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11120038 . • CITY OF'CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10210 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11120038 CONSTRUCTION OWNER'S NAME:-AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:121062011 R'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic,q y 6, 9(o iir ��V11-CC—Date / MECH r RESIDENTIAL r COMMERCIAL r Contractor % V 1-C C—Date 1 hereby affirm that 1 am licensed under the provisions of C apter 9 JOB DESCRIPTION:APT 6-DECK AND RAILING REPAIR (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 permit is issued. Sq.Ft Floor Area: Valuation:$5000 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. 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, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit�kd itionally,the applicant understands and will comply d with all non:"t sourc re�dations per the Cupertino Municipal Code,Section Issued b Date: 9.18. y' Signature Date VA RE-ROOFS: Orr OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,l agree to remove all new materials for 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 fallowing three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 2M5,25533,and 25534. 1 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 permit 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 1 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 1 will permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's O ut orized agent: Compensation laws of California. If,after making this certificate of exemption,I Date:_�Sz! become subject to the Worker's Compensation provisions of the Labor Code,I must T�T 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 1 have read this application and state that the above information is Lender's Name 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 Lender's Address upon 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 Ci ARCHITECT'S DECLARATION _ p y g City in consequence of the 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 4 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 # . . . : 11120038 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 5, 000 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 000.00 0.50 0. 00 0 .50 0.00 1DECKRAIL EACH 1.00 457. 00 0. 00 457 .00 0.00 1DECKWOOD EACH 1.00 457. 00 0. 00 457 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 915.50 0. 00 915 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1,440,.50 VISA --------------- TOTAL RECEIPT 1,440.50 • CONSTRUCTION PERMIT APPLICATION ( I a Jc 3� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 .CUPERTINO (408)777-3228 L FAX(408)777-3333•buildina0cuD^rtino.orG NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT K PROJECTADDRESS /();' 10 ,d6 d.�k. APN0 OWNER NAME /)yr (�J. 2 Y V l e t Na N+oNe - _ E-MAM /9 �C G.1' 6s o-46i-� 'Ta"71 p _ cTrY. ®VwvLtnn,! AALj rC�N Ems'• �wgl�= 7/ CONTACT NAMES L. D jLTVAt3r-%C- PYdfs-$obi 74.)� E rA LIl.✓ At a. �v STREET ADDRESS a-I CITY. A N /1 e U P —C/ M ❑OWNER ❑ OWNER-9Un.DEa ❑ OWNER AGENT W ONTCrOR ❑CONTRACTORAGENr 13ARCFmECr ❑ENoD a®I 13 DEVELOPER 13 TENANT CONTRACTOR NAME ee LICENSE Nt1ME /6 Q� LICB<7EE TYPE BUS.DC p qu7 COMPANY NAME 2 �L,r '�t �Q�C Qu Bu MatC �tl a-7P STREET ADDR81SQ€ - .STATE,IIP ONH u le L 1(vS ARCHTTECVENOINEERNAME , ) LICENSE NUMBER EUS.LICA COMPANY NAME ,v E-MAIL FAX STREET ADDRESS CITY.STATE ZIP PHONE DESCItIT'nON OP WORK L DUSTING USE PROPOSED USE CONSTR.TYPE I ASTOR�I9 USE TYPE OCC. SQ.". VALUATION(3) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA HET AREA - BATHROOM KITCHEN or,= REMODELARE . REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTAL DECKIPORCH AREA I GARAGE AREA DETACH ATTACH I DWELLING UNTS: LEASE CONO UNR YEE SECONDSTORY YES USING ADDED? NO AD01770N? NO 4czy �V Flt-APPLICATION ❑YES IP YES.PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PNNNINOAPPLO NO PLANNING APPROVAL LEITER EICELaR EOMI? ONO By my sipamre below,I cardit to each of the following: 14111 the property Owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the information I he a vidad is correct I have read the Desorption of Work and verity it u accurate. I agree to comply with all applicable local ordinances and state laws relating ding c 'on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Data: SUPPLEMENTAL INFO TION REQUIRED PUN Ct[ZCx TYYIt ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TH"OUNM ❑ BUILDING PLAN RIVMW eXisting building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ E RIM ❑ PLANNING PIAN RRVIRW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORJLS Form if any Hazardous Materials are being used as part of this project ❑ LARG ❑ Fm uat Copy of Planning Approval Letter or Meeting with Planting prior to ❑ MAJOR sANrrAarsEwER Dtsrrucr mittal of Building Permit application. ❑ ENVIROnaNTAL HEALTH B1dgApp 101 Ldoc revised 06/11/11 n _ CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 10210 parkwood drive DATE: 12/06/2011 REVIEWED BY: larrys APN: BP#: "VALUATION: $5,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK deck and railing repair SCOPE Af,vh Plan Cheek Phauh. P/cr,CGeoh Elea.Plan Chz;:k Mech. Perocr Nee: Plumb.Po n it fee: Paac. Permit F,,e: Olde), ,,ch Insp. t;1Nie P'Loirh/nap. Orbe,Eler.. Lisp, APih.Insp. Ft' Plu"A Insp.Yc,; Eler.Imp. Few NOTE.This es1/mate 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 prelinina In ormatlon avai/ab/e and are only an estimate. Contact the Dept for addh 7In a FEE ITEMS (/•'ee Resolution 11-053 Eff 7/U//1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Deck/Deck Railing Suppl. PC Fee: (F) Reg. C) OT 0.0 hrs $0.00 $914.00 IDECKWOOD I Deck&Deck Railing PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT Q,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 71 -x Administrative Feer: Q Work Without Permit? YesQ No $0.00 0 Advanced Plamiine Fee: -Residential$0.00 Select a Non 0 T'ruvel Documentation Fees: Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item iBldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $914.00 TOTAL FEE: 1 $915.50 Revised: 10/01/2011