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B-2017-0154CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0154 10174 PARKWOOD DRAPT 1 CUPERTINO, CA 95014-1409 (326 27 037) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE: 650-961-8330 LICENSED CONTRACTOR'S DECLARATION License Class C10. C20. C,36C.3R Lic. #256057 Contractor THERMAL MECHANICAL Date 01/31/2018 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. I hereby affirm under penalty of perjury one of the following two declarations: 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 /��eru erformance of the work for which this permit is issued. ave and will maintain Worker's Compensation hisurance, as provided for by tion 3700 of the Labor Code, for the performance of the work for which this it 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 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 -point source regulations per tbe Cupertino Municipal Code, Section 9.18. Signature Date 01/31/2017 OWNER -B THD R D RATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 2. 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. 3. 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 California. 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 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature . Date 01/31/2017 DATE ISSUED: 01/31/2017 PHONE NO: (408) 988-8744 PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG 31/UNIT 1; ADD (I) A/C; REPLACE FURNACE, SAME LOCATION; (1) WASHER AND DRYER HOOK UPS; (1) ELECTRICAL SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (1) RECEPTACLE OUTLETS; (N) LIGHT; (1) BATHROOM EXHAUST FAN . Sq. Ft Floor Area: I Valuation: $20000.00 "N Number: Occupancy Type: 326 27 037 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSANAMES Date: 01/31/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 01/31/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 01/31/2017 CONSTRU Y hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lenders Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ❑ (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.orqCURERTtNCI A]rTTTnN IS7T ATTlTf 1orcelnr— �NEW COTVSTRUCTION 4011-- o.t�l.J�+ f d 81dgAp1)_2011.c1oe revised 06/21/11 PROJECT ADDRESS 10174 Parkwood DR, BLDG 31, Unit#1 [APN # OWNERNAME Avery Glenbrook LLC PHONE E-MAIL 650-961-8330 avery@pacbell.net STREETADDRESS 130 East Dana Street CITY, STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT NAME Rob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech.com STREETADDRESS 4255 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 F408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑.OWNER AGENT I51 CONTRACTOR ❑ CONTRACTOR AGENT III ARCHITECT' ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMEThermalMechanical LICENSE NUMBER 256057 7 LICENSE TYPE BUS. LIC# 299 C-4,10,20,36.38 COMPANYNAME Thermal Mechanical r:MAILrmoyer@thermalmech.cam FAX 408-988-0233 STREETADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECTIF.NGIN BUR NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTIONOF WORK add new AC, replace furnace in same location, (N) washer/dryer hook ups, (N) electrical panel (70 -AMP), (N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan EXISTINGUSE PROPOSED USE CONSTILTYPE #STORIES I USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO 'TOTAL AREA AREA AREA NET AREA BATHROOM KITC M OTHER REMODELARBA RENIODELAREA REMODELAREA PORCHAREA DECK AREA TOTAL DECKIPORCIIAREA GARAGEARBA: DETACH ❑ ATTACH # DWELLTNG UNTrS: ISASECONDUNIT DYES SECONDSTORY ❑YES BRING ADDED? ❑NO ADDITION? [:]NO PRE-APPLICAPION ❑YES IF YES, PROVIDE COPY OF ISTHEBLDGAN ❑YES ENG JOTALVALION: PLANNINGAPPL# MNO PLANNING APPROVAL LEITER IIICIILERHOMLT? E]NO petty orYllor's behpl£ I have read this By Iny signature below, I certify to each of the following: I am the property owner or authorize agent to act onPt� application and the information I have provided is collect. [have read the Description of Work and verify itis I agree to comply with all applicable local ordinances and state laws relating to build' c sttucti D. I authorize pi tat' of Cupertino to enter th -ide fified pro city for inspection purposes. Signature of ApplicantlAgenl: Date: % 7 SUPPLEME AL INFORMATION REQUIRE15 ;p :: '; ; ❑.=Buuiiii�tcrnriiiTviEiv'' " _ New SFD or Multifamily dwellings: Apply for demolition permitfor existing building(s). Demolition permit is required prior to issuance of building .:ovEn-rir>-coiiivTix':° permit TOY IIBW bulldlllg.PRESS.:""::�`..'-. `'.?';.�i:`' :�l]?PL'ANNItYG,PLAiY.REXEEIQ•',;'::,':��,. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. C7 ° i At G i+iii — Copy of Planning. Approval Letter or Meeting with Planning prior to ❑:hIAJOR";'_ ❑`SANITARYSEWER DISTRICT, '.' submittal of Building PerntitaPplication. ' .. '❑::F.tvTIRONDIENTAI;iIPA[.Tfi.: 81dgAp1)_2011.c1oe revised 06/21/11 PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE.• CUPERTINO, CA 95014-3255 ., (408) 777-3228 • .FAX (408) 777-3333 • build! ng(a.cugertino.org This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 201,13 CBC Sections 420.6 and 907.2.11.2 where i -to interior access for inspections 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 follcil locations: AREA _ SMOKE ALARM CO ALARM Outside of each separate sleeping area in lithe immediate vicinity of the bedroom(s) X _ On every level of a dwelling unit including basements X XY Within each sleepin room X i Carbon Monoxide alarms are not required M', dwellings which do.not contain fuel -burning appliances and that do riot have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: h1 dwelling units. with no commercial power supply, alarm(s) may be solely battery. operated. Ti existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or craiwl 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 wiring. 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 a.larIns specified below have been tested and are operational, as of the date sighed bQlow. Address: VAltj017 y. Pat ky. o ` D1. ( Permit Nor-7-0 Specify Number of Alarms: # Smoke Alanus: I L�) I # Carbon Monoxide I have read and a ree to comply with the LaLa2sand conditions of this statement Owner (or Owner Agent's) Name: ,174 /40f 194 1094?0 Signature ....... ,r' ................................. .............................................................Date: �j/ ................................................................................................................................. Contractor Name:.. � i qq e 4 Si nature.....: Lica 5601 �.......Date:'f 1� 17mr&a mid ('n fnman dnr rani cn J 00/J 71M CUPERTINO Owner Name Address VVATER-CONSERVING PLUMBING FIXTURES. OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a(�cuoertino org _ n d1a'+-- Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1,101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its ,plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ,,Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ,I� 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 1101.1 through .1101.8 do not apply. Skip the rest of the form and sign bottom of form. "f�[ No Go to Question 4. 4. Is your real property built and available fb' use or occupancy on or before January 1, 1994? ❑ No Ivry real property is built and available for 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. �M3, Yes My real property is built and available', for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form,. 5. Please check ONE of the following: ❑ My property 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 multi/anidy 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-cornplian't plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or irmprovements). ❑ My property is a co»unercial 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). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 tluough 1101.8, 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 nage. s Owner or Owner Agent's Signature: Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your building pernit. SB4072015.doc revised 08/26/15 -