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B-2017-1174CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-1174 10134 PARKWOOD DRAPT 6 CUPERTINO, CA 95014-1429 (326 27 036) THERMAL MECHANICAL - SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 07/25/2017 OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744 LICENSED CONTRACTOR'S D . T.ARATION BUILDING PERMIT INFO: License Class C-4: C-10:C-36-C-38 Lic. #256057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: BLDG #23/UNIT#6; ADD (1) A/C; REPLACE FURNACE, SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION; (1) WASHER AND DRYER HOOK UPS; N ELECTRICAL 1. I have and will maintain a certificate of consent to self-insure for Worker's SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (1) RECEPTACLE Compensation, as provided for by Section 3700 of the Labor Code, for the OUTLETS; (1) LIGHT; (N) BATHROOM EXHAUST FANS. performance of the work for which this permit is issued. I`have and will maintain Worker's. Compensation Insurance, as provided for by c ' n 3700 of the Labor Code' for the performance of the work for which this Sq. Ft Floor Area: Valuation: $20000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 27 036 326 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant. understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sffre ate 7/25/2017 Issued by: AbbyAyende Date: 07/25/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons:, All roofs shall be inspected prior to any roofing material being installed., If a roof is 1. I, as owner of the property; or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do.the work, and the structure is not intended or offered for inspection. „ sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(Sec.7044, Business & Professions Code). Date: 7/25/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code; for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health &Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I Municipal Chapter exemption, Ibecome to.the Worker's Compensation the will maintain compliance with the Cupertino Code, 9.12 and 25534. subject provisions of the Health & Safety Code, Sections 2 05, 25533, and Labor Code, I must foithwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized a a APPLICANT CERTIFICATION Date: 7/25/201 7 certify that I have read this application and state that the above information is correct. I agree to compiy,yuvith"all city and county ordinances and state laws CONSTRUCTION LE GAG y I hereby affirm that there is a construction lending agency for the performance relating to building construction,: and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above'rrientioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, costs, and ex enses which Ima accrue against said Ci in judgments, P. , y g tY Lender's Address consequence of the granting of,this permit: Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. i 1 understand my plans shall be used as public records. Licensed Signature Date 7/25/2017 Si 9 Professional 3-201-+- tt,�-cC CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPBRTINC? w T 8) r (408) 777-3228 • FAX (408) 777-3333 • buildlIiin6 )cupertino.org M T—T—T I I A nnTTTnXT I X 1 1 AT'rT:D A'T•YC%XT / TT I - 1 RFVIQInXT / TIFFFRRFTI 041( TMAT PFRMTT # PROJECT ADDRESS 10134 Parkwood DR, BLDG 23, Unit#6 APN# OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAIL averY@Pacbell.net STREET ADDRESS 130 East Dana Street CITY, STATE, ZIP Mt. View, CA 94041 FAX 650=961-0571 CONTACT NAME Rob Moyer PHONE 408-593-8115 E -'MAIL rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY,. STATE, ZIP Santa Clara, CA 95054 FAx 408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR 1❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC # 299 Thermal C-4,10,20,36,38 COMPANY NAME Thermal Mechanical E-MAILrmoyer@thermalmech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP 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 EXISTINGUSE PROPOSED USE CONSTR- TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL D_ECKNORCH AREA GARAGE AREA: E DETACH []ATTACH DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? F]NO ADDITION? []NO , PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RECE D l� � �+ r, TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO A. By my signature below, I certify to each of the following: I am the property owner or authorized agent to ack on the pr perty owner's behalf. I have read this application and the information I have provided 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 to buil ' ct I authorize resentatives of Cupertino to enter the abo id tified property for inspection purposes. G' Signature of Applicant/Agent: Date:, SUPPLEMFT FORMATIO QU AH . ,LE Q, gig- New SFD or Multifamily dwellings: Apply for demolition permit for Ut�)iR iTi&COUNTER � B�iTl;DING PLAN. HEC�I�W _ existing building(s). Demolition permit is required prior to issuance of building�rr"� /��/�� E F 4 permit for new building. ��/' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure© sTArmARut, _ r Ptls wa, form if any Hazardous Materials are being used as part of this project. k❑��I�ARGR 3 � � a�-O�FIRE�D);PT a ��"�1��/��i Copy of Planning Approval Letter or Meeting with Planning prior to rF / r� Y _ MAJOR a sRwER ts�rRlcT � A submittal of Building Permit application.vpv ii „�°r6Gr/f , �L a �,l_i��aEiyi?TRf11VM�1�'1wAI'iHC�ALTkI,. � 9 �� BldgApp 201 Ldoe revised 06121/11