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B-2016-3062CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3062 10114 PARKWOOD DR APT 8 CUPERTINO, CA 95014-1438 (326 27 036) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 11/07/2016 OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-4. 10.20.36.38 Lic. #25 Q5 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 19/UNIT 8; ADD (N) 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; (N) 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 ' 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 Sq. Ft Floor Area: Valuation: $20000.00 permit is issued. 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 27 036 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 per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. o �> Signature 7/ 016 Issued by: Abby A, ej nde Date: 11/07/2016 OWNER-BUIL 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 1. I, as owner of the property, or my employees with wages as their sole installed without fust obtaining an inspection, I agree to remove all new materials for i 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 (Sec.7044, Business & Professions Code). Date: 11/7/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTED t. 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 z. 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. 1 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(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 Code, Se ions 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: 11/7/2016 1 certify that I have read this application and state that the above information is O I ON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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'S DECLARATION Code, Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 11/7/2016 professional COMMl NI-rf DEVELOPMENT DEPARTMENT = BUILDING DIMSION 10300 TORRE AVENUE s CUPERTINO, CA 950 1114-3255 (408) 777-3125 - FAX (408) 777-3333 - -7 a ❑ ADDrrioN FX1 ALTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10114 Parkwood DR, BLDG 19, Unit #8 APN# OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAILaverY@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 77' rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 FAX 408-988-0233 OWNER ❑ OWNERBUILDER ❑ OWNER AGENT IR CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE C-4,10,20,36,38 BUS. LIC # 299 co"ANYNAME Thermal Mechanical E"MAILrmoyer@thermaimech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY, STATE, 11 Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME - E-MAIL FAX STREET ADDRESS- CITY, STATE, ZIP PHONE DESCRIPTION OF WORK upgrade electrical, add washer dryer, new gas piping for range, add AC EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($� EMSTG NEW FLOOR DEMO TOTAL _ AREA. AREA AREA NETAREA BATHROOM - KITCHEN - OTHER . REMODEL AREA REMODEL AREA REMODEL -AREA PORCHAREA DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA: DETACH El ATTACH #DWELLINGUNITS ISA SECOND UNrr ❑YES SECOND STORY ❑YES , BEINGADDED? ONO ADDITION? - PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPROVAL LETTER. - IS THE BLDG AN Q YES EICHLER HOME? Q NO REC VED BY: TOT VATION: PLANNING ADPL # ,O NO 9 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read 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 id ordinances and state laws relating to b construction .I authorize representatives of Cupertino to enter the above ratified property for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL MORMAnON AQUIRED .. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. El EXPRESS El PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ STANDARD El _ To—rat if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121/11 i SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE . I COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CL)PERT1140 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing0cupertino.orq PURPObt TI -Lis affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for aspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: a - AREA I SMOKE ALARM CO ALARM. Outside of each separate sleeping area in the immediate vicinity of X_p the bedroom(s) On e-pery Je el of a dwelling unit including basements X ` X Within each sleeping; room X i Carbon Monoxide alarms are not required in dwellings whdch do,not contain: fusel burning appliances and that do -not have an attached garage. Carbon monoxide alarms combined with smoke alai -ins shall comply with . C. -'3C Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial. power supply, alarm(s) may be solely battery: operated. Til existing dwelliuig units, alarms are permitted to be solely battery operated where repairs or alterations do not result h -L the removal of wall. and ceiling finishes or there is no access ,bymeal s of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections. 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wirha& As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with .the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified belovT leave been tested and are operational, as of the date signed below. ¢ / 11f Address: && Alfe- cDa1 � l Z" Permit No. �'Zoi%��G'Z Specify Number of Alarms: t Smoke A larins: - Carbon Monoxide Detectors: I have read and agree to comply with the_tea and conditions of this statement Owner (or Owner Agent's) Name: r �L Signature` Date: Contractor Name: [[, Lrc: .. ..�. ..,...pate: ,.._.7!"n r .__. J_,. CUPEI TING Owner Name Address 101/ WATER -CONSERVING PLUMBING FIXTURES. OWNER. CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3258 (408) 777-3228 - FAX (408) 777-3333 buildinaC�cuoertho.oro rmrr c t Permit No./37zo/kp I 1. Is your real property a registered historical site? ❑ Yes ` Civil Code Sections 110 i .1',through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.. No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its' rlurnbing, installation of water -conserving plumbing Mures is not technically feasible? ,Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form ❑ No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and.sign bottom of form. No Go to Question 4. - 4. Is your real property built and available fo'r use or occupancy on or before January 1, 1994? ❑ No Ivly real property is built and available7for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom o.f form.. 5. Please check ONE of the following: ❑ Myproperty is a single family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing Fixtures shall be replaced„ with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements).. My property is a naultifanzily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, Specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019; all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a eonanaercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or iruprovenients:shall require non compliant plumbing fixtures to be replaced with water -conceiving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations. or improvements).. I, as the owner or owner's agent of this property, certify under penalty of peijury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature;----'""""rs / Date- 711&7 TT„n„ Cnmr%1Pt,,,o a,nr9 domino thic (e.rtificate_ nlease return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15