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Home My WebLink AboutB-2017-0166I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0166 10224 PARKWOOD DRAPT 8 CUPERTINO, CA 95014-1535 (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, C36 C38 Lic. #25057 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 I 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 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. APPLICANT CERTIFICATION 1 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,f R— Date 01/31/2017 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). ISSUED: 01/31/2017 (408)988-8744 PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL — COMMERCIAL JOB DESCRIPTION: BLDG 63/UNIT 8; ADD (N) A/C; (N) ELECTRICAL SERVICE (70 AMP); (N) RECEPTACLE OUTLETS; (N) .LIGHT; (N) BATHROOM EXHAUST FAN Ft Floor Area: I Valuation: $20000.00 IAPN Number:I Occupancy Type: ( 326 27 037 I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 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. a. 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSA NAMES 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 TO BE CLASS "A" 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.--11�''�� Date: 01/31/2017 CONSTRUCTION LENDING AGENCY I 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 Lender's 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 L�=! (408) 777-3228 •FAX (408) 777-3333'- buildingQcupertino.org e7 — -CUPERTINO I i: - 0 166 M NRW C"ON9TRUCTION n ADDITION MX ALTERATIONITI n REVISION/ DEFERRED ORIGINALPERMIT# ---J7 PROJECT ADDPX-SS 10224 Parkwood DR, BLDG 63, Unit #8 7APN20 �� Z,6 OWNER NAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAIL avery@pacbell.net STREET ADDRESS 130 East Dana Street CITY, STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT 'Am' Rob Moyer I PHONE 408-593-81 AIL rmoyer@thermaimech,com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 9505, PAX D8-988-0233 ❑ OWNER 0 OWNER -BUILDER El OWNER -AGENT IK CONTRACTOR 000NTRACTORAGENT 11 ARCHITECT 13ENGINEER 11 DEVELOPER 0TEmANT CONTRACTOR NAME Thermal Mechanical LICEN'SENUMBElt 256057 LICHNSETYPB C 10 20 3 38 BUS.LICM 299 cOm"ANY'Am' Thermal Mechanical B-MAILrmcyer@thermalmech.com FAX 408-988-0233 STREETADD"s' 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ALHrrE=ENaNFERNAMH LIC I' NUMBER BUS. LIC ft COMPANY NAME B -MAIL FAX STREET ADDRESS CITY, STATE, 71P PHONE DRSC,Rt1qION OF WORK add new AC, replace furnace in same location, (N) electrical panel (70 AMP}, (N) electrical outlets, (N) light, (N) bathroom exhaust fan FXJS'fl!46 USE PROPOSED USE CONST ILTPF RNIOMES USE I TYPE OCC. SQ.FT. VALUATION ($) EXTSTO NEVI FLOOR DEMO TOTAL AREA AREA AREA IY NET AREA MATHROOM —I KITCHEN N OTHER REMODEL AREA RFM=LARBA RBMODELAREA PORCHAREA DECKAREA TOTALDECMORCIIAREA GARA0,AREA. DETACH ATTACH 0DWELLING UNITS; —1 IS A SFCONB UNIT YES sncom)sroity E]YEs DIPINGADDFD? []NO ADDITION? []1','0 -FRB-APPLICATION QYES IF YES, PROVIDE COPY OF ISTUR BLDG AN 11 YES -,K, MV TOTALVALUATioN.. Gel PLANNINGAPPL# nNO PLAINNING APPROVAL LETTER EICIIbEll HOME? By my signature below, I certify to each of the followitig: I am the property owner Or nolorizdFagent. to the property owner's behalf I have read this application and the infortuation I have PrOvirlut is Correct I have read the Dmription of Work and verify it is accurate. I agree to comply with all applicable IM81 ordinances and state laws relating to building Sqp1t7rtion. ,1 autho *zo represell atives of Cupertino to enter the above-iderui�'!PropertyAl iaLgipc"tion. purposes. /Z.105 Data: Signature ofApplicant(Agent:. SUPPLEMENTAL INFORMATION REQUIRP-D -TObNT R 77— iw - Apply for demolition permit for SFD or Multifamily dwellingsbvER —Now existing buitding(s). Domolition.perruit is required prior to issuance ofbuildiDg permit for new -building. El EXPRESS Commercial Bldgs: Provide a completed Hazardous Materials Disclosure A" -form if ally Hazardous Materials are being used as part of this project. 1,1RE, D Copy of Planning Approval Letter or Meeting with Planning prior toII I A RI T. SANITARY SEWER DISTRICT — submitlat ofBuilding Permit application. FNVIRON B1dgApp.2011. doe revised 06121111