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B-2016-2824 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2824 10180 PARKWOOD DR APT 4 CUPERTINO,CA 95014-1407(326 27 037) THERMAL 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 C-410.20,26.28 Lia#256057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: BLDG 32/UNIT 4;ADD M A/C;REPLACE FURNACE,SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION;(I)WASHER AND DRYER HOOK UPS;(I)ELECTRICAL 1. I have and will maintain a certificate of consent to self-insure for Worker's SERVICE(70 AMP);(N)GAS LINE FOR STOVE;(N)9 RECEPTACLE Compensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS;(N)1 LIGHT;(N)BATHROOM EXHAUST FAN performance of the work for which this permit is issued. f, 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. 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 he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/20/2016 Issued by:Abby A endg Date: 10/20/2016 OWNER-BUJI DER 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 x. 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) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sce.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 2. I 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. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca 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 Code,S 1 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 J Date:10/20/2016 I certify that I have read this application and state that the above information is N 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 cityof work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree 'Lenders 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'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 10/20/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO {408}777-3228•FAX{408}777-3333•buildinatc�cupertina.ora �� c? �} ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION I DEFERRED ORIGINAL PERMIT# PROIEC'rADDRESS 10180 Packwood, BLDG 32,Unit#4 APN# r 2-7 © 7 OWNFRNAME PHONE E-MAIL. Avery Glenbrook 111-C650-961-8330 avery@pacbell.net. STREETADDRESS. 130 East Dana Street CITY,STATE,ZIP '.Mt.View, CA 94041 FAX 650-961-0571 CONTACT NAME Rab Moyer PHONE.408-593-8115 E-MAILrmoyer@thermaimech.com STREET ADDRESS CITY,STATE,ZIP FAX 425 Aldo ave. Santa Clara,CA 9504 408-988'0233 ❑OWNER D OWNER-BUILDER. 0 OWNER AGENT I$CONTRACTOR ❑.CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Thermal Mechanical LICENSENUM13ER 256057 LICENSETYPB BUS,LIC H 299 C-4,10,20,36,38 COMPANY NAME Thermal Mechanical E-MAILrmoyer@therrnalmech.com FAX 408-988-0233 STREETADDRESs 425 Aldo ave. CITY,STATE,"P Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT(ENGINEFR NAME LICENSE NUMBER BUS.LIC P COMPANYNAME E-MAIL FAX STREET ADDRESS CITY,s1ATE,ZIP PHONE ..-- '=Di?SCRIPTIONOF-WORK--•--,..-_ - - rrenovation_ A artment ,- ' 'Tr. � � �-.1 ! �� I 5-l�.l� �. /j LI C✓V/v( ��'L/ V��-.I� �/lr'�'Y EXISTINGUSE V PROPOSED USECONSTR.TYPE #STORIESV]! USE TYPE OCC. SQ.FT. VALUATION($) RXISTO NEWFIOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PARCH ARBA DECK AREATOTAL L)EChIPORCH AREAGARAGE AREA: ❑DGfACH p ATTACH #DWELLING UNITS: ISASECONDUNIT EYES SECONDSTORY (]YES BEING ADDED? E]NO ADDITION? []NO - PRE-APPLICATION r1 YES IF YES,PROVIDE COPY OF, IS THE BLDG AN ❑YES -RECEIVED$Y = TO L VALUATION: PLANNING APPL# ONO PLANNING APPROVAL LETTER EIC1ILRR HO6IE? []NO '��LIf ....... By my signat n-c below,I certify to each of the following: I am the property owner or authorized agent act on he property owner's behalf. 1 have reed this application and the information I have provided is correct. 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 to builr jD traction. I autha 'ze representatives of Cupertino to enter the above-identifi prop t for inapeetion purposes. Signature of Applicant/Agent: Date: SUPPLEMEN AL INFORMATION REQU FD PLANCHECK<TYPE'' , ROUTING SLIP;', _New SFD or Multifamily dwellings: Apply for demolition permit for p OVER THE eol7rsr>R ❑ Bt€iir3ilti PraN RRVIr�v existing buildings). Demolition permit is required prior to issuance of building permit for new building. `'❑ ExP>zs� I ranlvlNcriANREviiitiv Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ .$TANoARD 171'PITnLIC�vouics fomn if,ny Hazardous Materials are being used as part of this project. LARGE;' ❑ FII3EDFPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ I+zAJOR: ❑ s 11NITAItY5EwEMAS I.- ❑: . ..:. .......`.•':.: ... . .; `.'ENI�IROiVRIENTALIiEAI:TIf •_:'::i'. BIdgApp 20)Lcloo mvised 06121111