BREMSIGNS Remc del Signs, Marquee ELECTRICAL
BREMTHEATR Thee trical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSXS Ventilation Systems MECHANICAL
_ BSCBLVD Srb Specific Plan BUILDING
3,S,IF7SNf,f(; 0"A Sc r�i�r� �`nlZ�l�nr i ci,�I 1'TiI� �l"T\TC
BSEISMICR 3 2ismic Fee Res B UILDIN G
BSPECIAL Special Inspection BUILDING
BSWR\4 Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM TemF orary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC B-miness License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mec;i Permit Issuance MECHANICAL
PPERMITFEE Pluirbing Permit Issue PLUMBING
PPLBG Pluwnbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Faro PLANNING
PLLONGRNGR Planning ong Range Residential PLANNING
ZADDCHG Address Change BUILDING
3 cf3