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13100019 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21326 GLEN PL CONTRACTOR:STEVE PLEVANCIC PERMIT NO:13100019 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:10/01/2013 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. q tJ6/ BLDG 12-REMOVE AND REPLACE 20 WINDOWS TO ��-z� MEET Contractor � 'Qe u Date Z C� O ( EGRESS IN BEDROOMS I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I 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.Ft Floor Area: Valuation:$10000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofLabor Code,for the performance of the work for which this APN Number:32627036.21326 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1 0 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the l(f �p/► Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code Section 9.18. RE-ROOFS: Signature Date 1� 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio05, ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this �/ � permit is issued. Owner or authorized agent: Date: 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION 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 authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTM :NT- BUILDING DIVISION O�\ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \O (408)777-3228• FAX(408)777-3333•build ing(&cupertino.org y CUPERTINO \ ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/nTI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ( n7 OWNER NAME 4 i e7? / V (i 11a0o/,C t, p PHONE�J_0-Q61_k E-MAIL STREET ADDRESS V /C- CITY. ATE ZIP 7 n FAi �, �[{fQ_�� Z�/ 30 P. s�' vv�✓ , w lam' W CONTACT NAMEt� IAB, SfC'✓C- -1_->IL FVArJC�L PTd�-8706 7 `+)� ES�7`C t" A LL Cg Alt �v STREET ADDRESS 4-I CITY,STATE,ZIP F 4X S. M A: ()4671,ko Ahne CJ ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT LKCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME r ` LICENSE NUMB l C �j// LICENSE TYPE //�� BUS.I IC# e-v I �/Gi r1C, C_ `( COMPANY NAME E-MAIL f F 'T�a' Q;re v� I U h s u E L) ma STREET ADDRESSCTIY,STATE,ZIP PONE of tr v S zi vci If, c, s ARCHrrECT/EPIGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ��✓T�`� I `�au. EXISTING USE PROPOSED USE CONSTR TYPE #STORIES " USE TYPE OCC. SQ.1�7. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ONO // d v- PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE B PLANNING APPL# ONO PLANNING APPROVAL LETTER EICHL.ER HOME? ❑NO � 3T�TOTALALATION:F�U By my signature below,I certify to each of the following. I am the property owner or authorize'd'a t to act on the prrrperty owner's behalf. I have read this application and the information I ha a rovided is correct. I have read the Description of Work anverify it is accura I agree to comply With all applicable local ordinances and state laws relating ding c tion. I authorize representatives of Cupertino to enter the abov id Bed property for inspection purposes. Signature ofApplicanUAgent Date: ! SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER R ❑ BUMDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fns DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT Submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp jOl Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21326 Glen PI ATE: 10/01/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: j$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: wORK bldq 12- remove and replace 20 windows SCOPE �b5&n�o,»�5amre ,,,rv8-». .m�•sv. -- i IN j. i Aiech. t'ltiYt.Check 1'1.,nib. I'l air£:'dwck I'.hM Chh£c:k A 1'enraii Fee, Other Re,1a,lrsn. otherTlronb Ings . )Mer Elec.Ir;q% E—i X1crc fir. hr,.sp. fe,%, I'ltatrtt.Msp.Fee, € a'. Ir?a;z, I'€:£ NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn 7 infix FEE ITEMS (Fee Resolution 11-053 Eff. 7/U13J FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 20 # Window/Sliding Glass Door Suppl.PC Fee: Reg. 0 OT OA hrs $0.00 $696.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.-(j) Reg. O OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 yj PME Permit Fee: - $0.00 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non-Residential °Fees: Building or Structure C i Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 '� " $2.00 $696.00 2 E T $698.00 v OTAL FEE o; Revised: 08/01/2013