11120102 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10220 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11120102
CONSTRUCTION
OWNER'S NAME: AVERY CONSTRUCTION 528 S MATHILDA AVE STE 2 DATE ISSUED: 12/19/2011
OWNER'SPHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO:(408)806-9145
Q" LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class'7nWLic.A 13 r r r
MF.C11 RESIDENTIAL COSCOMMERCIALContractor,Qett e/7�/�et-tUnc• Z Date
0I3 DESCRIPTION: BLDG-10220 REPLACIi 30 WINDOWS IN APARTMENT
I hereby arm that I am licensed under the provisions of Chapter 9 C
affirm
COMPLEX
(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:$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 APN Number:32627037.10220 Occupancy Type:
permit is issued.
APPLICANTCERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property Ibr inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by/ Y Date:
granting
with all non-poin ucc re t anon per the Cupertino Municipal Code,Section
9.18.
_ RF:ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 ofthe Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with th Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Secti 505, 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work,for which this Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,alter making this certificate of exemption,I CONST'RUCT'ION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 have read this application and slate that the above information is
correct.1 agree to comply with all city and county ordinances and slate 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 ARCLiamT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037 . 10220
DATE ISSUED. . . . . . . : 12/19/2011
RECEIPT # . . . . . . . . . : BS000015591
REFERENCE ID # . . . : 11120102
SITE ADDRESS . . . . . : 10220 PARKWOOD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : AVERY CONSTRUCTION
ADDRESS . . . . . . . . . . : 130 E DANA ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041
RECEIVED FROM . . . . : STEVE PLEVANIC
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 30 . 00 782 . 00 0 . 00 782 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 785 . 00 0 . 00 785 . 00 0•. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 785 . 00 VISA
---------------
TOTAL RECEIPT 785 . 00
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10220 parkwood dr. DATE: 12/19/2011 REVIEWED BY:
19 APN: BP#: *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK a lace windows at exisitnq apt complex.
SCOPE
kkoh. Plan Cw,tk f'luarL. Plan Check Lhv.Plant Chach
,blec5. Pcrura Fee: 1'lunih, Permit Fee: li/ac. lie inn F/ e:
ON,) 1fieh. hap, t.7!hiu 1'luurh/, O(ho Elec, Orsi.
Poch.lnvp Pee: Plunrb. hrsp,k'rr: hiec.lnvl f'ce:
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 prelfaina fn ormaBon available and are only an estimate. Contact the Dept for addn7Info.
FEE ITEMS (Fee Resolution II-053 Elf 7/M FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 F30 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT F0,0Thrs $0.00 $782.00 1WINREP I Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT Q,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tir.c:
dminisfra live Fee: O
Work Without Permit? C) Yes (F) No $0.00
Advanced Planninc Fee: $0.00 Select a Non-Residential
Travel DoclUnenfariou Peas: Building or Structure
Stro . Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.00 $782.00 TOTAL FEE: 1 $785.00
Revised: 12/04/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CO TRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 0 t c 0Cj r PERMIT# /77 0
OWNER'S NAME: 6(/,O—V' PHONE# q0S -1"5 0 Co
GENERAL CONTRACTOR: 16 L BUSINESS LICENSE#
ADDRESS: a CITY/ZIPCODE: (,ti 6-&
*Our municipal code requires all businesses working in the city to have a City of Cupertin business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
Signature ate
Please check applicable subcontractors and complete the following information:
t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Pate
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION B
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
2 (408)777-3228• FAX(408)777-3333• building cuoertino.orD
CUPERTINO / j � � Zor o a
❑NEW CONSTRUCTION ElADDITION �/ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS /O.. 1,J O d APN`0 32 _ 2� -7.
OWNER NAME / Ve72 / CG/..1'�.�Kl/� C, /- PHONE6S 0-91//—kS / 1 V E- �114vekyl s 9,404, (a
STREET ADDRESS V CITY. TE,ffi
3o a�a s� , mb,`F40-w L"14,j CA 3e �(
CONTACT NAME F��rtGNE E-M�,
.s-F( JL- C//AtJCtC y0k frob ) +1' ST[ t
'
STREET ADDRESS if S. MAI CTCY,STATE, ZIP F
vl f1 U -
❑owNER ❑ OWNER-BUILDER ❑ OWNER AGENT D CmNn ACTOR ❑CONTRACTOR AGENT ❑ ARcErrEcT ❑ENGDNEEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME , e V LICENSE NUMB I /� LICENSE TYPE BUS.[SC p
l qua-73��
COMPANY NAME E -s 1eu QU ma rCC��1 P
STREET ADDRESS 1p(A •STATE.Z@ G le L U o -i5b 6 "-
ARCHITECT/ENOINFERNAME , ) .p_ LICENSE NUMBER BUS.LIC0
COMPANY NAME ,v p c E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCFUPTION OF WORE -
t'�""P /q-w-G.•dL D^�. �A't-11 IJ <-i nl�/Yi(
ExISTING USE PROPOSED USE CONSTR TYPE p� USE TYPE OCC. SQFr. VALUATION(S)
25E-TG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM RITCREN OTHER v1/
REMODEL AREA REMODELAREA REMODEL AREA
PORCH AREA I DECKAREA TOTALDECIOPORCHAAEA GARAGE AREA DETACH
ATTACH
p DWELLING UNM: 0A SECOND UNIT UYES SECONDSTORY 77RS
BRING ADDED? ONO ADDMON? ❑NO
PRE-APPLICATION ❑ II
YES IP YES,PROVIDE COPY OF IS TEE BLDG AN ❑YES RECEIVED BY- TOTAL VALUATION:
-W
PINIaOAPPLM NO PLANNGAPPROVALLHTTER E1CHLERHOMEt NO
Z'dr 000-
By my signature below,I certify to each of the fallowing: I am the propeM owner a authorized agent to act on the prpperty owner's behalf, i have read this
application and the information I he a v'dad is correct I have read the Description of Work® ta
d verify it is accate. I agree to comply with all applicable local
ordinances and state laws relating u cling c tion. 1 authorizo representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATIONREQUMED FLANCIIECETYPE t s18
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-.THE-Cotmnx EllUELDING PLAN RKMW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PCAXMC FLAX RrVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ PDtE nEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to C3 MAJOR SANITARY sswEn DISTRICT
submittal of Building Permit application.
❑ ENVERONMENTALUKALTH.
B/dgApp 201 Ldoc revised 06/11111