B-2016-2962 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2962
AON PARKWOOD DR CUPERTINO,CA 95014-1408(326 27 037) THERMAL
119940 MECHANICAL
SANTA CLARA,CA
95054
OWNER'S NAME:AVERY GLENBROOK LP DATE ISSUED:10/20/2016
OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#256057
Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BLDG 3PUNIT 12;ADD(I)A/C;REPLACE FURNACE,SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION;(N)WASHER AND DRYER HOOK UPS;(1)ELECTRICAL
i. I have and will maintain a certificate of consent to self-insure for Worker's SERVICE(70 AMP);(N)GAS LINE FOR STOVE;(I)9 RECEPTACLE
Compensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS;(N)1 LIGHT;(I)BATHROOM EXHAUST FAN
d, rformance of the work for which this permit is issued.
1. / ve 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. Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 27 037
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations p:41W Cup rtino M ,icipaI Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature a e 10/20/2016 Issued by:AbbyAvendg
Date: 10120/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/20/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
i. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the _ the Health&Safety Cq�Sectfa 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:10/20/2016
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 I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'Sseddaa DECLARATION
b
Code,Section 9.1.8. I understand my plans shall e used public records.
Licensed
Signature Date 10/20/2016 Professional
Zmcp 2AU4
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
IIPEEtT NC? (408)777-3228•FAX(408)777-3333•buildingP—cupertino.org
El NEW CONSTRUCTION, _ '❑ ADDITION nX ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS
Parkwood DR
, APN#Jnit#� 1 41
�'f08BLDG 3 "b
a-1� 0
OWNERNAME Avert'Glenbrook LLC PHONE 650-961-8330 E-MAIL
avert'@pacbell.net
STREET ADDRESS 130 East Dana Street CITY,STATE,ZIP Mt.View,.CA 94041 FAX
650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-8115 E- rmpyer@thermalm-ech.com
STREET ADDRESS CITY,STATE,ZIP FAX
425 Aldo ave. Santa Clara, CA 95054 408-988-0233
❑OWNER ❑OWNER-BUILDER ❑ OWNER AGENT IX CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER Il DEVELOPER ❑.TENANT
CONTRACTORNAME LICENSENUMBER.256057 LICENSE TYPE BUS.LIC# 299
- Thermal'Mechanical C-4,10,20,36,38
coMPANYNAME Thermal Mechanical E-MAILrmoyer@thermalmech.com FAX 408-988-0233
STREETADDRESs 425 Aldo ave. CITY,STATE,ziP Santa Clara, CA 95054 PHONE 408-988-8744
ARCHITECUENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK -
.Apartment renovation
o _ _ el
EXISTING USE PROPOSED USE CONSTR-TYPE #STORIESi
USE TYPE OCC, SQ:FT. VALUATION($)
EXISTG NEW FLOOR. DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN -.OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREAE DETACH
❑ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑.YES SECONDSTORY []YES
BEINGADDED? []NO ADDITION? []NO'
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ES THEBLDG AN ❑YES E T $y VAR % QTAL VALUATION:
PLANNING ADPL# RNO PLANNING APPROVALLETTER EICHLER HOME? []NO AJ
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on le,property owner's behalf. I have read this
application and the information I have provided is correct. Ihave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building o tructio . I authorize-epr tatives of Cupertino to enter the ab;�7�ms
pection purposes.
Signature of Applicant/Agent: Date:
l' tc4C3I-tNGI1'e;
SUPPLEMENTAL INFORMATION REQUIRED
_New SFD or Multifamily dwellings- Apply for demolition permit for Ti T COI R
existing building(s). Demolition permit is required prior to issuance of building urtntrre�r A Yii w
permit for new building. l EPRSS P � 1C�Rti w,
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure AmA>zD �� l�rtBxCt
form if any Hazardous Materials are being used as part of this project,
_Copy of Planning Approval Letter or Meeting with Planning prior to v ��
submittal of Building Permit application.
f', �Iuvtricsr��t�� L�i�A
BldgApp_201 1.doc revised 06121/11