B-2017-1176 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1176
10125 PARKWOOD DR APT 2 CUPERTINO,CA 95014-1448(326 27 036) THERMAL
MECHANICAL
SANTA CLARA,CA
95054
OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED:07/26/2017
OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744
I s► t. SC P S► BUILDING PERMIT INFO:
License Class C-4.10.26 Lic.#256057
Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESH)ENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BLDG#14/UNIT#2;ADD(N)A/C;REPLACE FURNACE,SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION;(N)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);(N)GAS LINE FOR STOVE;(N)RECEPTACLE
eCompensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS;(N)LIGHT;(N)BATHROOM EXHAUST FANS.
performance of the work for which this permit is issued. REV#1 -CHANGE LOCATION OF FURNACE TO ATTIC SPACE-
iiaaye and will maintain Worker's Compensation Insurance,as provided for by ISSUED 9/26/2017
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 27 036
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 gulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
S' ature ,
t -- i pate ' Issued by:AbbyAyende
7/C--.6-'
// Date:07/26/2017
OWNER-:UILDER 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 of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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. I 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
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Seetiots 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. O r authorized agent: i ---------)
APPLICANT CERTIFICATION •
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING A NCY
correct.I agree to comply with all city and county ordinances and state laws 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 mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in 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 understand my plans shall be used as public records.
Licensed
Signature Date Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO: B-2017-1176
10125 PARKWOOD DR APT 2 CUPERTINO, CA 95014-1448 (326 27 036) THERMAL
OWNER'S NAME. AVERY GLENBROOK LP
OWNER'S PHONE: 650-961-8330
a M I_: I
License Class C-4, C -1 0:C -36-C-38 Li'c. #256057
Contractor THERMAL MECHANICAL pate 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 Cade and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two 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.
.i'. ' I have and will maintain 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.
Signature Date 7/26/2017
OWNER -BUILDER DECLARATION
SANTA CLARA, CA
95054
ISSUED: 07/26/2017
PHONE NO: (408) 988-8744
BUILDING PERMIT INFO•
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION
BLDG #14/UNIT#2; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION, (N) WASHER AND DRYER HOOK UPS, (N) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE, (I) RECEPTACLE
OUTLETS; (I) LIGHT, (N) BATHROOM EXHAUST FANS.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the properly, 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)
2. I, 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:
L 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.
2. 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
permit is issued.
s. 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.
C
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.
Signature Date 7126/2017
Sq. Ft Floor Area: I Valuation: $20000.00
APN Number- Occupancy Type:
326 27 036
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by- Abby Ayende
Date: 07/26/2017
RE -ROOFS:
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.
Signature ofApplicant:
Date:7/26/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Code, 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, Section 05, 25533, and 25534.
Owns authorized agent:
Date: 7/26/2017 a
N TRU LENDINCIAGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
C PERTIN+1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE + CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq(@cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION Q ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS 7APN #
10125 Parkwood DR, BLDG 14, Unit #2 7 0
OWNER NAME PHONE - - E-MAIL
Avery Glenbrook LLC 650-961-8330 avert'@pacbell.net
STREET ADDRESS CITYSTATEZIP FAX
1 , , .30 East Dana Street Mt. View, CA 94041 650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech`.com
STREET ADDRESS CITY, STATE, ZIP FAX
425 Aldo ave. Santa Clara, CA 95054 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT N CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 1:1 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER 256057 TCT-4
SE TYPE BUS. LIC # 299.
Thermal Mechanical
cOMPANYNAME Thermal Mechanical E-MAIL rmoyer@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
EXISTING USE - - - 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. REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH -
[]ATTACH
#DWELLINGUNITS: IS A SECOND UNIT []YES SECONDSTORY ❑YES. -
BEINGADDED? NO ADDITION? [:]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -RC8 D BY:: T Q , AL VALUATION:
PLANNING ADPL # ❑ 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 acct on the property 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 building c n. authorize repr sentatives of Cupertino to enter the above -identified p operiy f r inspection purposes.
Signature of Applicant/Agent: Date: /
SUPPLEMENTAL WORMATION REQUIRED u, , rl cxcx;'ty Rur►�s�;"
New SFD or Multifamily dwellings: Apply for demolition permit for C( ttviEu cozvaiR [�ItL31Ch1i A11 itYS-E4Y
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. Y�1TIt+iG
g � a
_ Commercial Bldgs: Provide completed Hazardous Materials Disclosure Ci s ANnARtt Q TttB WRI
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval. Letter or Meeting with Planning prior to "
submittal of Building app Permit lication.A�otz D sAN�TazzX x>T>r -
t=1 ENVIIFUII�MENTAYr�II•Ai3'CH
BldgApp_2011.doc revised 06/21/11