13100086CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10125 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 13100086
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/11/2013
OWNER'S PHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806-9145
LICENSED CONTRACTOR' DECLAR(AATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class Lic. # & _` BLDG # 14 - REMOVE & REPLACE 28 (E) WINDOWS (WILL
MEET EGRESS & BE TEMPERED WHERE REQUIRED BY
Contractor P.eiC 1/+ Vic. Date CODE)
I hereby affirm that I am licensed under the provisions of Chapt
(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
Co nsation, as provided for by Section 3700 of the Labor Code, for the
rformance of the work for which this permit is issued. ` Sq. Ft Floor Area: Valuation: $20000
I 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 APN Number: 32627036.10125 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 WITImv AYS 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 1 YS FRO ALLED 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 lt•J
granting of.this permit. Additionally, the applicant understands and will comply y'
with all non -point urce regulation a Cupertino Municipal C e, S tion
9.18.
/ RE -ROOFS:
Signature ate ` � l f 3 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. 1 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 whichthis permit is issued. will maintain compliance with thACtino Municipal Code, Chapter 9.1 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio25 , a d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater
permit is issued.
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408).777-3228 - FAX (408) 777-3333 - building(cDcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI [I REVISION / DEFERRED
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BUS. LIC #
COMPANY NAME
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DESCRIPTION OF WORK R(;a10L �� C/ �•
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
RI
USE TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NEr AREA
-
BATHROOM
IUTCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECR'JPORCH AREA
I GARAGE AREA U DETACH
[]ATTACH
# DWELLING UNITS: IS A SECOND UNIT []YES
SECOND STORY ❑ YES
' BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
I TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following. I am the property owner or authorized agent to ac a prrrperty owner's behalf. I have read this
application and the information 1 ha a rovWed is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ding c tion I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
-THE -COUNT ER
❑ BuILDiNG PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
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
C1STANDARD
El PUBLICWORKS
form if any Hazardous Materials are being used as part of this project.
11 LARGE
❑ FIRE nt
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
Submittal of Building Permit application.
❑ ENVIRONMENTAL HEnLTa
BldgAppj011.doc revised 06/21/11
e- 71
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS:. 10125 PARKWOOD DR BLDG 14 1 DATE: 10/11/2013 REVIEWED BY: MELISSA
APN: 326 27 036 BP#: *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY MINI AMATION 1 GENRES
USE: I I SFD or Duplex PERMIT TYPE:
WORK REMOVE & REPLACE 25 E WINDOWS WILL MEET EGRESS & BE TEMPERED WHERE
SCOPE REQUIRED BY CODE)
ilecfx. flan CheckPlumb. Plan Check Elec. Plan Check
11i:ch. Perynit Fee:Plrtmb. Permit 1%c:e: Elt:c. Permit Fee:
Other Alech. Insp. Other Plumb Insp. u Other Elec. Insp.
Plumb. Ins I ee: Glee. Insp. fee:
,��ech: Insp. Fee: 1
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.).. These fees are based on the relimina information available and are on an estimate. Contact the Dept or addn'Z
FEE ITEMS (Fee Resolution 11-053 E . 7 /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 28 j # Window / Sliding Glass Door
Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $835.00 I WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.1D Reg. ®OT O,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee:
Constrzrction 7 -ax:
Administrative ]`61e:
Work Without Permit? ® Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non -Residential E)
Building or Structure
Travel Documentation Fees:77=0
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCSSC $1.00
$3.00 $835.00 o $838.00
�M . �11 �.
Revised: 10/01/2013