B-2017-0164CITY OF CUPERTINO BUILDING PERMIT I
BUH.DING ADDRESS:
10205 PARKWOOD DRAPT 4 CUPERTINO, CA 95014-1562 (326 27 037)
CONTRACTOR: PERMIT NO: B-2017-0164
THERMAL
MECHANICAL
SANTA CLARA, CA
OW'NER'S NAME: AVERY GLENBROOK LP I I DATE ISSUED: 01/31/2017 1
OWNER'S PHONE: 650-961-8330
191 y Will M 1X9163cmt_: o] 143 11 K: t_. E►
License Class C10. C20, C36, C38 Lic. #25EM
Contractor THERMAL MECHANICAL Date 01/31!2018
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:
1. 1 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
9_performance of the work for which this permit is issued.
CI have and will mahxtain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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 indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the 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.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
S. I, as owner of the property, ormyemployees 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)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
Z 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.
1 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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 to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the 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.
Signature Date 01/31/2017
NO: (408) 988-8744
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL V COMMERCIAL
JOB DESCRIPTION:
BLDG 48/UNIT 4; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION; (I) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
SERVICE (70 .AMP); (I) GAS LINE FOR STOVE; (N) RECEPTACLE
OUTLETS; (N) LIGHT; (N) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: ! Valuation: $20000.00
"N Number: Occupancy Type:
326 27 037
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: MELISSA NAMES
RE -ROOFS:
All roofs sbali be inspected prior to any roofing material being installed. I£ a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 01/31/2017
2017,
ROOF COVERINGS TO BE CLASS "A" OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code,ns 25505, 25533, and 25534.
Owner or authorized agent:
Date: 01/31/2d17
Ct�NSTUCTION LEND AGENCY
I hereby affirm that there is a construction lending agency for the performance
of works for which this permit is issued (Sec. 3097, Civ C.)
Lender"s Name,
Lender's Address
ARCHITECI'S..DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
V
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
G'I.UPERTING (408) 777-3228 • FAX ((408) 777-3333 • building (d),cupertino.org
El NEW CONSTRUCTION M ADDITION Ihl AT.TFRATTO,. rTI I I ul~vteTnT�TInFCT~n� 2_10ncn nnrrMrer n
016
PROJECT PROJECT ADDRESS 0205 Parkwood DR, BLDG 48, Unit #4 -7APN#
7
OWNER NAME Avery Glenbrook LLC
PFIONE E-MAIL
650-961-8330 avery@pacbell.net
STREETADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
FAX
650-961-0571
CONTACT NAME Rob Moyer
y
PI•IONE
408-593-8115
B -MAIL
rmoyer@thermalmech.com
STREETADDRESS 425 Aldo ave.
CITY, STATE, ZIP
Santa Clara, CA 95054
PAX 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT Ii`[ CONTRACTOR ❑CONTRAGI-ORAG13NT ❑ ARCHITECT ❑ HNGINEER ❑ DEVELOPER I-] TENANT
CONTRACTORNAMEThermalMechanical
1 7 LICENSE NUMBER 256057
LICENSETYPE
BUS, LIC #299
C-4,10,20,36.38
COMPANYNAME Thermal Mechanical
thermalmech.com E-MAIL
rmoyer@thermaimech.com
er
FAX
408-988-0233
STRBET ADDRESS 425 Aldo ave.
CITY,STATE,ZIP Santa Clara, CA 95054
PI•IONE 408-988-8744
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC # '
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, "LIP
PHONE
DESCRIPTION OF WORK add new AC, replace furnace in same location, (N) washer/dryer hook ups, (N) electrical panel (70 AMP),
(N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan
EXISTING USE
PROPOSED USE CONSTR,
TYPE
# STORIES
USE, TYPE OCC,
SQ.I"I',
VALUATION ($)
HXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KIDCHEN
OTHER -
REMODELAREA REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DF-CKIPORCH AREA
ARAGEAREA; 0 DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECONDSTORY ❑YES
BEINGADDED? ON,
ADDITION? ONO
PRE -APPLICATION OYES 1F YES, PROVIDE COPY OF
ISTHEBLDGAN OYES y;,•,:.,- ..-•:
.; TOTAIW
PLANNING APPLY ONO PLANNING APPROVAL LOITER
ICICIILER IIOME? O.NO
rr
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is connect, 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 to bull lin uc 'on. I att iorize representatives of Cupertino to enter the above -idem ' ed prop 'ty for inspection pulposus.
Signature of ApplieanVAgent: Date;
SUPPLEMENTA INFORMATION REQ RED
:PL`ANCFIECKTYNEt.I .>_.;:.:';;:>'.;
,.::yi'. ROiITl11IG.SLIP:
_'
iii DINGpi:Ar
_ New SFD or Multifamily dwellings: Apply for demolition permit forflvER'THE=coni'
existing building(s). Demolition permit is required prior to issuance Of building
TER'
lltViily
permit for new building.
. EXPRESS ..
L . PL"A'.N YING PLAN REVISIV .
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
atANI)AB'D
�: Y1JBLic.\VoRKS
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
AfASOR.'':'
:.
SANITARYSEWEIZIlISTRICT .
submittal of Building Permit application.
.0r,ENVTRONMENTALHEALTH..-.
BldgApp_2011.doc revised 06/21/11
SMOKE 1 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION
CVPER` ( 0 10300TORREAVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buHdlng(d)cupertino.org
PURPOSE.
This -affidavit is a self -certification for the installation of all required Smoke and Carbon, Monoxide Alarms for
'Compliance with 2013 CRTC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where i -Lo interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM .
Outside of each separate sleeping area in the immediate vicinity of
X
X,
the bedroom(s)
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
G
Carbon Monoxide alarms are not required in dwellings which do.not contain fuel -burning appliances and that
do riot have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with .
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
hz existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result iri the removal of wall and ceiling finishes or there is no access by means of attic, basement or crai,\Tl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
iristalled 111 accordance with .the manufacturer's instructions and in compliance with the California Building
al -id California Residential Codes. The alarms specified belovT have been tested and are operational, as of the
date signed below.
f) r�
� LyAddress: n t
Specify Number of Alarms: # Smoke Alain s: 4 Carbon Monoxide Detectors:
I have read and agree to comply with theierrms_and conditions of this statement
Owner (or Owner Agent's) Name:
- ._,
Signature Daze:
Contractor Name: p
t�deil t"L i c2r v
Signature Lic. .......Date:
C'._.-7.,, ..__.l /,In r .___ .7. - _.__.___j nn Mair I
CUPERTINO
Owner Name
Address / ()
'WATER -CONSERVING PLUMBING, FIXTURES -
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form..
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
rnbing, installation of water -conserving plumbing fixtures is not technically feasible?
es Civil Code Sections` 1101.1 through 1101.8'do not apply.
The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom .of form. No Go to Question 3.-
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through. 1101.81 do not apply. Skip the rest of the form and sign bottom of form.
19 No Go to Question 4.
4. Is your real property built and available fdr use or occupancy on or before January Lj 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
XYes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101,1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after Januaiy 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. -On or before January 1, 2017, all non-
compliant
on
compliant plumbing fixtures shall be, replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
My property is a multifandly residential real property. ,See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
My property is a c0772777ereial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water-conseiving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations. or improvements).
1, as the owner or owner's agent of this property, certify under penalty of perjury that noncompliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature:.' Date:
77
Unnn emmi-leting and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doc7-evised 08/26/15