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07050139CITY OF CUPEx'r11vu BUILDING DIVISION PERMIT BUILD) UIT) V'EY ARKWOOD DR OWNER'S NAME: GLENBROOK APTS rNE: ARCHITECT/ENGINEER: LICENSED CON RAUIUR'S Utta-AKAt tutu 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, pod my license is in full force an ct. License Class Lic. # Date Contractor C'_ ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed slatcment that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 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 is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does 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.). ❑ I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 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 Contrxtoes License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Dare WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I 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, az required by Section 3700 of the Labor Code, for performance of the work for which this permit is issued. Y W M Insurance carrier and Polity number are: ComPensati Cartier ` •C�w' o Policy No.: Zd YUO� 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, 1 shall not employ any person in any manner so az 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 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 onze representatives or this city to enter upon the above property (ori coon purposes. (We) agree to save, in nify and keep harmless the City of Cupertino against liabilities, judgments, costs expenses which may in any way accrue against said City in consequence oC the g g of this permit. APPLICANT ND WILL COMPLY WITH ALL NON -POINT SOU E R S. HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino M ni�Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants az defined by the Bay Area Air Quality Management District? ❑ Yes -f?tvo 1 have read the ardous materials requirements under Chaptcr6.95 of the Califor- nia Hcalth & Safct ,Sic 5, 25533 and 25534.1 understand that if the building does not curre avc nant, that tis my responsibility to notify the occupant of the require�yn h be met w issuance of a Certificate Owner or authorized agent Date PERMIT NO. AVERY CONSTRUCTION 1 07050139 PERMIT ISSUE DATE 130 E;= DANA ST 05/16/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO REPLACE' WINDOWS LIKE FOR BLDG ELECT PLUMB LIKE A', Job Description Issued by Re -roofs 3q. Ft. Floor Area APN Number Required Inspections valuation Type Type of Roof 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 IT aterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 4 ITEMS OF 56 PERMIZ RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32627037.10 DATE ISSUED.......: 05/16/2007 RECEIPT #.........: BSC00001350 REFERENCE ID # ... 07C50139 SITE ADDRESS .....: 10270 PARKWOOD DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GLENBROOK 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 7.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 CUPEk INN CITY OF CUPERTINO PERMIT APPLICATION FORM coject Size: Standard u l.air,-� Fee ID flee Description Fee Group -- Quantity Date: N ailing Address (if different from building address): Building AririrPcs: Boner <= 100,000 Btu MECHANICAL BBOILER2 Owner's Name: Phone #: _Z 0-1 3 6 BBOILER3 Boiler > 500K to 1M Btu MECHANICAL License #: Boiler > 1M to 1.75 M Btu MECHANICAL Phone.' �`` ' Cupertino Business License#: Contact. 1 vx 6,z ',. Fax Building Permit Info: v` BUILDING BCONSTAX Ind/Off/Comm/Quasi Bldg ❑ Elect ❑ Pl Amb ❑ Mech ❑ Job Description: Res %_ � � � L�c� � �� b �'' Commercial [Iidential Sq.Ft. Floor Aria: Sq.Ft.: �H Occupancy Group Cost of Proje^+- -- -5 = BUILDING BELEC 1000 Please check this box if the project is a Type of Construction: second -story addition: El Elee 600V > 1000A ELECTRICAL r_1 T _ n AAnirx I-1 Elec Svcs 600V <= 200A coject Size: Standard u l.air,-� Fee ID flee Description Fee Group -- Quantity Cther Appliances pliances MECHANICAL BBOILERI Boner <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILERS Bailer > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor.. Tax for BQ Zone BUILDING BCONSTAXH liotel and Motel BUILDING BCONSTAXR Cor stax — Resi/Mobile BUILDING BELEC 1000 Elc c 600V <= l OOOA ELECTRICAL BELEC1001 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD ]Energy Add Multi BUILDING BINVESTIGA 'Investigation fee BUILDING 1 of 3 7 7 g�. CITY OFPERMIT CITY OF CUPERTINO APPLICATION AF S O F Quantity Fee ID BMISCD r BMITIGATC BNUCOMME BNUCOMMM BNUCOMMP BOVERTIME FE:e Description Mi 3cellaneous Fee Comm . Housing Mit. Fee New Comm Electric New Comm Mechanical New Comm Plumb Fee Group BUILDING BUILDING ELECTRICAL MECHANICAL PLUMBING Inspection Overtime BUILDING -- RPBACKFF,OW Atti,�sp1ieric `,vacuum p T1� BINCr - - BI'CESSPOOL - — Cesspool_ Ju MB I NG� ------ - - Wig Permit Fees BUILDING BPERMFEE BPFIXTURE MIR 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 BPREPIPE Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Sorm/Rain Water PLUMBING BPTFAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Insta]UAlter Water Pie PLUMBING BPWHEATER W<<ter Heater/Vent PLUMBING BPWSVCS M, -.in Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMA]RHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R,. -model Busways ELECTRICAL BREMFIXT L ighting Fixtures ELECTRICAL BREMFURN Rel kation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R, -.location of Hood MECHANICAL BRENIREPALT Repair/Alter Heating MECHANICAL A" vo„,r%ripI RPc Annl;ance ELECTRICAL }�tC�1V11�GJtir i 2 of 3 CITY Of CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION f Quantity Fee ID BREMSIGNAD Fee Descri tion Rmdl Signs Add Branch Fee Group ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ven `. Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING 13SE SM1 CIO iV BSEISMICRE Seismic Fee Res t7lT�TC, BUILDING _ -- BSPECIAL ST ecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Bldg Permit BUILDING BTEMPSVCS -Temporary Temp Dist Svcs ELECTRICAL BUSLIC B-.isiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec. Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mec Permit Issuance MECHANICAL PPERMITFEE Pluff tbing Permit Issue PLUMBING PPLBG Planbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin l,on Ran a Residential PLANNING ZADDCHG Address Change I BUILDING 3 of 3