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11110041
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11110041 CONSTRUCTION OWNER'S NAME: AVERY OLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: II/082011 C 'ER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clags_ .Lic. r r. "__� MECH RESIDENTIAL COMMERCIAL Cootractor t-Barr yc. Date 1 herebyeffirm that I em Iicetised under the provisiond of epter 9. JOB DESCRIPTION:APT 2-DECK REPAIR,128SQFT (commencing wittiSection 7000)of Division 3 of[tie Business&Professions Code and that my license is in full force and effect. 1 hereby arcrm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$5000 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. APN Number:32627037.10200 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the Emoting of this permit. Additionally,the applicant understands and will comply Wt With all non-poi t source regulations per the Cupertino Municipal Code,Section 9.18. Issued bx� i �� Date: Signature Date ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to anyy roofing materiel berg installed.If a roof is 1 hereby affirm that 1 am exempt from the Contractor's License Law for one or Installed without first obtaining an inspection,1 agree to remove all new materiels for inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE. declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as de0ned by the Bay Area Air Quality Management District 1 will permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work forwhich this permit is issued,I shall Health&Safety Code,Sections 25505,25533,end 25 34. not employ any person in any manner so as to become subject to the Worker's O rt ache genu Compensation laws of California. If,after making this certificate of exemption,I 1 _ -- — — ---Dat . / become subject to the Worker's Compensation provisions ofthe Labor Code,I must, forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING ACF.NCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name corect.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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION fd expenses which may accrue against said City in consequence of the g of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. t 'wit all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 C (408)777-3228• FAX(408)777-3333• buildinGCrllcuoertino.orG NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I TI ❑ REVISION I DEFERRED ORIGINAL Pmtivu M Fa01ECTADDHFS9 i(dOCUZ APNa 'l ( O —1 . I J 2 . OWNERNAME,4ly&7z Y G•e t Na ( C, P �s_O-961_ EOE,,4vL'K'fS STREET ADDRESS CCCY. RID n a F i ti [/�y.�/ - 130 A A,a s-f- m V!✓ ,AAAA AA-1 (244 w CONTACT NAMEF`4�qONE E• St �✓L- ls•t/ArJCiL. `tOJs-$o6- AFI r lbJ non- Gv STREETADDRE99 i-I CITY, ATNZIP Ue2P VZJ ❑OWNER ❑ OwNER•aun cap ❑ OWNER AGENT ItYCON RACroa ❑CONTRACTOR AGENT ❑ ARcmrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME aITC{ LICENSE NVMB /� �� LICENSE TYPE BUS.LIC0 PVC(COMPANY NAME EMAIL Y P 4�a-73�^ Ere1 Q.re >, S 2u 2u Ma ' ,C >11 STREET ADDRESS C yt .SCAT$ZIP ONE O Y o' le,L vgf. foa-91stes ARCHITECTIEdODnEERNAME , J LICENSE NUMBER BUS.LIC0 COMPANY NAME ,v E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE DESCRIPTION OF WORM ' kbrl e EXISTING USE PROPOSED USE CONSTRTYPa RsTOR[ES �' USE TYPE OCC. SQ.FT. VALUATION(S) EXBTO NEWFLOOR DEMO TOTAL _ 2 AREA AREA AAPJ, NHT AREA •� BATHROOM KITCHEN OTIVIR ��J REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECXAREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH Y DWELLING UNITS: IS A SECOND UNIT YES SICONDSTORY YES BEING ADDED? QNO ADDITION'. NO PRE-APPLICATION YES IF YES,PROVIDE COPY OF Ia THRBLDGArt YES RECIIV®BY: T VVALUATION: PLANNING APPLa EYES Pf.WND10 APPROVAL LITRFR EICBLER HOER? �NO ,�� `� /r —v BY my sigoanue below,I certify to each of the following: I am the property owner a authorized agent to act on the prppaty oweeei be`aH 1 haveread tl s application and the informed I he a vided is correct I have read the Description of Work and verity it a accurate. I agree to comply"rh all applicable local ordinances and sura laws relating ding c tion I authorize repreTrnutives of Cupertino u carer Na above•ideati�ed' or sp=on purposes. Signature of ApplimnNAgenD Data: SUPPLEMENTAL INFORMATION REQUIRED c' cKiYrEa1fM— G SLIP New SFD or Multifamily dwellings: Apply for demolition permit for a H-rtsa.COUNTER ;QMI IC PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ &XPaEss ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ElPUBLIcwoRio form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ FmE Dvr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANTTARY SEWER DISTRICT ttal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 10200 parkwood apt 2 DATE: 11/08/2011 REVIEWED BY: bobs. 5 APN: BP#: "VALUATION: $ , *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Building is PENTAMATION 1GENRES USE: 3 Stories © Yes E) No PERMIT TYPE: WORK r-2 complex replace 12 windows non structural SCOPE J,, t d?erh PLa;Ctta�/e NleanL. }'!an t7reck iitec. 1'(au Chr.:7 .Nlu<:h. Ynr,r$lEe: ,(un,F. J'srnae lima: FIT- i'arnat Flee: t/a r.18 r1t. crp>. O.ue Phwpo bup. r1Jx, ,.: Lrep. Ej Avec§ trop. (`ecr Piu.gC,Ine,,. Pe,, /Sie,.Imp, Ice: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prefimfna information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1I-053 Ef! 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 12 # Window/Sliding Glass Door Suppl.PC Fee: Q Reg, 0 OT 0.0 hrs $0.00 $522.00 IwINREP Replacement PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes (F) No $0.00 Suppl.Insp. Fee:Q Reg. 0 OT 0,0 1 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CbBStY•Iwfion ]et ,ielminim-alive fee- 0 Work Without Permit? 0 Yes (D No $0.00 G Advanced Planning,Fee: $0.00 F 17 hours Inspections 0 Travel Documeniution Fees $130.00 1STINSP Inspection,Hourly S1 101-1.6 Motion Fee: IBSEISMICR $2.00 0.57 hrs Admin./Clerical Fee ��. (,i40 • Bldg Stds Commission Fee 1BCBSC $1.00 $41.00 /ADMIN j,`,SUBTOTALS:, $3.00 $693.00 TOTALFEE:' 6.00 Revised: 10/01/2011 • CITY OF CUPERTINO 5 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32627037.10200 DATE ISSUED. . . . . . . : 11/08/2011 RECEIPT #. . . . . . . . . : BS000015261 REFERENCE ID # . . . : 11110041 SITE ADDRESS . . . . . : 10200 PARKWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : AVERY GLENBROOK LP ADDRESS . . . . . . . . . . : 130 E DANA ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041-1508 RECEIVED FROM . . . . : STEVE P PLEVANCIC CONTRACTOR . . . . . . . : STEVE PLEVANCIC LIC # 32967 COMPANY . . . . . . . . . . : STEVE PLEVANCIC CONSTRUCTION ADDRESS . . . . . . . . . . : 528 S MATHILDA AVE STE 2 CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 806-9145 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN -HOURS 1. 00 41. 00 0 . 00 41 .00 0. 00 1BCBSC VALUATION 5, 000. 00 1.00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 000. 00 0 .50 0 . 00 0 .50 0. 00 1STINSP UNITS 1. 00 130.00 0. 00 130 .00 0. 00 1WINREP EACH 8 12 . 00 522 . 00 0 . 00 522 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 694.50 0 . 00 694 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 868.50 VISA -------'------- TOTAL RECEIPT 868. 50 • Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST tJ JOB ADDRESS: Wdo Or Z PERMIT# i IU OWNER'S NAME: VQI/ PHONE# O IS" -6D C. -91`1 S' GENERAL CONTRACTOR: e BUSINESS LICENSE# ADDRESS:,& S. � .fn Vel le- CITY/ZIPCODE:,Su b *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRATTORS HAVE OBTAINED A CITY OF UPERTINO BUSINESS LICENSE. I am not using any subcontractors: r Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile %�Owner/Contractor Signature Date