Loading...
12080177 CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 21297 PARK\FOOD DR CON I'RACTOR:STEVE PLEVANCIC PERMIT NO: 12080177 CONSTRUCTION OWNER'SNAME: AVERY GLENBROOKLP 528 SMA'TIIILDA AVESI'F.2 DATE ISSUED:08/152012 OWNER'S PlIONE: 6509618330 S11NNYVALE.CA 94086 PI ZONE NO:(40S)806-9145 ❑ LICENSED CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r License Class Lic.yQL !7 r [, b1ECli RESIDENTIAL COMMERCIAL Contractor u0 e"L Date hfrfb\'llBlrrmm Ih:llIam licensed under the provisions of Chap erg JOB 1)ESC R I PT I ON:BLDG 37-UNIT 6-DE•CK REPA IR (commencing with Section 7000)of Division 3 of the Business&Professions Code and that inr license is in full force and effect. 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.Pt Floor Area: Valuation:$20000 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:32627037.21297 Occupancy•Type: .\rrL1a\N•r c1•:arrPlc\•ITON I certify that I have read this application and state that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT E\1'112ES 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 012 indemnify and keep hamlless the City of Cupertino against l iabilities,judgments, r >, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Addilionally,the applicant understands and will comply with all non-poitource �regulations per the Cupertino Municipal ode,S ction Issued 1) Date: 9.18. ,(y C Signature Date (J J RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 materials for berth yfirm afm that 1 am ezcnmpt frothe Contractor's License Law fur one of inspection. the following two reasons: 1,as owner of(he property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the slmcture is not intended or offered for sale(Sce.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS•1'O BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 herchy affirm under penalty of perjury line of the following three IIA%ARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California llfallh&Safety•Code.Sections 25505.'_5533,acid 25534. I will nminmin Compensation,as provided for by Section 3700 of the labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the 11eallh& performance of the work for which(his permit is issued. Safety Code,Section 25532(a)should 1 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.perfommnce of the work for which this cantaminnnl5 as defined by the Bay Area Air Quality Management District 1 will pcnni(is issued. mnainumin compliance with the C ipertino Municipal Code,Chapter 9.1_and the ' lealth Safety Code.Sections 25505.25533,and_5534. 1 certify that in the performance of die 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 Owr ora i iz d agent: Compensation laws of Cali fimia. If,alter making this cenificateofexemp(im I Done. become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked CONS•I RU47 I ION LEINDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's AI'I'LIC.\N'1'CP:I2'1'IPIC,1'I'ION for which this permit is issued(Sec.3097,Cir C.) I certify that I have read this application and state dont 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(o save indenmify and keep harmless the City of Cupertino against liabilities.judgments, costs,and expenses which may accrue against said City in consequence of the A RCI I I'TECT•S DECLARA'T'ION granting 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 Septic Tank - - - - _--- -- — - -- - — Sheet Metal CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• F 008 77- 33& buildina(dcuoer5no.oro ❑NEW CONSTRUCTION ❑ A/DD O ALTERATION./TI ❑ REVISION/DEFERRED OPJCLNAL PERMIT@ PROJECT ADDRESuAS //_,I t/ // _ � u n'5 APNa / OWNER NAME /7Oj/tL / �IVCi PNON- 6S O- QTY E-RAE AVL'F)L`f-S �+kl STREET ADDRESS V_ \ l% (/ � �^t,^, A,X�, '� ��'0 J/--j Z 3 0 `.J a+/A s+• CITY. 2-w' " 1 "i (.../' F ! CONTACT NAME I PHONE - H, SfC:✓C- � �C-VAr�crC- VOy Sob` 7 4�1_ I ESTI- r LILL) STREETADDRESS v i-1 CTY,STATE IIP F � ' ,� P. n e d� v ❑OWNER Cl OWNER-BUILDER ❑ OWNER AGENT G�111 =R ❑cowrxnCTORAGENT ❑ ARCHTECT ❑ENGWEER. Cl DEVELOPER ❑ TENANT CONTRACT OR NAME e VC I LIC-ISE NUMB... I // (7 LICENSE TYPE/(7� BUS.LIC9 COMPANYNAME f E-MAII. F �Ua.'75�•' 1 ei 2 e r C>h h�tc- S eu CU Ma, �t�CJ%N STREET ADDRFSS CTl,STATE.IIP P ONE ARCHITECT/ENGLNEER NAME r ) ✓�, LICENSE NUhIDER I BUS.LIC A COMPANY NAME 1� E-MAIL FAX STREETADDRESS CIMY.SiATB,ZIP PHONE DESCRnMON OF WOR% 2a,I J / EXISTING USE PROPOSED USE CONSTR TYPE !STORIES USE TYPE OCC. SQ.FT. VALUATIONS) EOSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEi.V1FA - aATHROCM KITCHEN OTHER REMODET-AREA REMODET.ARFA REMODEL AREA PORCHAREA DECKAREA TOTALDECK/PORCHAREA I GARAGE AREA: DETACH AT ACH a DWE1 t.LNG@+T9: ISASECONDUMr ❑Y^3 SECODTISTORY ❑Y3 BELNCADD®! ❑NO ADI)MONt []NO PRE-APPLIGTION ❑YES IF YES,PROVIDE COPY OF ISTHEaLDGAN ❑YES RECEIVED BY: TOTAL VALUATION:_ PLANNING APPIp ❑NO PLANNING APPROVAL IFTIER EICHLER HOME' ENO Z• dr OOO By cry sigcannc below,I certify w each of the following: I a©the property owner or authorized agent W act on the prppery owncr's behalf I haver rad this application and the information 1 ha a re"ad is correct. I have:ad the Description of Work and veiff it is accurate..I agree to comply With all applicable local ordinances and sate laws relating u ding c .. tion. I ant.Sotize represcatatives of Cupc=o to Iter the above-identified pmpery for inspection purposes. Signature of AppGcandAgcnt Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CnECK TYPE ROUTING SLIP New SPD or Multifamily dwellings: Apply for demolidon permit for ❑ ovER-Tl�comrrER ❑ BUDN.Divc PIARevrEw existing building(s). Demolition permit is required prior to issuance of building p=it for new building. ❑ EXPRESS ❑ PLMYNI.NC PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El SrAN'DARD ❑ PUBLIC WORKS fora if any Hazardous Materials are being used as part of LES project ❑ LARGE ❑ FIRE DFP[ _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MASOR E. SANTrARYSEWER DISTRICT submittal of Building Permit application. ❑ E.YVDRON. PrrALBEALTH 3/dgApp20ll.doc revised 06/21/11