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12080176 CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 21297 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12080176 CONSTRUCI'ION OW'NEXS NAME: AVERY GLENBROOK LP 528 S M ATHILDA AVE S E 2 DATE ISSUED:08/152012 OAA;NER'SPBONE: 6509618330 SUNNYVALE.CA 94086 PHONE—NO:1408)806-9145 ❑ LICENSED CO\fR ACI'OR'S DECLARA'T'ION BUILDING PERNUIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# c'/4' NIECll r RESIDENTIAL r COMMERCIAL r Contractor C. Date hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION: REMOVE AND REPLACE(20)WINDOWS (commencing with Section 7000)of Division 3 of the Rusiness&Professions Code and that nn,license is in full force and effect. herebyaffirm 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 rhe Labor Code,for the perfomtance of the work for which this permit is issued Sq.Ft Fluor Area: Valuation:$20000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of dun work for which this permit is issued ,U.N Nmnber:32627037.21297 Occupancy'type: nrrl.l c.AN'r ceR rl r•IaA•IIDN I certify that I have read this application laid state that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City ol'Cupenino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the graining of this permit. Additionally,the applicant understands and will comply F with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. Z4 Sigmalurn Date RE-ROOFS: ❑ O\YNER-BUILDER DECLARATION All roofs shall be inspected prior to any rooting material being installed.If a roof is installed without first obtaining an inspection,Iagree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Las,for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant: Dane: will do the work,and the structure is not intended or olTered for sale(Sec.7044, Business S Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVER]NGS'TO BE CLASS"A"OR BE ITER construct the project(Sec.7044,Business&Professions Code). I hereby idlirm under penalty of perjury one of the following three IIA„ARDOIIS MATE.RIAIS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure lar Worker's California l]calth S Safely Code,Sections 25.505,25533,and 25534. 1 will maintain Compensatioi,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health S performance of the work for which this permit i5 issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hvardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the]may Arca Air Quality Management District I will cit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the prIlealth S Safety Code.Sections 25505.25533,and 25534. I cenify that in the performance of the work f'or which this permit is issued.I shall / not employ any person in any manner so as to become subject to the Worker's Ow ormaf1hori*l d agent: \ Compensation Imus of California. If,alter ranking this certificate of exemption,I L c Date: / become subject to the Worker's Compensation provisions of the Labor Code,I must /I forthwith comply with such provisions or this permit shall be deemed revoked COINS'I'ItI1Cl'I(1N LPN DING AGENCY I hereby aBinn that there is a construction lending agency for the performance of work's APPLICANTC-EI TI FICATION for which this permit is issued(Sec.3097,Civ C.) I certify that 1 have read this application and state that 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 no enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnity and keep harmless the City of Cupertino against liabilities,judgments, ,\RCI I I'rP.CI"S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the 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 \dam (N ' CITY OF CUPERTINO FK ESTIMATOR - BUILDING DIVISION ADDRESS: 21297 G ace (Bldg#37) DATE: 0811512012 REVIEWED BY: Sean APN: BPH: *VALUATION: $20,000 *PERMITTYPE: Building Permit PLAN CHECK'PYPE: Alteration / Repair PRIMARY Buildlno Is PENTANIATION USE: Multi-Family Dwelling >3 Stories O Yes e) No PERI HTTYPE: 1GENRE WORK Remove and replace 20 windows. SCOPE Afech.Plan Check Plumb. Plan Check Flee.Plan Check Mech.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: Oiher,lfech. lags. Other Plumb Insp. Ll I Oilier Elec. Lisp. Hech.Insp. Fee: Plumb. hasp.Fee: Elce.Imp.Fee: NOTE: This winmte doer not include jeer clue L,other Departments(i.e. Planting, Public (Yorks, Fire,Sanitary Sewer District,School District. etc.). These feav are based on the prelintinan information available and are only an esthnate. Contact die Dept/or ndcht7 info. FEE ITEMS (Fee Resohaion 11-053 Elf 7/1/1 U FEE' QTY/FEE MISC ITEMS Plan Check Fee: $0.00 20 # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $666.00 1nZvREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 1 0.0 1 [its $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consowelion Tax: Administrative Fee: O Work Without Permit? O Yes Q) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential G Tremel Documentation Fees: Building or Structure O i Slrone Motion Fee: 1BSFISAllCR $2.00 Select an Administrative Item Blclg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.00 $666.001 TOTAL FEE: $669.00 Revised: 07/01/2012 Building Department City Of Cupertino 10300 Torre Avenue I. CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: Q wao� PERMIT# 20,712019 OWNER'S NAME: 2 PHONE # C) 19 U GENERAL CONTRACTOR:� BUSINESS LICENSE# ADDRESS: u a CITY/ZIPCODE: Gt *Our municipal code requires all businesses working in the city to have a City of Cupertino usiness license: NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CON'T'RACTOR AND AL .SUBC i RACTORS HAVE OBTAINED A Cl ' OF CUPERT]NO BUSINESS LICENSE. � � /� I am not using any subcontractors: Signature I Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile O% er/Contractor Signature IDate Zoe CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255 CUPERTINO (408)777-3228 (408El Plw-• b ildin _ rtinO.O ❑NEW CONSTR. /�•/j,❑ ADDITION ATION/TI ❑ REVISION I DEFER RED ORIGLNAL PERMIT k PROJECT ADDRESS II ,./` 1 /, u'Ce I .-')-37)1 ^fes I AFNa 2 / v -2 I . OWNER NAME i/ (/1,J �� L�iPHONENE / E-MAIL'OvL� ` V / aooiC L � 6s"o-46i-fir Ys .(. STREET ADDRESS CONTACT NAME _ �H SLC: ✓L 7 �C!/ArJCIL. I PYDO,ts'$Ob' 7 `♦•1` ES 7`r r" fie✓ �q M.�- � �v STREET ADDRESS Z 1-I CITY.STATE IIP - �E ❑owNEx El0w -S=ER ElN owAGENT i1YCONTRACTOR ❑COFnRACTOR AGENT ❑ ARcmEcr ❑ENGPIE='a ❑ DEVELOPER ❑ TENANr CONTRACT OR NAME �', 1 J // `7( /(L LICENSE TYPE j5 BUS.LIC 0 LICENSE NUMB 1l� qua-�s� 1 COMPANY NAME e✓e. 11 CJh •'� EMAH� eu 'ere STREET ADDRESSCITY,STATE ZT ONE 5. a�l ' u v S r vale L v G-91 S ARCHTTECT/ENGINEER NAME , ) LICENSE NUMBER BUS.LICA COMPANY NAME 'v E-MAIL FAX STREET ADDRESS QTY.STATE ZIP I PHONE DESCRIPTION OF WORK C) yr , ,_ (a C"— r O BGW� EX15TD+G USE PROPOS USc CONSTR YPE f SIDRH3 A '�� 1/ USE TYPE occ. sQr . vALuaroxlsl EX 0 NEW FLOOR DEMO TOTAL AREA AREA AREA NET.VtEA - BArHROOM KITC} OTHER - 0.BAOOEf.AAEA AEMODELAP A REMODQ.AREA PORCH AREA DECI[AREA TOTALDECl/ORCH AREA GARAGE AAPJ. DETACH ❑ATTACH NDWM1MGUNrrS: IS A SECOND UNTT ❑YTS sLCOIT STORY ❑YES 11MCADDED' []NO ADDITION` ❑NO PRE-APPLICATION ❑VES IF YES,PROVIDE COPY OF Is THE BLDG AN ❑YTS RECIIVEDBY' TOTAL VALUATION: PLANNINGAPPLA ❑NO PLANNING APPROVAL LETTER EICHLER HOME' ❑NO "- zdr000 By my signature below,I certify to each of Lhe following: I am the prone:y owner or authorized agent to act on the pcppeny owner's behal`. I have;rad this application and the infor...ation I ba a rovided is comcL I have read the Deseipdon of Work and verify it is accurate. I agree to comply with all applicable local ordinances and rate laws relating• u ding c ,. tion. I authors representatives of Cupertino to enter the above-identified pmpe rr for hsspectien proposes. 0 Signature of AppGcandAgrnn � Daze: �D •�l ' SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKME ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for �4f1 OVER-THE-CoGN-mt BCB.Divc PLAN REVIEW misting building(s). Demolition permit is required prior to issuance of building P permit for new building. ❑ EXPRESS Cl PLA.N•--ZM PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ S AINDARD ❑ PuJlucwoRK9 form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ FIRE bErT _Copy of Planning Approval Letter or Meering with Planning prior to 11 .wOR ElSANITARY SEWER DISTRICT submittal of Building Permit application. ❑ E.wrnoN.mrrAL aYALTH BldgApp_2011.doc revised 06/21/11