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07050135loo W ?Z� Z) CA sE U3 �ai m X96 U. F _O14a coo FFso 23 BUILDING DIVISION PERMIT BUILDJI l(�f�pJtESPARKW00D DR OWNER'S NAME: GLENBROOK APTS _)NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect i V �2 16 f License Class _#�-- Lic. # 1 Date Contractor SA, y ARCHff crS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I 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 statement 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). [11, 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 U - 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 Contractofs License Law. ❑ I am exempt under Sec. B & P C for this reason 0z z0� ►r �z UC w E, OU a rF-t l%I Uz 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. —11 have and will maintain Worker's Compensation Insurance, as required by Section )700 of the Labor Code, for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy numberam b L �G Carrier. S • •� Policy No.: V 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 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 performance of the work for which this permit is issued (Sec. 3097. Civ. C.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city andsounty ordinances and state laws relating to building construction, and hereby auth a representatives of this city to enter upon the ahove-mentioned property for ins on purposes. (We) agree to save, indc fiify and keep harmless the City of Cupertino against liabilities, judgments, costs expenses which may in anyway accrue against said City in consequence of the ng of this permit. APPLICANT UN ANDS AND-WJLL COMPLY WITH ALL NON -POINT of l h -o7 Date HAZARDOUS MATERIALS DISCLOSURE 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 Code, Section 25532(a)? ❑ Yes Will the applicant or future buildWt occupant use equipment or devices which emit hazardous air contaminants ascd by the Bay Arca Air Quality Management District? ❑ Yes 1 have read the hazafdu(is materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cog, tions 25505.25533 and 25534.1 understand that if the building docs not currently v5 (crani'�Lisi ponsibility w notify the occupant of the rcyui w ' of a Certificate of Occupancy. Owner or authorized agent Date AVERY ('ONSTRUCTION 130 EliST DANA REPLACE WINDOWS LIKE FOR PERMIT NO. 07050135 PERMIT ISSUE DATE 05/16/2007 _ SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LULL .. VLLiY YYVV✓ Job Description Issued by Re -roofs Type of Roof 3q. Ft. Floor Area Required Inspections Valuation Occupancy'lype 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 rr aterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32E27037.14 DATE ISSUED.......: 05/16/2007 RECEIPT #........-: BSC00001350 REFERENCE ID # ...: 07C50135 SITE ADDRESS .....: 10160 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 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 c INO PERMIT M_ c'E1' _4i FORM ,M CEJ 5cl3 'N # Date: ^(/ Mailing Address (if different from building address): Buildin. AdrlrPss: of��. MECHANICAL BBOILER2 Phone #: Owner's Name: BBOILER3 - Licel,se #: BBOILER4 Boiler > 1M to 1.75 M Btu Phone �v Cupertino Business License#: Contact: f✓ _. 64', 1: Fax: MECHANICAL • Building Permit Info:,t�, y- lc BUILDING BCONSTAX Bldg ❑ Elect ❑ Pl imb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: BCONSTAXH Occupancy Group: Cost of Pro] e,+ BCONSTAXR Cor. stax — Resi/Mobile Please check this box if the project is a Type of Construction: �� second -story addition: � BELEC1001 A/Tnirx F-1 ELECTRICAL roiect Size: Standard u Lal 6%, u Quantity Fee ID fee Description Cther Appliances Fee Group MECHANICAL BAPPLOTHER BBOILERI Boiler <= 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 Bc,iler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comn /Quasi BUILDING BCONSTAXBQ Cor. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cor. stax — Resi/Mobile BUILDING BELEC 1000 Elc c 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING yo 7 7 1 of 3 CITY , CUPERTIND F CITY ofPERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee oup BMISCELL Miscellaneous Fee IN G BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP Ne,v Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING -- --Q,trll PJ.T1N4BING BPCESSP00t, Cesspool - - — _ --I--- - BPERMFEE i Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas-3iping 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 Re»i a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Mein Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C 1ts <-- 10,000 cfm Jni MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R, -model Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace > l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Ing tallation of Hood MECHANICAL BREMMISC Vise Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE ure Po e/Platform FixE ELECTRICAL BREMPOWER Powc r Device/A ratus ELECTRICAL BREIVIRECEPT Rc ia, Switch & Outlets ELECTRICAL BREMRELOCA R:location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL -DD I7'Ktru F c A pp I Remodel Res Appliance ELECTRICAL L1W1�++�vv� 2 of 3 CITY B r YF,r C U 7- z `,. t PERMIT APPLICATION - P . quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd � Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSXS Ventilation Systems MECHANICAL BSCBLVD S :b Specific Plan BUILDING l'.1',J l 11 C Cil fi -_ 1 SEISMYCREl BSPECIAL c1 in i! �n�nnn�r�°ial - es Special Inspection BuILDIN BUILDING BSWIM 11-wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS r'emp 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 Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin .LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning ],on Range Residential PLANNING ZADDCHG ELddress Change BUILDING 3 of 3