11120037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; 10210 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11120037
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 12/062011
R'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE.NO:(409)8069145
❑ LICENSED CONTRACTOR'S DECLARATION r r r-
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N r" r` r
MECH RESIDENTIAL COMMERCIAL
Contractor Q¢1dLYtu Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 30B DESCRIPTION:REMOVE&REPLACE 13 WINDOWS
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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 peril 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
permit is issued. APN Number:32627037.10210 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 18U DAYS FROM LAST CALLED INSPECTION.
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-p 'nt source r• lotions per the Cupertino Municipal ode,Section �2__29 18 Issued b Date:
1/2
Date f0
RE-ROOFS:
OWNER-BUILDER DECLARATION 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
1 hereby affirm that t em exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this peril is issued. Safety Code,Section 25532(x)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
end 25/34
I certify that in the performance of the work for which this permit is issued,l shall Health&Safety Code,Sections 25505,25533,not employ any person in any manner so as to become subject to the Worker's Ow I ri ez d agent: � a
Compensation laws of California. If,after making this certificate of exemption,I Date:
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.1 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 Lender's Address
u on the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18, Licensed Professional
Signature Date
• CITY OF CUPERTINO
3 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037.10210
DATE ISSUED. . . . . . . : 12/06/2011
RECEIPT #. . . . . . . . . : BS000015499
REFERENCE ID # . . . : 11120037
SITE ADDRESS . . . . . : 10210 PARKWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AVERY GLENBROOK LP
ADDRESS . . . . . . . . . . : 130 E DANA ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041-1508
RECEIVED FROM . . . . : STEVE P PLEVANCIC
CONTRACTOR . . . . . . . : STEVE PLEVANCIC LIC # 32967
COMPANY . . . . . . . . . . : STEVE PLEVANCIC CONSTRUCTION
ADDRESS . . . . . . . . . . : 528 S MATHILDA AVE STE 2
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 806-9145
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------=------ ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 20, 000. 00 1.00 0.00 1.00 0.00
1BSEISMICR VALUATION 20, 000.00 2.00 0. 00 2 .00 0.00
1WINREP EACH 8 13 .00 522.00 0. 00 522 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 525. 00 0. 00 525. 00 0 .00
•
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333• buildinGCcDcu J0rtino.orD
•❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEF/ER M .O�RrIGINAL PERWT Is
PROJECT ADDRESS AFN N 1^--� / ! 637
3 .
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CONTACT NAME c-tca LevArJCtC n,-$0b` ) `I )' E e I1 L, Ma- I tee.
MEET ADDRESS � LI CITY, ATN IIP � P
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C3OwNER 13OwNss-aumin t E3OWNERAGENT &`CONTRACTOR ❑CONIAACrORAOEiT Cl ARCHITECT ❑SHowsea ❑ DEVELOPER ❑TENANT
CONTAAC[OR NAME eUe e E
\ LICENSE NUMB i /6 b� LICENSE TYPE BUS.iSCN
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COMPANYNAME &MAILS 11 4WtZ 'V^
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STREET ADDRESSSTATE,IIP ONH
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ARCHTTECTJENGINEERNAME a ) .A_ L&CENSENUABER BUS.11C
COMPANY NAME 1'c S-MA =FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORM -
vr ' -i' Lptac ,r 13 windaw
ZXSTING USE PROPOSED USE CONSIR.TYPa asmO !s
Z'- USE TYPE OCC. SQX-T. VALUATION(S)
ATO NEW FLOOR DEMO
TOTAL
tAREA AREA AREA NET ARBA
07THR00M I KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA DECKAREA TOTALDECKMORCHAREA I GARAOBA"A' DETACH
ATTACH
NOWELLDNIUNITS: ISASECONDUNIT YES SECONDSTORY
BEING AODtDi NO ADDrnOM. NO
PR&APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEN®HY: IT)TAL VALUATION:_
PLANNING APP L# NO PLANNING APPROVAL LETTER EICHLER HOME? NO TAL
BY Dry signature below,I certify to each of the following: I am the property owner a authorized agent to act on the prpperryw
owner's behalf. I have read this
application and the nmfotmad. I he a rovided is correct I have reed the Description of Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laws relating td ding c aG! tion. I authorize m7resentatives of Cupertino to entar the above-identified property for inspection purposes.
Signature of ApplictureAgent Date:
SUPPLEMENCALINFORMATIONREQUIRED PLAN CtuCETrrs ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ova-T>m cowman ❑ BUILDING PLAN REVIEW
building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ Exrxyss ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srANDARD ❑ POHUCWORM
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEFT
Copy of Planning Approval Letter or Meeting with Planning prior to 13 MAJOR ❑ SANITARY saweR DLsralcr
bmittal of Building Permit application. ,
❑ &VVmONMENTAL REAL TH
BldgApp_20/Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 10210 parkwood drive DATE: 12/06/2011 REVIEWED BY: larrys
APN: BP#: *VALUATION: j$ 00
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PERMIT
1GENRES
USE: PERMIT TYPE:
WORK
SCOPE
Heth. Plan Chatic Plumb. Plan Check Elec.Pini CK.C4
.Mru:h. Period Fce: 1'1uwh, Pernur 1"ce: Paar. Ferns,free:
01her Afeeh. hap, Other 11114n,h b,aP. 01he., Eler:. hive.
vech Invi. Pec: Plmnh. Inj).Fi,e: Flee,Inv" Fee:
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 prelindna In ormatlon available and are only an estimate. Contact the Dept foraddn'l info.
FEE ITEMS (Fee Resolution I1-053 LIE 71111!/ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 13 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $522.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. lnsp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Ce mstructiun T ox
A(nlinislrutire Fee: 0
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Trove!I�ocrnnamlcnion Fins Building or Structure 0
• Strong Motion Fee: IBSEISMICR .00 Select an Administrative Item
Bldg Stds Commission Fee: iBCBSC $1.00
"SUBTOTALS: $2.00 $522.00 TOTAL FEE: $524.00
Revised: 10/01/2011