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12090012CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21317 GLEN PL I CONSTRUCTION STEVE PLEVANCIC I PERMITNO: 12090012 OWNER'S NAME: AVERY GLENBROOK LP 1528 S MATIULDA AVE SI'E 2 I DATE, ISSUED: 09/04/2012 OWNER'S PI IONS: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806-9135 ❑ LICENSED CON`TRACIOR'S/DECCLLAARATION BUILDING PERMIT INFO: BLDG r rl ELECT PLUMB r License Class Lie. 4 cnq to /(,O r r r: n y D1ECH RESIDENTIAL COMMERCIAL Contractor EDCVt Date Z 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UNIT4- DECK REPAIR (commencing with Section 7000) of Division 3 of the Business S Professions Code and that my license is in full force and effect. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of die work for which this permit is issued. APPLICANT CFRTI FICATION I certify that I have read this application and state that the above information is correct. 1 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 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -poi t source re alit - s per the Cupertino Municipal Code, Section 9.18. Signatur Date ( f ❑ OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and dee 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 construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: 1 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, I 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. APPLICANT CERTIFICATION I 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to stave indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulatiors per the Cupertino Municipal Code, Section 9.18. Date Sq. Ft Floor Area: Valuation: $5000 APN Number: 32627036.21317 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYSIVAOM LAST CALLED INSPECTION. Issue Date: U RE -ROOFS: All roofs shall be inspected prior to any roofing material beiig installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signmure of Applicant: Date: AL1, ROOF COVERINGS TO BE CUSS "A" OR BETTER IIAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25.534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth ._Safety Code clions 25505, 25533, and 25534. Oss'ne aau bo ' d,agentcc: are: COMT1211CI'ION LENDI#CCE'NCY I hereby affirm that (here is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCIII'1'ECf'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT A BUILDING DIVISION 10300 TORRE AVENUE A CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)cupertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DZi UGLNAL PERMIT q PROJECTADDRESS Gterj n APNa 3 (� 4_103 ME OWNER NAPHO 6s O' 9 6 L FSO E K -a STREET ADDRESS�. CrfY, TE ZIP Ce 30 a a sf- 0b3/4 --) Iui CONTACT NAME PHOvNEfs , 4i E AUR+ 8 J //�� I f( ✓�- C-'v��clL I V06- N r UZY nT� STREET ADDRESS i1 tC"M"ln ZIP F e ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 11YCOM'MCr00. ❑ CONr%A=RAG1Nr O ARCHRECr ❑ ENOtNEER ❑ DEVELOPER ❑ TENANT 11 11R NI' `C I LICENSE NUNM �// O� LICENSE TYPE j7 I BUS. LIC _TJ V _l✓ICA CONVANY NAME E -MAKS F Q�2. ,� � CJh .'• 2v EV 11?a,�rCr>�1 STREET ADDRESS �.1 CTFY, STATE. LT P ONE S alr7 4 S vule C v E- ARCWTELT/ENr IXEZ.R NAME a ) J.n_ LICENSE NUMBER I / Y c I BUS. IICt COAO'ANY NAbJE I E-MAIL I FAX STREET ADDRESS QrY, STATE, ZIP PHONE DESCRIPi ON OF WORX EXISTING USE PROPOSED USE CONSTR. TYPE asTOR1ES USE ME OCC. SQFf. VALUA ZION (S) EXISTG NEW FLOOR DEMO TOTAL AREA, AREA ( AREA NET .AREA - BATHROOM KITCHEN QD' RFMODELAR:A REMODEL ARTA REMODEL AREA PORCH AREA DE AREA TOTAL DECX/PORCH AREA GARAGE AREA DETACH ATTACH p DWMI NO UNRS: MA SECOND UNIT Ll YES nCONDSrORY OYES BEING ADDED? ONO ADDITION' ONO / / PRE-MPLIUT30N ❑ YES ❑YES IFYFS,NGAPPR RE TOTAL VALUATION:_ LF Elcm-ELDGwN PLANNING ADPL/ ONO PLANNING APPROVAL LET TEit EICIILER ROME? ANO APPROVAL / By Dry signature below, I certify to each of the following: I am Lhe property owner or out c gent w act on the F p owner's behalf, 1 bave read this application and the information I ba a rovided is correct. I have read the Description of Work and verify it is accurate. I e D comply with all applicable local ordinances and state laws :elating u ding c don. f authorize representatives of Cupertino ;o ma the aboygi tis profor inspection purposes. Signanme of Applicant/Agent ' Date: G� SUPPLEMENTAL rlTFOR.MATION REQUERED PLAN CEECIC 4E Ie ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building y�-.rr�-coetrrEx BUD.DmG PIAN REVIEW permit for new building. ❑ E%PRPSS ❑ PLANNING PLAN REVIEW Cc mmercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ ETA.NDARD 13PU-ELIC WORKS form if any Hazardous Materials are being used as part of his project. ❑ LARGE ❑ Fina uPDT _ Copy of Planning Approval Letter or Meeting with Naming prior to ❑ ❑ submittal of Building Permit applica on. MAIOR SANITARY SEWER DISTRICT ❑ B.YVDtONAZNTAL HEALTH 31d&4pp_2011.doc revised 06/21/11 7 z 7l CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 403-777-3223 Fax: 408-777-3333 JOBADDRESS: 13 G e61 P7aLe_ PERMIT# OWNER'S NAME: a PHONE# e�-r5u GENERAL CONTRACTO g„e_ F lo�kc/t Co S BUSINESS LICENSE # ADDRESS:,] - CITY/ZIPCODE: t �tU *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 13E SCHEDULED UNTIL THE GENERAL CONTRACTOR ANDA L SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. q 1 am not using any subcontractors: �— Signature Date Please check applicable subcontractors and complete the following information: D -- Date SUBCONTRACTOR BUSINESS NANIE BUSINESS LICENSE # CabinetsS Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleu n / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile D -- Date 9M�� CITY OF CUPERTINO o FEE ESTIMATOR—BUILDING DIVISION NOTE: This estimate does not include fees clue to other Departments (i.e. Planting, Public rf'orks, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminarlinformation available and are only an estimate. Contact fire Dept for addn'I info. FEE ITEMS (Fee Resolulion /1-053 E0: 7/l/1 /I ADDRESS: 21317 GLENPLACE Plumb. /'lot Cheek DATE: 09/04/2012 REVIEWED BY: Sylvia Plumb. Permii Fec: APN: BPt1: 'VALUATION: $5,000 *PERMIT TYPE: Building Permit Phanh. lay,. reg: PLAN CHECK TYPE: Alteration / Repair PRITIARY SFD or Duplex USE: $0.00 PENTAMATION 1GENRES PERMIT TYPE: WORK UNIT 4, DECK REPAIR $0.00 SCOPE NOTE: This estimate does not include fees clue to other Departments (i.e. Planting, Public rf'orks, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminarlinformation available and are only an estimate. Contact fire Dept for addn'I info. FEE ITEMS (Fee Resolulion /1-053 E0: 7/l/1 /I blech. flan Check Plumb. /'lot Cheek Flee. Plan Check Meeh. Permit Fee: Plumb. Permii Fec: Elec. Permit Fee: Other S1ech. Insp. Other Plumb Insp.Lj Other Flee. Insp. ,1•tech, rasp. Fee: Phanh. lay,. reg: Flee. Insp. ree. NOTE: This estimate does not include fees clue to other Departments (i.e. Planting, Public rf'orks, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminarlinformation available and are only an estimate. Contact fire Dept for addn'I info. FEE ITEMS (Fee Resolulion /1-053 E0: 7/l/1 /I FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1 # $467.00 Deck / Deck Railing IDECKIVOOD Deck (wood) Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.,0 Reg. Q OT O,Q Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consttvtcdon Tar: Administrative Fee: Work Without Permit? O Yes (F)No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Ti -ave! Documentation Fees: SVong Motion Fee: IBSEISMICR $0.50 Select an Administrative [tem Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $467.00 TOTAL FEE: $468.50 Revised: 07/01/2012