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07050137I cd 100 ;rad i O 10 z. n Z F am a )0. :0< LG0 Llu-�rn '?a i .CITY OF CUPER11 NU BUILDING DIvisioN BUILf31NGAgf)B.ESS:ARKWOOD DR OWNER'S NAME: GLENBROOK APTS NE: ARCHITECTIENGINEER: PERMIT LICENSED CONTRAUIUR'S utc1-vtA1 [UN I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a c t. S License Class Lic• k Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following 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 prior to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(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: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 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 required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Corn tance carrier and Policy number ate: Cartier. z --o" " Policy NX.0 -E.Q CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for " spcction purposes. (We) agree to save ' demnify and keep harmless the City of Cupertino against liabilities, judg�Tcand expenses which may in any way accrue against said City in consequence it.APPLICANTDS AND W L COMPLY WITH ALL NON -POINT SOUR 7 Signature of Applicant/Contractor Dale HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes ❑ Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes 1 have read the hazardous a uilcmcnts under Chapter 6.95 of the Califor- niaHcalth&Safct 25505.2553 25534. 1 understand that if the building docs not Ely vc a 'bility to notify the occupant of the requi met prior to issu of a Certificate of jyt . Owner or authorized agent (7 Date AVERY CONSTRUCTION 130 EltST DANA ST REPLACE WINDOWS LIKE FOR PERMIT NO. 07050137 PERMIT ISSUE DATE 05/16/2007 SANITARY NO. CONTROL NO. ...._ _ . . Job Description sq. Ft. Floor Area Issued by Re -roofs Type of Roof Required Inspections BUILDING PERMIT INFO ELECT PLUMB MECH atlon All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT' RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: B1}:. Lot: APN ........: 32627037.12 DATE ISSUED.......: 051'16/2007 RECEIPT #-----....: BS000001350 REFERENCE ID # ...: 07050137 SITE ADDRESS .....: 10:44 PARKWOOD DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: GLE;NBROOK APTS ADDRESS ..........: 10:.00 MARY AVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1502 RECEIVED FROM ....: BR --.-AN AVERY/MATT CONTRACTOR .......: AVERY, BURT LIC # 12134 COMPANY ..........: AVERY CONSTRUCTION ADDRESS 130 EAST DANA ST CITY/STATE/ZIP ...: MTP1 VIEW, CA 94041 TELEPHONE ........: (9(10)961-8330 FEE ID UNIT QUANTITY l►MOUNT 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 VOICE ID DESCRIPTION VOICE -------- ID DESCRIPTION ---------------------------- -------- 101 ---------------------------- FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH noF CUPEk INN CITE' OF CUPERTINO PERMIT APPLICATION FORM E -IC, 5Gl3 `1 — 1 `N # � t� �s w C Date: BAPPLOTHER N ailing Address (if different from building address): Building Ar1drPcs: Boner <= 100,000 Btu MECHANICAL �� Pr 'r t � v c- Owner's Name: Phone #: �� mss- - 2 0j - � " 3 E MECHANICAL BBOILER4 License #: r`n��t.rrictc�r: BBOILER5 Bc,iler > 1.75M Btu MECHANICAL Phone Cupertino Business License#: Contact. Fax Building Permit Info: BCONSTAXBQ Cor.. Tax for BQ Zone BUILDING Lis hotel and Motel Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor ArQa: ELECTRICAL Sq.Ft.: Cost of Proje-*- ^' ELECTRICAL Occupancy Group Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING check this box if theproject is a Type of Construction:Please second -story addition: El BINVESTIGA ]nvestigation fee BUILDING Mnir.r F— olect Duc: ot,nnucuu Quantity Fee ID 1'ee Description Fee Group BAPPLOTHER C ther Appliances MECHANICAL BBOILER1 Boner <= 100,000 Btu MECHANICAL BBOII.ER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Bc,iler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor.. Tax for BQ Zone BUILDING BCONSTAXH hotel and Motel BUILDING BCONSTAXR Cor. _tax — Resi/Mobile BUILDING BELEC 1000 Ele c 600V <= 1 OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA ]nvestigation fee BUILDING 1 of 3 -7 7 MRSS� . "j CITY of C1 IDVOTIKIn CITY OF _ TINO PERMIT APPL14--_11ATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Mi3cellaneous Fee BUILDING BMITIGATC Comer. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBAC'KFI,C}W A n-)spfienc Vacliurn PLUMBING - - - - -; - Bl'( ESSPC�C?L C spool —es -- I LUMBIN6 ' -- - -- BPERMFEE BI lit Permit Fees BUILDING EPLUMBING BPFIXTURE PbIg Fixture BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind VVaste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain & Vent PLUMBING BPWATER Insta.1/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS M<dn Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMppLI Appliance Install MECHANICAL BREMBUSWAY R, -model Busways ELECTRICAL BREMFIXT I_ ighting Fixtures ELECTRICAL BREMFURN Rebeation of Furnace MECHANICAL BREMFURNOV Relc Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Iw tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Po'.e/Platform Fixture ELECTRICAL BREMPOWER PowEr Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R -,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL r,r♦,,,� D_.Tal RPC Annlignr,P ELECTRICAL tiK.C1V11�GJtirr � ��.,.�••,....._ _ __ _ 2 of 3 CITY , s tw 7 �> t � PERMIT APPLICATION 6`__ V Quantity Fee ID BREMSIGNAD Fee Description Rmd: Signs Add Branch Fee Group ELECTRICAL BREMSIGNS Remc del Signs, Marquee ELECTRICAL BREMTHEATR Thez.trical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S,,b Specific Plan BUILDING j 11S,F VS -MI nn;1\ BSEISMICL1 E In,P.0 C,nng1lIffCI-r, a f Szismic Fee lies BUILDINU BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Teml,orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec. Permit Issuance ELECTRICAL MPERMFEE Mcchanical sq. foot MECHANICAL MPERMITFEE Mec4 Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plunbing Fee sq foot PLUMBING PLLONGRNGC Plannin-LR Comme/ Multi-Fam PLANNING PLLONGRNGR PlanniRCIong Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3