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07050141 7777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT ..... N' BUILD D ESS: PERMIT NO. L��� PARKWOOD DR AVERY CONSTRUCTION 07050141 OWNER'S NAME: PERMIT ISSUE DATE GLENBROOK APTS 130 EAST DANA ST 05/16/2007 JNE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLAC:E WINDOWS LIKE FOR BLDG ELECT PLUMB MECH 10 o LICENSED CONTRACTOR'S DECLARATION Job Description V P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing j z with Section 7000)of Division 3 of the Business and Professions Code,and my license is H in full force and { 6 j�z License Gala LK•M t- Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records a U.f Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county m 9 which requires a permit to construct alter,improve,demolish,or repair any structure o"14 prior to its issuance,also requires the applicant for such permit to file a signed statement - < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation EC F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑I•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 Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of q p 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 sak.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 contraclas to constmct 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 Contractors License law. ❑1 am exempt under Sec B R P C for this reason Owner Date 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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Workers ompersati Insurance carrier and Policy number are: r Carrier. Z t 0_"""7 Policy No.: Z Q It DL S{� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if tete 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 Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY [~. SCA 1 hereby affirm that there is a construction lending agency for the performance of a> etc work for which this permit is issued(Sec.3097,Civ.C.) WCs.A Lender's Name a Lenders Address V Q I certify that 1 have read this application and state that the above information is CI. correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the G>'•1 above-mentioned property or inspection purposes. LL (We)agree to sa ,indemnify and keep harmless the City of Cupertino against nFa to liabilities,judgments sets and expenses which may in any way accrue against said City U Z in consequence o granting of this ppcmit.- Date ►+ APPLICANT ERSTANUS'AND WILL C MPLY WITH ALL NON-POINT Issued by: SOU E NS. Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of F.00f 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 C«k,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Bun Will the applicant or future building occupant use equipment or devices which If a roof is 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 materials for inspection. District? ❑Yes EW--, have read ardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Satet de,Sections 25505.25533 and 25534.I understand that if etc building docs not currcn have a-tenant this it is my res ibility m notify the occupant of the reyuircmcn hieh t be met prior to issu a Certificate of Occupancy Signature of Applicant Date 16-W7 All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 32627037. 08 DATE ISSUED. . . . . . . : 05/16/2007 RECEIPT # . . . . . . . . • : BSC00001350 REFERENCE ID # . . . : 07C50141 SITE ADDRESS . . . . . : 10280 PARKWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER GLE'NBROOK APTS ADDRESS . . . . . . . . . . : 10300 MARY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1502 RECEIVED FROM . . . . : BRIAN AVERY/MATT CONTRACTOR . . . . . . . : AVERY, BURT LIC # 12134 COMPANY . . . . . . . . . . : AVERY CONSTRUCTION ADDRESS . . . . . . . . . . : 13( EAST DANA ST CITY/STATE/ZIP . . . : MTrf VIEW, CA 94041 TELEPHONE . . . . . . . . : (9E0) 961-8330 FEE ID UNIT QUANTITY 1,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 CITE' OF C1 JPERTINO rv.oF PERMIT APPLICATION FORM CUPEkTINO r G Date: Buil Ac1rlrPss: A[ailing Address (if different from building address): Owner's Name: Phone#: Lice��se#: F s r _ ------- ------- Contact: Phone U�' ` ' ` " ` Cupertino Business License#: Fax C'11-- Building Building Permit Info: 'Z L1 Bldg ❑ Elect ❑ Plumb [I Mech ❑ Job Description: Residential � ��� /3G��R�,'�- �� .Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Pro]er*-" ��= Occupancy Group Please check this box if the project is a Type of Construction: second-story El�1 v� second addition: roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boi.er<= 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 BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Inc/Off/Comm/Quasi BUILDING BCONSTAXBQ Coli. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elce 600V <= l OOOA ELECTRICAL BELEC1001 El ec 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 CITY OF CUPERT'INO CITY OF PERMIT APPLICATION FORM CUPEkTIN0 Fee ID F(a Description Fee Group Quantity BMISCMi 3cellaneous Fee BUILDING ELL BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING ?3PB CKT ,C})hj �_tM)spheric `,racu.um FL JNIBING - - - - I?LU LslN<� - - - BPCESSPOO Cesspool -- --- BPERMFEE B1,1Permit Fees — — BUILDING BPFIXTURE --Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind'JVaste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Reps a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM StDrm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain &Vent PLUMBING BPWATER Instal.I/Alter Water Pie PLUMBING BPWHEATER Waiter Heater/Vent PLUMBING BPWSVCS Mein Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIlZHAN A/C Units<-- 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R,-model Busways ELECTRICAL BREMFIXT I-ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Ing tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po: ELECTRICAL e/Platform Fixture BREMPOWER Powcr Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R-,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance liance ELECTRICAL 2 of 3 CITY OF C�UPERTIN C1 oF' PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID F-e Descri tion Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Venn.Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S(b Specific Plan BUILDING Sc�r�rrt�f!e0iqrnime 1rc°r`2I 1113-UFF-In INTCr � BSEISMICRF S�ismic Fee RCS _ BUIL DINU BSPECIAL S-recial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plurrbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3