12030022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10203 PARKWOOD CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12030022
CONSTRUCTION
OWNER'SNAME: AVERY GLENBROOK LP 528 S NIATHILDA AVE STE 2 DATE I.S-SUED:03/052012
OWNER'S PHONE: 6509618330 SUNNYVALE.CA 944186 PHONE.NO:(1118180(.9115
/Q LICENSED CONTRACTOR'S DFCLARATION BUILDING PERMIT INFO: BLDG C ELECT r PLUMB F-
License Class— /--2— Lic.N
0
C�r h1ECH (- RESIDENTIAL r COMMERCIAL
Contractor . )1- �IOVUI""'�L Date1:541- )-
I
1 )_
1 hereby affirm that 1 am licensed under etre provisions of Chap er 9 JOB DESCRIPTION:REPLACE 20 WINDOWS AT EXISTING APT.COMPLEX
(commencing with Section 7018)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 mid 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
Ierformnce of the work for which this permit is issued. Sq.Ft Floor Area: Vahmtion:515000
(have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of She work for which this
permit is issued. APN Number:32627037.10203 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application mid state that the above information is
correct. I agree to comply wish all city and county ordinances and stale 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 mix 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. .Additionally,tile m e applicaunderstands mid will comply
with all non lint source regulatims per the Cupertino Municipal Code,Section Issued b Date-3'
9.18.
Signor Date3S I
RE-ROOFS:
❑ OWNER-RUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed If a roof is
installed without first obtaining an inspection,(agree to remove all new materials for
1 hereby affirm that 1 all,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 wort:,mid the structure is not intended or offered far sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractus to ALL ROOF COVERINGS TO HE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 herebv affirm under penalty of perjury one of the follmring three HAZARDOUS MATERIALS DISCLOSURE
declarations: 1 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 25505.2.5.533,and 25534. l will maintain
Compensation,as provided for by Section 3700 of the tabor Code,for the compliance with the Cupertino Municipal Code.Chapter-9.12 and the Health&
perfonna ce of the work for which Ellis pctrmit is issued. Safety Cade.Section 25532(x)should I sure 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 Islanagement District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code.Sections 255415,25533,and 25534.
I certify that in the performance of the work for which this pernit is issued 1 shall
not employ any person in my manner so as to become subject to the Worker's lh r tar a or ed ogenC
Compensation laves of California. If,after making this certificate of exemption,I - Date:
iveome subject to the Worker's Compensation provisions of the Labor Code.I must
fonhwidm comply wish such provisions or this permit shall be deemed revoked CONSTRII(TION LENDING ACF.NCI'
I hereby affirm that them is a construction lending agency for the performance of wudc'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
cored.1 agree to comply with all city and county ordinances and state pars relating
to building construction,mid hereby authorize representatives of this city m enter Lender's Address
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnify and keep hardess the City of Cuperino against Iiabilities,judgmenu,
costs,and expenses which may accrue against said City in consequence of die ARCHITECT'S DECLARATION
gaming of this permit.Additionally,the applicant understands and will comply I understand my plansshatl be usedas public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Dale
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10203 parkwood dr. DATE: 03/05/2012 REVIEWED BY: bobs.
® A NN: BP#: 'VALUATION: $15,000
•PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK re lace 20 windows at existing apt. complex.
SCOPE
4fe'll.Plan Clwrk Plmob. Plan Chet.k Blee.Mush Chrck
Meah. Permit lea: Plunhh.Peahit.Fee; Fl,-,. Pernik Fee
Other Uc•h. Insp Other Phooh 1jup. Other Flea. In sp.
a1..h !Writ Fee phanb.bhsp.Fee: Fier.lny. Fee,.-
NOTE:
ee:NOTE: This estinurte does nol include fees due to other Departnhents(i.e.Planning, Public Works. Fire,Sanimrr Sewer District,School
District,etc). These fees are based on the prelininan in ornhution avrdlable and are only an estintale. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 Efi 7/1/11) FEE QTY/FEE MISC ITEMS
# Window/Sliding Glass Door
Plan Check Fee: $0.00 20
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $652.00 10'INREP Replacement
PM E Plan Check: $0.00
Permit Fee: $0.00
Supp!. Insp. Fee-.0 Reg. Q OT 0.0 brs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
('nits(rtwtlon Tar:
Chnintstrative Fre. O
Work Without Permit? O Yes No $0.00 G
Advanced Plannin¢ Fee: $0.00 Select Non-Residential 0
/ntvel IJoeumentution Fees: Building or Structure
Strong Motion Fee: IBSE1SMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2.50 $652.00 TOTAL FEE: $654.50
Revised: 1/1 g/2012
�
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinD(acuoertino.ore
❑ NEW CONSTRUCTION ❑ ADDITION ❑ El R
ALTERATION/TI EVISION/DEFEl= OOFLIIGI�N^AL PERMIT#
PROJECT ADDRESS. /OP O`--'n7GC._�Waj-d AFNR
OWNER NAME S-M&A
Vl� moi( LF 6s"a- 96i-Fr Avenys �(.�+.tr.�./•
STREET ADDRESS _ CITY. ATE 2Z F O FAr - L7
pv ✓fin icj ' i
CONTACT NAME PHONE
S (:✓ L- 7jL0,VArJG\L V0"5--STC) 7 41� STr r" �u.J Lq M.`=- 6"
SCRFPI'ADDRESS }I CITY,STATE IIP 'F
❑OWNER ❑ OWNER-BUADER ❑ OWNERAGENr 11YCONTRACTOR ❑CONTRAC CRAGENT ❑ ARCHITECT ❑mNGD1EPA ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMEEgjeUe I LICENSENUNID P // LICENSE TYPE BUB.LIC/e uckIcO
eoe.QANYxAME •'• _ EMAAS Qv Ev Ma, �/C!J%\t F �(Ga'731^ 1
Q./e n r ch
STREET ADDRESS CRY.SLATE IIP P ONE
S a S uGI Ie v 6- S
ARCFDTECT/ENOLNEERNAME l J ,t. LICENSENUMBER BUS.LIC0
COMPANY NAIME (v YC E-MAIL FAX
STREET ADDRESS l.Ti Y.STATE.ZIP PHONE
DESCRIPTION OF WORK '-wno 'a ' w, a>A,
'XVII �
EXSTnmG USE PROPOSED USE CONSTR.TYPE #STURIES
`Z"- USE TYPE OCC. SQ.FT. I VALUATION(S)
EJtSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET.ARFA \ �J�
\ rT t S
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELARFA REMODEL AREA
PORCHAREA DECKA? A TOTALDECK/PORL:.AREA GARAGE ARA DETACH
❑ATTACH
a DWELLP'G UNM: ISASECONDUNR YEs sECONDSTORY YEs
BMC ADD®t []NO I ADDmoO .. ❑NO I
PRE-APPUCAnON []YES IPYES•PROVDECOPYOF IS THEBLDCAN ❑YES RECEIVED BY: / TOTAL VALUATION:
PIA.NNRIGAPPLY []NO PLANNNG APPROVAL LEITER -CMJtR HOME! ❑NO �`r,-i(.A`J(- ai5l
r --,oma —
By my signature below,I certify to each of the following: I=:he pronery owner or authorized agent to act on the pretty owner's behalf. I have=d dds
application and the information 1 ha a vided'u correct. I have mad the Description of Work and verify it is accna e. I agree w cornply with aR applimble local
ordinances and state laws relating u ding c don. I sudmorize mprescutacves of Cupercno w carr the above-iden/ti�Eed ptopery for inspection purposes.
Signature of Applicant/Agmt DazJ
e: -- r/ q
SUPPLEriVE TAL INFORMATION REQUIRED PLANCaECKr. ROUTINGS OP
_New SFD or Multifamily dwellings: Apply for demolition permit for d`3 -T�oarvTzx - —ouetovc PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ =RFSS ❑ PLAXMG PLAN REVIEW
_Cornmemzial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ SrANnARD Cl PGBUC wORM
torn if arty Hazardous Materials are being used as part of[his project
❑ LARCz ❑ FazbEPr
_Copy of Planning Approval Letter or Meering with Planning prior to ❑ .woR ❑ sANrrARYszwzR DrsTTuer
submittal oe Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_r0ll.doc revised 06121/11