12030020CITY OF CUPERTINO BUILDING PERMIT
BIJILDING ADDRESS: 10205 PARKWOOD DR
CONTRACFOR: STEVE PLEVANCIC
PERMIT NO: 12030020
CONSTRUCTION
OWNER'SNAME: AVERT' GLENBROOK LP
528SMATHILDAAVESTE2
DATE ISSUED:03/052012
OWNER'S PHONE: 6509618330
SUNNYVALE. CA 94086
PHONE NO: (409) SG6-9145
❑ LICENSED CONT'RACTOR'S DDCLARAT'ION
r C r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lie.W g4rr Cf I / V
r r r
COMMERCIAL
II �yJj++
ISIECH RESIDENTIAL
Comraclocr7F¢c7C&.urt e.3.- &J, Data -
hereby affirm that 1 am licensed under the provisions of Chapter
30B DESCRIPTION: REMOVE& REPLACE 27 WINDOWS AT EXISTING APT.
(commencing with Section 70011) of Division 3 of the Business & Professions
COMPLEX
Code and that my license is fn full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
pertbnnance of the work for which this permit is issued.
Sq. Ft Flair Area:
Voluatfon: $20000
I have and will maintain Workers Compensation Insurance, as provided for by
Section 3700 of the Labor Cale, for the performance of die work for which this
permit is issued.
A 1.14 Number. 32627037.10205
Occupancy Type:
APPLICANT CERTI FICATION
I unify that I have read this application mid state that the alxwe information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building consnuc[ion, and hereby authorize representatives ofthis city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon (lie above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City otCupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs. and expenses which may accrue against said City in consequence of (lie
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Addie pally, the applicant understands mid will comply
with all no n -p nu — gulat its per the Cupertino Municip Code, Section
9.18.
R
Issued by: Date:
c-
Sianature Date
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be in -,vested prior to any roofing material beiig installed If a roof is
hereby affirm that 1 am exempt front the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the fallowing two reasons:
inspection.
I, as owner of the property, or my employees with wages ms [heir sole compensation,
will do the wort:, mid the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, tan exclusively contracting with licensed contractors to
cons(mct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR RETTER
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm tinder penalty of perjury one of the following three
declarations:
I have mid will maintain it Cenifiewe of Consent to self -insure Ibr Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505.25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have mid will maintain Worker's Compensation Insumnce, as provided for by
Safety Code. Section 25532(a) shard 1 Mare or handle haurdous material.
Section 3700 of the Labor Code, for the performance of the wart: for which this
'additionally, should I use equipment or devices which emit livardous air
contaminants as defined by the Ray Area Air Quality Management District I will
I Hermit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
1 unify that in the performance of the work for which this pennit is issued, I shall
Henith & Safe - ode, Sections 25505. 25533, and 25534.
not employ tiny person in any manner so as to become subject to the Worker's
/
Compensation laws of Cal ifomia.If,atlermakingtliiscerlificateofexemption,l
r!) , .�
Out m i razed a -en•
become subject to the Worker's Compensation provisions of the Labor Code, I nwst
Date: �f/-evF-'�6�
-'`
forthwith comply with such provisions or this permit shall be deenhed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read (his application and slate that tate above information is
for which this pemnit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
fndemnifV and keep hxrdess the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
pRCHI'1'EC"1'tS DECLARATION
grating of (his permit. Additionally, (lie applicant understands and will comply
with all non-poin( source regulations per the Cupertino Municipal Code, Seclini
I understand my plans shall he used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BIJILDING ADDRESS: 10205 PARKWOOD DR
CONTRACFOR: STEVE PLEVANCIC
PERMIT NO: 12030020
CONSTRUCTION
OWNER'SNAME: AVERT' GLENBROOK LP
528SMATHILDAAVESTE2
DATE ISSUED:03/052012
OWNER'S PHONE: 6509618330
SUNNYVALE. CA 94086
PHONE NO: (409) SG6-9145
❑ LICENSED CONT'RACTOR'S DDCLARAT'ION
r C r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lie.W g4rr Cf I / V
r r r
COMMERCIAL
II �yJj++
ISIECH RESIDENTIAL
Comraclocr7F¢c7C&.urt e.3.- &J, Data -
hereby affirm that 1 am licensed under the provisions of Chapter
30B DESCRIPTION: REMOVE& REPLACE 27 WINDOWS AT EXISTING APT.
(commencing with Section 70011) of Division 3 of the Business & Professions
COMPLEX
Code and that my license is fn full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
pertbnnance of the work for which this permit is issued.
Sq. Ft Flair Area:
Voluatfon: $20000
I have and will maintain Workers Compensation Insurance, as provided for by
Section 3700 of the Labor Cale, for the performance of die work for which this
permit is issued.
A 1.14 Number. 32627037.10205
Occupancy Type:
APPLICANT CERTI FICATION
I unify that I have read this application mid state that the alxwe information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building consnuc[ion, and hereby authorize representatives ofthis city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon (lie above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City otCupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs. and expenses which may accrue against said City in consequence of (lie
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Addie pally, the applicant understands mid will comply
with all no n -p nu — gulat its per the Cupertino Municip Code, Section
9.18.
R
Issued by: Date:
c-
Sianature Date
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be in -,vested prior to any roofing material beiig installed If a roof is
hereby affirm that 1 am exempt front the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the fallowing two reasons:
inspection.
I, as owner of the property, or my employees with wages ms [heir sole compensation,
will do the wort:, mid the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, tan exclusively contracting with licensed contractors to
cons(mct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR RETTER
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm tinder penalty of perjury one of the following three
declarations:
I have mid will maintain it Cenifiewe of Consent to self -insure Ibr Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505.25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have mid will maintain Worker's Compensation Insumnce, as provided for by
Safety Code. Section 25532(a) shard 1 Mare or handle haurdous material.
Section 3700 of the Labor Code, for the performance of the wart: for which this
'additionally, should I use equipment or devices which emit livardous air
contaminants as defined by the Ray Area Air Quality Management District I will
I Hermit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I unify that in the performance of the work for which this pennit is issued, I shall
Henith & Safe - ode, Sections 25505. 25533, and 25534.
not employ tiny person in any manner so as to become subject to the Worker's
/
Compensation laws of Cal ifomia.If,atlermakingtliiscerlificateofexemption,l
r!) , .�
Out m i razed a -en•
become subject to the Worker's Compensation provisions of the Labor Code, I nwst
Date: �f/-evF-'�6�
-'`
forthwith comply with such provisions or this permit shall be deenhed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read (his application and slate that tate above information is
for which this pemnit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
fndemnifV and keep hxrdess the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
pRCHI'1'EC"1'tS DECLARATION
grating of (his permit. Additionally, (lie applicant understands and will comply
with all non-poin( source regulations per the Cupertino Municipal Code, Seclini
I understand my plans shall he used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 9 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627037.10205
DATE ISSUED.......: 03/05/2012
RECEIPT #.........: BS000016190
REFERENCE ID # ...: 12030020
SITE ADDRESS .....: 10205 PARKWOOD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......:
OPERATOR: patg
COPY # : 1
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 27.00
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 1,833.00
--------------------
VISA
---------------
TOTAL RECEIPT 1,833.00
CITY OF CUPERTINO
ISI FEE ESTIMATOR -BUILDING DIVISION
Lai
ADDRESS: 10205 parkwood dr.
DATE: OWEET771
REVIEWED BS': bob s.
bhvh. Penna f•ee:
APN:
BP#:
"VALUATION:
$20,000
•PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY' Or Duplex
USE:
Fier. Incp. Fee:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
replace 27 windows at existing apt. complex.
SCOPE
$0.00
NOTE: This estinule does not include fees due to other Departments (i.e. Planning, Public Works. Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nrelininarr inh)rnution available and are onh, an eainate. Contact the Dent for addo'I info.
FEE ITEMS (Fee Resolution 11-053 E2 7/I/11)
Vrdh. Phw Ch..1,
Phunb. Plan Check
Due. Plan Ckcck
bhvh. Penna f•ee:
Pluad'. Pelma Fee:
Fle. Perno%Fac
t olive Am lh. Insp.
Odin. Plunk hu?
A* Gee. Imp. ET
1,kch. Int? Fee-
Plund). ha'p. M.:
Fier. Incp. Fee:
NOTE: This estinule does not include fees due to other Departments (i.e. Planning, Public Works. Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nrelininarr inh)rnution available and are onh, an eainate. Contact the Dent for addo'I info.
FEE ITEMS (Fee Resolution 11-053 E2 7/I/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
27 #
$782.00
Window / Sliding Glass Door
116'INRFP Replacement
Suppl. PC Fee: Q Reg. O OTF0_01hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl.Insp. Fee -.0 Reg. Q OT
10.0-1
has
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
( emstruction lax:
. h Indnl,siraln'e Fve-
O
Work Without Permit? O Yes Q No
$0.00
Advanced Plannine Fee:
$0.00
Select Non -Residential
Building or Structure
Q
Tr,roel Documentation Fees'
Strong Motion Fee: IBSEISAIICR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $3.001
$782.001
TOTAL FEE:
1 $785.00
Revised: 1/19/2012
CUPERTINO I
FI NEW CONST:FU=C)N
12-oo-Z ZJ
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40188)) 777-3228 - FAX (408) 777-3333 • buildinG(dGuoertino oro
I I ADDITION F1 r1 ALTERATION/T7 n RFVISiON/nFFFZRFtI ORfr.t Al PCR�s
PROJECT ADDRESS AFN lI
Z 0 -3 --11 0-2-05
� _
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n
OWNER NAAM IqU((liJJ7ZY �LtN3 atpo l- PHONE6S0' EMAm ALI J7L71s [-k/.
rnv. bz-"l
saEE130 �a�a
s+.
CONTACT NAME
St('✓I-- 7 l'unractC_
PHONE E-AA++AAEH,,
ruts -$o6-
STRFFrADDRESSVgS, 11
QTY, STATE. IIP
F
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110 ❑ OWNER-BUBDER ❑ OWNERAGENT l4'CONTRALTOR ❑CONraACTORAGENT ❑ AEcHr ECT ❑ ENG� ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME \
I LICENSE NUMB i /
LICENSE TYPE
BUS. LIC 0
COMPA.YY NAME
f,
E-MAH.P
v
S e� e✓ Ma, 'LC)'Lt
STREET ADDRESSS c a elve P
( u
ON
6- S
ARCHITECTIENGINEERN ° , 7 .,tLICENSE NUMBER
(v Y�
BUS. JIG
COMPANY NAME E -MALI.
FAX
STREET ADDRESS CrrY, STATE- ZIP PHONE
OFSCRUMON OF WORK
EJGSTING USE
PROPOSED USE CONST TYPE I Ma1F5
USE
I TYPE
OCG
SQ.ET.
VALUATION (S)
EJGSTG
AREA
NEW Fl.000.
AAFA
DEMO
AREA
TOTAL
NErAREA
BATiiROOMt 'LQ OTHER
REMODELAREA RFMODELAREA REMODEL AREA
PORCHAREI DECKARFA
TOTAL DEC. RCH AREA GARAGE AREA: DETACH
ATTACH
I
I
r)0 OUO
NDWELLlNG UNITS:
15 A SECOND UNIT ❑YES
SECOND STORY ❑YES
SMG ADDED? ONO
ADDITIOM ONO
PRE -APPLICATION ❑YES ff YES, PROVIDE COPY OF
PLAAn+pmG APPLI ONO PWYNDIG APPROVAL LETTER
3THE BLDG AN ❑YES
EICHLER HOMEt ❑NO
RECEIVED BY:
TOTAL VAL ATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent W act on the pW=Ty owners behalf. I have :cad this
application and the information I ha a vided is corrcCL I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinauees and state laws relating u ding c tion. I authorize representatives of Cupertino to enter the above-idendfied property for inspection parposea.
Signature of Applicant/Agent Date:
SUPPLEffiNTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTLNO SLB
New SFD or Multifamily dwellings: Apply for demolition permit for
�—ovex
Q
existing building(s). Demolition permit is required prior to issuance of building
TTiEiooxrm
Bva.Dme PLAN Rzvaw
permit for new building.
❑ E RESS
❑ PLA.N.YHSO PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
.`ori if any Hazardous Materials are being used as part of this project
❑ LARGE
❑ FrnE nErr
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAIOR
❑ sANrrARY
submittal of Building Permit application.
sewEx otsruer
❑ EYVMON.,d.YTAL HEAJ.TH
3IdgApp_201 Ldoc revised 06/11/11