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B-2016-3232 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; CONTRACTOR: PERMIT NO:B-2016-3232 10243 PARKWOOD DR APT 2 CUPERTINO,CA(326 27 037) THERMAL MECHANICAL SANTA CLARA,CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED:12/09/2016 OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744 LICENSED CONTRACTOR'S DECf A ATION BUILDING PERMIT INFO: License Class C-4.10.20.36:38 Lic.#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 19/UNIT 2;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 1. T 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. . . 'I-have and will maintain Worker's Compensation Insurance,as provided for by ection 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 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 27 037 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.erre Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. y Signature1= -/ Date 12/9/2016 Issued by:AbbyAyende Date:12/09/2016 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 roofmg 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) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant; contractors to construct the projecf(Sec.7044,Business&Professions Code). Date:12/9/2016 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. 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 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 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,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ag nt: APPLICANT CERTIFICATION Date: 12/9/2016 I certify that I have read this application and state that the above information is CONSTRU,% ION LENDING A NCY 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'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 12/9/2016 Professional \,'�' /f CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION s.�q 10300 TORRE AVENUE•CUPERTINO, CA r i4-3255 (408)777 3228• FAX(408)777-3333.bCA s3.gna cupertino.orq CUPERTINO ca T3 - ZQl c _ 3Z3Z ❑NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION,/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# e '7 / _ 2 r9 10114 Packwood DR, BLDG 19,Unit#8 J [_.�j i 5 OWNER NAME _ PHONE E-MAIL Avery Glenbrook LLC 650-961-8330 avery@pacbell.net STREET ADD 130 East Dana Street CITY,STATE,ZIP Mt.View, CA 94041 FAX 650-961-0571 CONTACT NAME Rob Moyer PHONE 408-593-8115 E 'rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY,STATE,ZIP FAX 408-988-0233 Santa Clara, CA 95054 ❑OWNER 0 OWNER-BUILDER ❑ OWNER AGENT IX CONTRACTOR ❑CONTRACTOR AGENT ❑ AZCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Thermal Mechanical 256057 299 C-4,10,20,36,38 COMPANY NAME Thermal Mechanical E- Lrmoyer@thermalmech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY,STATE,ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGINEER NAME - E-MAIL LICENSE NUMBER BUS.LIG COMPANY NAME FAX STREET ADDRESS CITY,STATE,ZIP PHONE .�..— DESCRIPTION OF WORK - _. .. _ _� —- add new AC replace furnace in same location, (N)washer/drye hook ups, (N)electrical panel (70 AMP), (N)gas line for stove, (N)electrical outlets, (N)light, (N)bathroom exhaustfan EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES - - 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 GARAGE AREA: 0 DETACH 0 ATTACH #DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY DYES - - -_ BEINGADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES •I Cry+ r ,� i= = �� ,', TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ 1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to a eTproperty owner's behalf. I e read this application and the information I have provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to bmld'+:-+ns+ ction I authorize representatives of Cupertino to enter the above-identified p pe ,for inspection purposes. Signature of Applicant/Agent: r= - � Date:_ ! e' SUPPLEMEN''AL INFORMATION RE UIRED 'V eHEc T3 4„aiTINt SY?I?, c New SFD or Multifamily dwellings: Apply for demolition permit for a,OVER/ E-COUNTER Q BCUILD PL I,1, existing building(s). Demolition permit is required prior to issuance-of building permit for new building. 1EXPRESS © ANNINGPLAN v1EW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STA tBA ❑ PUBLIC wORRE form if any Hazardous Materials are being used as part of this project. LRC. QT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. AJCJit, sA7CTAttXRt DISTRICT (. EF1V RONME+NTALHIA FR BldgApp_2011.doc revised 06/21/11