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07050138 CITY OF CUPERTINO BUILDING DIVISION PERMIT ' ` Il}�ZMtT�fJl�i' PERMIT NO. BUILD1N�x0.DARrESSt)ARKW00D DR AVERY CONSTRUCTION 07050138 OWNER'S NAME: PERMIT ISSUE DATE GLENBROOK APTS 130 EAST DANA ST 05/16/2007 SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH i p LICENSED CONTRACTOR'S DECLARATION �T Job Description vI hereby affirm Nat I am licenced under provisions of Chapter 9(commencing ?Z U with Section 7000 of Division 3 of the Business and Professions Code my license i Z)y in full force an est C � t .b ? License Class Lic•# t— Date-- Contractor Wr ARCHITECTS DECLARATION 0�< I understand my plans shall be used as public records )WU w in Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 4 0which requires a permit to construct alter,improve,demolish,or repair any structure o Z> prior act its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.FIOOr Area Y H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnotintendedorofferedforsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workeees Compensa, insurance carrier and Policy number arc: Carrier.�" r 4 _1 � PoI'tey No.: ` o st CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY (~t►�-� I hereby affirm that there is a construction lending agency for the performance of fY r7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address V C) 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 Ubuilding construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property f inspection purposes. (We)agree to sav, ndcmnify and keep harmless the City of Cupertino against tF,y liabilities,judgments, ta and expenses which may in any way accrue against said City U Z in consequence of tb0graming of ' ►� APPLICANT Ttii co LY WITH ALL NON-POINT Issued by Date SOURCE -r—IC-67 Re-roofs S' ure of A icant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cade,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. C]Yes Will the applicant or future building occupant use equipment or devices which If a roof i 3 installed without first obtaining an inspection,I agree to remove - emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new Ir aterials for inspection. District? ❑Yu �I 1 have read th ardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safct ode,Scc 5.25533 and 25534.1 understand that if the building docs not curie 'a icnant that it my responsibility to notify the occupant of the rcqui c ich ust be met priorto of a Certificate of Occupan Signature of Applicant Date _�/6,Q All roof coverings to be Class"B"or better Owner or authorized agent Dare CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot: APN 32E27037. 11 DATE ISSUED. . . . . . . : 05/16/2007 RECEIPT #. . . . . . . . . BSC00001350 REFERENCE ID # . . . 07C50138 SITE ADDRESS 10264 PARKWOOD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER GLE',NBROOK APTS ADDRESS 10100 MARY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1502 RECEIVED FROM . . . . : BRIAN AVERY/MATT CONTRACTOR AVERY, BURT LIC # 12134 COMPANY AVERY CONSTRUCTION ADDRESS 13C EAST DANA ST CITY/STATE/ZIP . . . : MTY VIEW, CA 94041 TELEPHONE (9E0) 961-8330 FEE ID UNIT QUANTITY I,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 147. 96 71. 02 0 .00 71.02 0. 00 BPERMFEE VALUATION 7, 785. 00 147. 96 0 .00 147 . 96 0 . 00 BPLANCHK PERMIT FEE 147 .96 197 .45 0. 00 197.45 0 .00 BSEISMICRE VALUATION 7, 785 .00 0.80 0 .00 0. 80 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 417.23 0 .00 417 .23 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH CITY OF CIJPERTINO TY OF PERMIT APPLICATION FORM CUPS TI i , Date: N # owe - /, 7 Nailing Address (if different from building address): Building A(JcirPcs: Owner's Name: Phone#: License #: ----- — ----— -------- — Cupertino Business License#: Contact- Phone y,\<<s A. z � Vx 0 c Fax: Building Permit Info: Bldg ❑ Elect ❑ PI zmb ❑ Mech ❑ Job Description: Residential 3 VI-4 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: *,� Occupancy Group: Cost of Proje Type of Construction: � Please check this box if the project is a �� r second-story addition: ❑ :oject Size: Standard ❑ Large ❑ Maj cr ❑ Fee ID Fee Description Fee Grou Quantity Other Appliances MECHANICAL BAPPLOTHER pp BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOII.ER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Bc iler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Cor.. Tax for BQ Zone BUILDING BCONSTAXH hotel and Motel BUILDING BCONSTAXR Con stax.-ResWobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elae 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING �O 1 of 3 -7 7 CITY OF CUPERTINO � Y_Q PERMIT APPEI��`I`I®l� F'® CUPEkTINO Quantity Fee ID FF:e Description Fee Group BMISCELL Mi;cellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Gomm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING I PR ('KFL0`hj h:tti-i)spJieric �jactium PLIWB1NG BPCLSSPOOL Cesspool PLUMBING BPERMFEE Bjjg Permit Fees — --- BUILDING - BPFIXTURE ?big Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind'Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BpgEpIpE Repi a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Sten- /Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalI/Alter Water PiejE�PLUMBING BPWHEATER W24er Heater/Vent PLUMBING BPWSVCS M�in Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C IJnits <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R,.-model Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rel kation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC -gisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus— ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BRENIRELOCA R,-.location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C UPERI9INO CITY OF `I" APPLICATION FORM CUPEkTINO PE I Quantity Fee ID F ee Descri tion Fee Group BREMSIGNAD Rmd. Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR The,-.trical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S,-,b Specific Plan BUILDING -- 13SIu 7SM-f(11 0-1\I' C'��nrnr�rre)-ci�I TyFTI >�,:iNTCr BSEISMICkE Seismic Fee Ides BUILDING BSPECIAL Special Inspection BUILDING BSWIM S wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temy,orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec. Permit Issuance ELECTRICAL MPERMFEE Mochanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plunbing Fee sq foot PLUMBING PLLONGRNGC Planning..,R Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3