B-2017-1312CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:-
PERMIT NO: B-2017-1312
10245 PARKWOOD DR CUPERTINO, CA 95014-1506 (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 08/15/2017
OWNER'S PHONE: 650-961-8330
PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-4: C-10: C-36: C-38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
X BLDG —ELECT _PLUMB
—
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:
BUILDING #49 - (N) HOT WATER SYSTEM & ENCLOSURE;
I hereby affirm under penalty of perjury one of the following two declarations:
UPGRADES AND REPAIR OF EXISTING BUILDING SERVICES
r. Lhave 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.
ave and will maintain Worker's Compensation Insurance, as provided for by
)0�.S...On 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:'
Valuation: $0.00
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 27 037
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 per upertino Munici I Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatt ate 8/15/2017
Issued by: Jasmine Archbold
or
Date: 08/15/2017
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
r. 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)
z. 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: 8/15/2017
I hereby affirm under penalty of perjury one of the following three declarations:
I have Certificate Consent to self for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r: and will maintain a of -insure
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. 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
a. I certify that n7 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, S s 25505, 533, and 25534.
Labor Code, I. must forthwith comply with such provisions or this permit shall
be deemed revoked. ,
Owner or authorized agl
APPLICANT CERTIFICATION
Date: 8/1512017
-01
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
CTION LEN
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorizerepresentatives 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
L'ender'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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 8/15/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CtiFERTtNt? (408) 777-3228 • FAX (408) 777-3333 - bulld1ng cftupert!no.ora /7}D r ., 1 ,-,
I—I wpw rnNCTRITCTT0W I`1 ADDITION Ixl ALTERATION / TI n REVISION/ DEFERRED ORRIGIN..r.L PERMIT #
PROJECT ADDRESS 10203 i'arkwood-drive Building 49
TAPN N 326-27-037
OWNER NAME Avery Glenbrook LLC
PHONE 650-961-8330 E-MAIL Avery@pacbell:net
SPREGCADDRESS 130! East Dana St
CITY, STATE, ZIP Mt. View, CA 94041
FAX 650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115
MAIL
STRHETADDRESS 4258,Ald0 Ave
CITY, ZlFsanta Clara CA 95054
rA>t
❑ OWNER ❑ OWNE-rR�BUILDER ❑'OWNBRAGLNT M CONTRACTOR ❑CONTRACTORAGBN'C ElARCHITECT ❑'ENGINEER El DEVELOPER ❑ TENANT
CONTRACTOR NAME 1 hermal Mechanical
LTCENSENUMHER
LIC256057 C4, G10,C20,C38,C36 SBTYPF
BUS, LIC# 299
COMPANYNAMF. Thermal Mechanical
E-MAILrmo er thermalmech.com
FAX 408-988-0233
STREET ADDRESS 425�AIdo Ave li
C1TY,STATB,7.[P
nt lara CA 95054
PHONE 408-988-8744
ARCHITECT/ENGINEERNAME
Thermal Mechanical
LICENSENUMBER 256057
BUS. LIC# 299
COMPANYNAME
Thermal Mechanical
rmoyer@thermalmach.com Ermoer@MAIL thermalmech.com
FAX 408-988-0233
"r`-EL
425!Aldo Ave
CITY,STATH,ZIP Santa Clara, CA 95054
PHONE 408-988-8744
DESCRIPTION OF WORK j�,
!New domestic hot water system with new water heater and enclosure
Opgrades and repair of existing building services
EXISTINGUSE
PROPOSEI)USE CONSTR.
TYPE
#STORIES
USE
1 YPE
OCC,
SQ.FT.
VALUATION ($)
EXISTG
NEW FIAOR.
DEMO
TOTAL
AREA
AREA
AREA
NHT AREA
BATHROOM
.Ku'CHEN
OTHER
REMODELARBA
REMODELARRA
'I
REMODEL AREA
PORCHARFA
DECKAREA•
TOTAL DECIQPORCH AREA
GARAGE ABPA; DETACH
[]ATTACH
I
# DWELLING UNITS:
ISA'$ECONDUNIT L]YES
SECONDSTORY ❑YES
BEINGADDED? []NO
ADDITION? ONO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
1S THE BLDG AN ❑YES
+'RE D.
TOTAL VALUATION:
PLANNINGAPPL# []NO PLANNEJGAPPROVALLETTF.R
I
EICIILERIIOME? [3 NO
By my signature below, I eeitify 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 inforvlation l have provided is correct. 1 have read the Description of Work and Yerity it is accurate. I agree to comply with all applicable local
ordinances and state law's relating to baililil tnl ion. I aui ri• representatives of Cupertino to enter the above-ide prope for inspection purposes.
Signature of Applicant/Agerit: 'i Date:
RE U• D
SUPPL;EMF A INFORMATION I
Q
:.PL'ANCtiECICCYPE% i..:..
...
New SFD or Multifamily dwellings: Apply for demolition permit forj.:ovER,iiiEcouiaTER..:,
existing building(s). Demolition permit is required prior to issuance of building
pennitfornew building.
E1 •`..
I] .Pi nniiyrivc Pl niv)Zl vii iv
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
.EXPRESS
0 "STANAARI) :.
' PusLj(c'4voxxs :
_
form if any Hazardous Materials are being used as part of this project.
C�'L.1RGE".
0 FIRE DEPT.'..:".
Copy of Planning Approval Letter or Meeting with Planning prior to
"
_
I lY1RJQR' ::
p •s.{ipirAiiSEwi itDisliiicz;' '°.'; •;
submittal of Building'Pcrmit application.
:
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•' h' iEN'}4R6NMENTAL HEALTH
B1dgApp_2011.doc revised 06121111