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B-2017-1317CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1317 10153 PARKWOOD DR APT 4 CUPERTINO, CA 95014-1456 (326 27 037) THERMAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP I I DATE ISSUED: 08/15/2017 1 OWNER'S PHONE: 650-961-8330 1 .- _.I_: _ 9 . 1 License Class C-4: C-10: C-36: C-38 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: r. 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 Ver formanceofthework for which this permit is issuedhave and willmaintaiWoresCompensationInsrance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this 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 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 p5yt4e Cupertino Municipal Code, Section 9.18. •1/»., --.Date 8115120 I hereby affirm that I am exempt ffom the Contractor's License Law for one of the following two reasons: t. 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) 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: 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. 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. Date 8/15/2017 NO: (408) 988-8744 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG #35/UNIT#4; ADD (1) A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (1) RECEPTACLE OUTLETS; (N) LIGHT; (N) BATHROOM EXHAUST FANS. Sq. Ft Floor Area: I Valuation: $20000.00 APN 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: Jasmine Archbold Date: 08/15/2017 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 ofApplicant: Date: 8/15/2017 ,r A 11 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, Section 2 ; 25533, and 25534. Owner or authorized t: Date: 8/15/2017 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 Iml 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255. CtJ1PEltTIN4 (408) 777-3228 • FAX (408) 777-3333 - building(c)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION i TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PRoJEcrnDDREss 10153.Parkwood DR, BLDG 35, Unit #4 APN# (� OWNERNAME Ave Glenbrook LLC Avery PHONE 650-961-8330 E-MAIL avery@pacbell.net y@ P 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 STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054. FAX 408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CK CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER . ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEThermal Mechanical LICENSENUMBER 256057 LICENSETYPE C-4,10,20,36.38 BUS.uc# 299 COMPANYNAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAx 408-988-0233 STREET ADDRESS 425 Aldo ave. crrY,STATE,zIP Santa Clara, CA 95054 !PHONE 408-988-8744 ARCIIITECT/ENGINEER NAME LICENSE NUMBER abs. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION Gr"'va-dd new AC, replace furnace in same location, �) washer/dryer hook ups, electrical pane/ (70 AMP), qN) gas line for stove; N) electrical outlets (N) light, (NWathroom exhaust fan EXISTING USE PROPOSED USE CONSTR. TYPE 0 STORIES USE TYPE OCC, SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NI?r AREA ' BATHROOM KITCHEN OTHER REMODELARBA REMODELAR1iA REMODELARBA PORCH AREAUECKAREA TOTAL DECKIPORCH AREA GA Oil AREA: DETACH ❑ ATTACH #D'kLLING UNITS: ISA SECOND UNIT [j YP.S SECOND STORY ❑YES BEING ADDED? []NO ADDITION? [lNO PRE -APPLICATION []YES IF YES, PROVIDE COPY: OF IS THE BLDG AN ❑YES 'R>:_CEI I ' TOTAL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVALLE'17ER EICHLERHOh7F.? NO }�© 00 By my signature below, I certify to each of the following: I am the property owner or authorized aged to act on the property owner's%chalf, I have read this application and the information l bave provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con ve on. I authorize representatives of Cupertino to enter tie above-identi p ' jpeip for inspection purposes. Signature ofApp] icant/Agent: Date: SUPPLEMET`T, INFORMATION REQUIRED ::P[ N,cuMKTrrE: .' I] OVER.-TZCtiUNTER :' '. :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. f�:. i xrRess : '; :; : ` .:: d. `,rr�nivivitcel nis.IiE)W _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STAI-j"Iiv := <'. : ❑r;P'vsiii .wotifis. :; forth if any Hazardous Materials are being used as part of this project. ::❑' LARGE` •. .. 0i ': Eli _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJQR',:. "• :' '+ �aSANITARY.SitWhkDI.STRICT' submittal of Building Permit application. .: ... ' ❑ ENVIRONMENTAL HEALTH.. B14gr4pp_2011.doc revised 06/2//11