11110118 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10204 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO:I 1110118
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 1122/2011
CwdlkvR'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806.9145
❑ LICENSED CONTRACTOR'S DECLARATION I_ r, G
BUILDING PERMIT INFO: BLDG - ELECT PLUMB
License Class_ Lic.q
�+ MECH r RESIDENTIAL r COMMERCIAL r
Contractor. y�P>IQV2LM.c'-z'� Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 8-MULTI FAMILY DECK REPAIR;NON-STRUCTURAL
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm 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.FI 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:32627037.10204 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
granting of this permit. Additionally,the applicant understands and will comply Z2
J
with all non-poi source regulatims per the Cupertino Municipal ode, ectim Issued by: Date: cy
9.18. / )
Signature �/— Date
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
Y P inspection.
the following two reasons:
1,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)
1,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: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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&
perfomtance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 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 defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 O r r hor ed agent: a
Compensation laws of California. If,after making this certificate of exemption,I Date: /
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perfomtance 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
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabil ities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
`T.Wng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
• CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037. 10204
DATE ISSUED. . . . . . . : 11/22/2011
RECEIPT #. . . . . . . . . BS000015372
REFERENCE ID # . . . : 11110118
SITE ADDRESS . . . . . : 10204 PARKWOOD DR
SUBDIVISION . . . . . . . -
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AVERY,GLENBROOK LP
ADDRESS . . . . . . . . . . : 130 E DANA ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041-1506
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 . . .1. . . . . : (408) 806-9145
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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
1DECKWOOD EACH 1.00 457.00 0.00 457 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 458.50 0.00 458 .50 0.00
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinG(rIlcuoertino.OrO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECTADDRESS d OO dL APNY 2� 7
OWNER NAME A102 G•C Na /( `• 7'6-0-96/-a &MARAVI- -YE I�uA.I
3O A ua s f . �' 0
BTR>�T 0VV 0'"J 1 N.A.i C-4
CONTACT NAME
S,1- ;-JLCT>jewAtzlr—,(r Ynfl-fro 6- ) 41� E rA LL Ma. I
STREET ADDRESSi-t CITY, A„IIP F n 712 -
❑OWNER ❑ OWNER-BDD.DER ❑ owNERAGENT 11YCONTRACTOR ❑CONTRACPOR AGENT ❑ ARcwmcT 13 ENGINEER 13 DEVELOPER 13 TENANT
CONTRACTOR NAME LICENSE NUN® t[6 <76LICENSE TYPE J3 HUS.LIC e
COMPANY NAME EMAIL P 4�d-731
e Ne >1 Sett L Ma ,Cv�N
STREET ADDRESS C .STAT&ZIP PHONE
O ale [� u 6 - S
ARCHITECTENODtEFJI NAME ' ) .ii. LICENSENUMBER BUB.LIC0
COMPANYNAME (v P� E-MAIL FAX
STREET ADDRESS �1 CrN,STATE,ZIP PHONE
DESCRIPTION OF WORK
8X[SID1G USE PROPOSED USE CONSTR Y S ;f
M me{ &-i Z' USE TYPE OCC. SQFI'. VALUATIONS)
BXISTG wWFLoOR DRubTOTAL
AREA AREA AREA NEr ARBA t1 vrS 6(Z-
BATFm M 1OICHEH OTHER l� L
REMODELAREA REMODEL AREA REMODELAREA
PORCH AREA DECKAREA I TOTALDECK/PORCHAXS GARAGBAAPA DBrACH
ATTACH
Y DWELLING UNnB: IS A SECOND DNRY85 SECOND SrORY YFS
BEING ADDED
? NO ADDITION NO
S UGU—�
PRE-APPLICATION ❑YES H,YES,PROVIDE COPY OF 13 TEX BLDG AN ❑ E9YRgCENED BY. �-•. TOTAL VALUATION:PLANNINOAPPL/ NO PLANNING APPROVAL TSTTER EICHLER HOME? NO J
By my signature below,I certify to each of the following; I am the property owner or authorized agent to act on the prppetty owners behalf I have read this
application and the information I ha a vided is correct I have reed the Description of Work and verify it u accurate. I agree to comply with all applicable local
ordinances and tate laws relating ding c tion. I authorize representatives of Cupertino to enter the above- tis property for inspectiea purposes.
Signah=of APplinrrt/Ageat Date;
SUPPLITvfEN'fAL INFO 0
RMATION REQUIRED PLANCHECKTYPE ROUTING 4.R
New SFD or Multifamily dwellings: Apply for demolition permit for � ��--''
Busting building(s). Demolition permit is required prior to issuance of building L7'ovsa-T�ccomrrn IHNC PLAN REVIEW
permit for new building. ❑ EOVRLW ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11BrANDARD 13 PUBLIC wom
form if airy Hazardous Materials are being used as part of this project
❑ LARGE ❑ FIRE uEn
Jb
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
bmittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
•its ADDRESS: 10204 parkwood#8 DATE: 11/22/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: j$2q40
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration [Repair
PRIMARY Multi-FamilyDwellingBuildino is PENTAMATION 1GENRES
USE: >3 Stories O Yes 0 No PERMIT TYPE:
WORK muitv family deck repair non structural
SCOPE
11e,Jr. P&w Chae% Phnrb, Plcn C'frcck Elea.plan Checb-
4fech. Pernat t•'ee: 1'tunrh.Pernait t%ee: F.7ac. Pernrie I%i!e:
• ll7her df-cA.heel:, rilhnr}>hrndt Ursp. O1ber Flec. lnsp.
.11och. Inep. Fire: 1'luwb. hrgr.}"rye: Flee. Imp, Fee.
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 prefiffina Information available and are on!p an estimate. Contact the De t or addn7Info.
FEE ITEMS(Pee Resolution 11-053 E}i 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: V
1 # Deck/Deck Railing
Suppl.PC Fee: Q T 0.0 Reg. 0 Ohrs $457.00 IDECKwOoD Deck(wood)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C onstruc Nan 1 kr
A,Iminislrative Fee-
Without Permit? Yes (F) No $0.00 .(D
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Doevinentatinrt Fe": Building or Structure 0
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.001 $457.00 TOTAL FEE: 1 $460.00
Revised: 10/01/2011
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
JOBADDRESS: lodoLf Vcx4t-wood PERMIT#
OWNER'S NAME: U24' o PHONE# VJ - U
c,
GENERAL CONTRACTOR: p h c,Z ah BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: n
*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 AL SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature I 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