B-2018-1559 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1559
10140 PARKWOOD DR APT 8 CUPERTINO,CA(326 27 037) THERMAL
MECHANICAL
SANTA CLARA,CA
95054
OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED:09/27/2018
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#25§057
Contractor THERMAL MECHANICAL Date 01/31/2020 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BLDG 24 UNIT#8-(N)AC UNIT;REPLACE FURNACE(SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION);(N)WASHER/DRYER HOOK-UPS; REPLACE
t. I have and will maintain a certificate of consent to self-insure for Worker's ELECTRICAL PANEL(70 AMP)(SAME LOCATION);(N)GAS LINE
Compensation,as provided for by Section 3700 of the Labor Code,for the FOR STOVE;REPLACE OUTLETS(10);REPLACE LIGHT
performance of the work for which this permit is issued. (BATHROOM);(N)(2)EXHAUST FAN(BATHROOM)
2. 1 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. Sq.Ft Floor Area: Valuation:$10000.00
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 ith all non-point
source regulations per the Cupertino Mun' ' n 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign a �acu
9-27-2018 Issued by:Kim Dunbar
Date:09/27/2018
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 roofing 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)
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:9-27-201
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
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
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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized a
APPLICANT CERTIFICATION Date:9-27-2018
I certify that I have read this application and state that the above information is CON TR CTION LE AGENCY
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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 9-27-2018 Professional
CONSTRUCTION PERMIT APPLICATION
us� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building@cupertino.org
CUPERTINCt
El NEW(:O NSIRUC1'ION ❑ ADDI'LION ALTE,,RATION 11 Ti ❑ REVISIONIDEFERRED ORIGIN.ALPERMIT#
PROJECTADDRESS 10140 Parkwood DR, BLDG 24, Unit#8 APN ~
OWNER NAME Avery Glenbrook LLC PHONe E-btAIL
650-961-8330 Avery@pacbell.net
EREETADDR''SS 130 East Dana Street `.TTY,STATE Mt.View, CA 94041 Eax 650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo ave. cITY,STATE.ZIP FAX 408-988-0233
Santa Clara, CA 95054
. ... L -
❑OWNER ❑ OWNER-BUILDER ❑ OWNE.R..AGENT CONTRACTOR ❑CON'IRAC:FOR AC.EEV'I ❑ ARCHITECT ❑P:NOINF'E.R ❑ DE.VEiLCH'E'.R ❑ TENANT
CONrRAcTox NAME Thermal Mechanical Lac ENSE NUMBER 256057 LICENSE:.TYPE BUS.Llc r 299
C-4,10.20.36.38
CON4PANY NAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAX 408-988-0233
STR.EETADDRESS 425 Aldo ave. C11Y,STATE•ZIP Santa Clara, CA 95054 PHONE 408-988-8744
ARCHITECTEl"GINEER.NAME LICENSE NUMBER BUS.LIC t.I ris r j
COMPANY NAME E-MAIL FAX
SIREET ADDRESS CITY.STA'FE.,7AP PHONE
DESCRIPTION OF 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
EXI•STLNG USE PROPOSED USE CONSTR.TYPIi I #STORIES
USE TY'P.F.. OCC. SQ.F'r. VALIDATION t,S)
EXIs ru NEW FLOOR DEMO TOTAL -- - --""""--
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PARCH AREA DECK AREATOTAL DECRPORC'Lf AttEA GARAGE.AREA: DETACH
❑ATTACH
+DWFiI.I_lNG UNITS: IS A SECONU tlNrr ❑YES SECONI)5TC)RY ❑1'ES
BEING ADDED? ❑NO ADDIIION? []NO
PRE-APPLICATION ❑Y'IS IFYFS,PROVIDECOPYOF _ ISTHEBLDG A:N 13 YES 11.XII'VED LUTAI VALUATION:
PLAN:NIiKO APPI r []NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO t j��I ,10'11
a
By my signature below,1 certify to each of the following: I atn the property owner or authorized agent to act on the proper owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description or Work and verify it is accurate. I agree to comply with all applicable local
ordinances and State laws relating to building const ty 1 authorize representatives of Cupertino to enter the above-identified p perry for inspection putlxlses.
F
Signature of AppiicantfAgeut: Date:_ _(
SUPPLEMENTAL INFORMATION REQUIRED ELANCHECE:TVPE ROunNcsLw
New SFD or Nlultifarnily dwellings: Apply for demolition permit for (] OVLR-rItE,t_cx Nl�:e El BUtt.ntNt:PLAN REVIEW
building(s). Demolition permit is required prior to issuance ofbuildins.
permit for new building. ❑ EKPRI_SS ❑ PLANNIN,PLAN REVIEW
Commercial Bldgs; Provide a completed IlazardouS Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE' ❑ FIRE DEPT
_Copy of Plartning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. 1771 MAJOR ❑ SANTE:tlr se:a t:R DIST1ucT
❑ rNVIRONMENI-AL HE:AI:rx
Bldg4pp_201 Ldoc revised 06;21,,1.1