12070129'CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10144 PARKWOOD DR
CONPRAC7FOR:.STEVE PLEVANCIC
1'FRMIT NO: 12070129
CONSTRUCTION
O\\'NER'SNAME,; AVERY GLENBROOKLP
528SMAT11ILDA AVF.STE2
DATE ISSUED: 07/172012
OWNER'S PIIONE: 6509618330
SUNNYVALE, CA 94086
PRONE NO: (408) 8069145
LY LICENSED CONI'R.\CI'IIR'S IIIiCI.,\R,\'PION
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BUILDING PERMIT INFO: BLDG ELECT PI-WVIB
License Class It R Lie.4 6 ?I/,r
r_ r
i\IECII RESIDENTIAL COAI IIERCLV.
Conlmclor 9_e..L,-e P// Elt.✓lurL Date 7
11
1 hereby affirm (hat I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: BLDG 25 - REPLACE 18 WINDOWS NON-STRUCTURAL AT
(commencing with Section 7000) (if Division 3 of the Business S Professions
RI -COMPLEX
Code and that my license is in full force and effect.
I hereby affirm tinder penally of perjury (tire of the following two declarations:
I have and will maintain a certificate ofconsent to self -insure for Worker's
Compensation, as provided for by Section 3700 of lire Labor Code, for the
performance of the work for which this permit is issued.
Sq, Ft Floor Area:
Valuation: $20000
I have and will maintain Worker's Compensation Insurance. as provided for by
Section 3700 of the Labor Code, for die performance ol'the work for which this
permit is issued.
AM Number: 32627037.10144
Occupancy'1'ype:
Arruc.w'r cbarru�lc.\•noN
I certify that I have read this application and sone that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives ofthis city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless tire City ofCupertino against liabilities,judgments,
WITHIN 980 DAYS OF PERMIT ISSUANCE 012
costs, and expenses which may accrue against said City in consequence of the
180 DAY M LAST CA�LED INSPECTION.
granting of this permit. Additionally, the applicant understands mid will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued/v: Date:
—
Signator Date42
//
Go
❑ O\VNER-RI1ILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
I, as owner of the property, or my en)ployees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant: Date:
Business S Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sce.7044, Business S Professions Code).
ALL ROOF COVFRINGS TO BF, CLASS "A" OR BE"FfEIR
I hereto• affirm tinder penally of perjury one of the following three
declarations:
IIA7.ARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate ol'Cunsent to self insure for Worker's
I have read the hazardous materials requirements lender Chapter 6.95 of file
Compensation, as provided for by Section 3700 of the Labor Code, for the
California I lealth S Safety Code, Sections 25505, 25533, and 25534. I "ill maintain
performance ol'the work for which this permit is issued.
compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health
I have and will maintain Worker's Compensation Insurance, as provided lir by
Safety Code. Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance ol'the work for which this
Additionally, .should 1 use equipment or devices which emit hazardous air
permit is issued.maintain
contaminants as defined by [lie Buy Area Air Quality iNlamlgemeat District I will
compliance with the CupertinoMunicipal Code. Chapter 9.12 and the
I certify that in the performance of the Work for which this permit is issued, I shall
health S Safer• Code. Sections 25505, 25533, and 25 34.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after makingthis certificate of exemption,1
e Labor Code, I must
become subject to the Worker's Compensation of tire
Own rnr�a-mho >�agent. ,Z
Date: ,
/
provisions
forthwith comply with such provisions or this pemnit shall be deemed revoked.
V
CONSTRUCf10N LENDING AGENCY
APPLIC NT CF.RTI FICATION
I hereby aDirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances mid state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against Iiabilities,judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicwm understands and will comply
ARCA ITFCI'-S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CUPERTINO I
n NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
12.0-7 01 �—
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 7773333 • building (o)Cuoerano.orD `�/,r11
nADDMON nALTERATION /TI n REVISION/DEFERRMr�ORIGNALPFR.VT
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PROIER ADDRESS /(1✓r�`� - O ��t I
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OWNER NAME 4 V i //...R Y �L � %`�3-�+(,/rl 1_P PHONE6s'o- 961-k
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STREET ADDRESS CttY. aTE ffi F i
CONTACT NAME
-111/ArJC.sL
PHONE
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STS r" Lc. t/ Vg n -L~ -
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STREET ADDRESS�--
CRY. STATE
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 11YCONTRA=R ❑ CON' CTORAGENT ❑ ARCHTRLT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC`1'ORNAMEgjeVC P 1p LICENSE N[7MH
LICENSETYPE/3
HU9. LICq
C0.18A.NY NAME
E-MAI
F
e e v
S e� By Ma.
STREET ADDRESS
S
QTY. STATE UP
P ONE
aity Cr v
S yule L2 iykk,6-
S
ARCIGTECT/EN'GLYEERNAME , ) .,t
'v YC
LICENSE NUMBER
HUs. tIC4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
QTY, STATE, ZIP
PHONE
OESCRtPL70N OF WORK
-R&—t'1Ar)(rr Cl.1A nA \BIIiICL C_.P / l/ /A) 4Q(AJS
rffi
Ex.STII+G USE
ly
PnoeasE USE
CGNSMaPE ° STOEUES
USE
TYPE
I OCC.
SQFT.
VALUATIONS)
AREA
AREA
NEW FLOOR
AREA
0&MO
ARER
TOTAL
T
TAA&1
VI
— I
BATHROOM KRCTffN OTHER
REMODELARE\ REMOOELAREA REMODEL AREA
PORCH AREA DEIX ABA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
H ATTACH
Y DWELLMG UNRS:
ISASECONDUMT DYES
I SZCONTSTORY 13 YES
BELNGADDED? ❑NO
ADDEITON? ❑NO
PRE-APPUCATLON ❑YES T YES, PROVIDE COPYOF
IS Tifl'. BLDG A.N ❑YES
RECEIVED BY: -
TOTAL VALUATION:
PLANNING APPLY ❑NO PI.RNT+IJG APPROVAL IFRER
EICm.ER HOME? ❑NO
_
Zar ooc�_
By my Signamte, below, I certify to each of the following: I am the property owner or authorized agent to At on the prpperty owner's behalf. I have read this
application and the information I ha a rovided is corral 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 u ding c don. I authorize representatives of Cupertino to enter the above -identified property fareccon purposes.
Signature ofAppbcanr/Agcnt Date: �r "'71
SUPPLEMENTAL TNFOR.MATIONREQUIRED
PLAN CEnEcIcTYrE
�..R-O=GSLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
emsting building(s). Demolition permit is required prior to issuance of building
oven T•L�-CoomzR
t7'Btm�mc nA.v RevrEw
permit for new building.
❑ EXPRESS
❑ PI.A.NNNG PIAN REVIEW
_ Corrlmercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sTA.NDARD
❑ PUBLIC WORES
To= if any Hazardous Nfarerials are being used as part of :his project.
❑ LARGE
❑ FIRE binq
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑
❑
submittal of Building Permit application.
MAIOR
SANITARY SEWER DISCRLCI'
❑ ENVMON, NTALFIFAITR
B(dgApp_201 Ldoc revised 06/21/11
'- ;7(
IIr��r��'�� CITY OF CUPERTINO
I"I FEE ESTIMATOR - BUII.nINc. niviClnN
t itis ecnmate noes not tttctuaejees aue to ether Departments (i.e. Planning, Ptthlic Works, Fire, Sanitary Sewer District, School
District. etc.). These (ens are haled nn rhe nrn/h..innm h.rn:......:...,— ... n..Alo ..... I--.... A. .... .....:....... I- �__. 1__- "
.._
FEE ITEMS (Fee Resolution 11-053 Eli 7/1/11)
ADDRESS: 10144 parkwood dr bldg 25
DATE: 07/17/2012
REVIEWED BY: bob s.
,Llech. Permit Fee:
APN:
±BP#:
'VALUATION: $20,000
*PERMIT TYPE: Building Permit
PLAN CRECK TYPE: Alteration / Repair
PRIMARY
USE: Multi -Family Dwelling
USE:
Buildina is
>3 Stories 0 Yes (D No
PENTAMATION
PERiMITTYPE: 1GENRES
NVORK
a lace 18 windows non structural at r-1 complex.
SCOPE
t itis ecnmate noes not tttctuaejees aue to ether Departments (i.e. Planning, Ptthlic Works, Fire, Sanitary Sewer District, School
District. etc.). These (ens are haled nn rhe nrn/h..innm h.rn:......:...,— ... n..Alo ..... I--.... A. .... .....:....... I- �__. 1__- "
.._
FEE ITEMS (Fee Resolution 11-053 Eli 7/1/11)
Aleeh. Plan Check
Phath. Plan Check
Elec. Plan Check
,Llech. Permit Fee:
Ptnmh. Pernat Fee:
Iilec•. Permit Fee:
Other Afech. Insp.
Other Plumh Insp.
Other Dec. Lisp.
Alech. Insp. Fee:
Plump. Iusp. Fee:
Fier. Lisp. Fee:
t itis ecnmate noes not tttctuaejees aue to ether Departments (i.e. Planning, Ptthlic Works, Fire, Sanitary Sewer District, School
District. etc.). These (ens are haled nn rhe nrn/h..innm h.rn:......:...,— ... n..Alo ..... I--.... A. .... .....:....... I- �__. 1__- "
.._
FEE ITEMS (Fee Resolution 11-053 Eli 7/1/11)
_.__..__.-_.-......._......
FEE
..._......
QTY/FEE
.... _............. .—..... ............
MISC ITEMS
u....
Plan Check Fee:
$0.00
= #
$666.00
Window / Sliding Glass Door
1WINRFP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consn•ttction Tac:
Adminisn•ative Fee:
0
G
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning, Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Doc umenlalion Fees•:
Stron . Motion Fee: I8SF-ISMICR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 1
$3.00
$666.00
TOTAL FEE:
1 $669.00
Revised: 0 7/0 112 01 2
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 0 LIZ -1 CA
PERMIT#
OWNER'S NAME: g-
PHONE # 09 —
GENERAL CONTRACTOR: e e ani.
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE: u O
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL BCO\TRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. -
1 am not using any subcontractors: %
Signature Oate
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing "
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
4 711
ate