12010083 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10224 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12010083
CONSTRUCTION
OWNER'S NAME: AVERT'GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:01/11/2012
OWNER'S PHONE: 0509168330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
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LICENSED ENSE.D C'ONTRAC'T'OR'S DECLARATION BUILDING PERMIT INFO: BLDG ._ ELECT F PLUMB F
License Class Lic.# �O
L74, µ
MECH RESIDENTIAL COMMERCIAL
Contractor� cztie..c:j-L...— Date / �1
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 320SQFT OF SIDING FOR MULTI-FAMILY
(commencing with Section 7000)of Division 3 of the Business&Professions DWELLING
Code and that my license is in full force and effect.
I 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 tite
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$20000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32627037.10224 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of ttte 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-p . tsource re )ars per the Cupertino Municipal 'od ,Section
9.18. Issued�� Date: A
Signatur Date (1
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing-material being installed.If a roof is
I hereby affirm that I ani exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,arts exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for 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. I 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 and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 534.
not employ any person in any manner so as to becorne subject to the Worker's
Compensation laws of(_'alifornia. If,after making this certificate of exemption,I Own e gent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such previsions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit 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,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnity and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
granting I Ip�
with all tion-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: C)) PERMIT# 0L�
OWNER'S NAME: VQ'; PHONE# O - V
GENERAL CONTRACTOR: 6 4,e, e h9lo v c,n Z BUSINESS LICENSE#
ADDRESS: . %u d 0,q 410 ICITY/ZIPCODE*I�cI(Y)'Y\VIV'Ck- (? (Osf-
*Our municipal code requires all businesses wor mg in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL SUBCO RACTORS HAVE OBTAINED A CIT OF CUPERTINO
BUSINESS LICENSE. j
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
6/ 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
ner/Contractor Signature Date
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 3 0/2
Name of owner. �Db PRA0IS
Project address. /3//
p Jo7l ftR
Contactperson. Phone.
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? 'N
Is privacy protection planting required for the project? �\
Build it Green Total Points
On what floor(s) is work being done?
Brief description of work. KD11)-S7uC77`1'fiL
Code editions: 2010 CBCN)2010 CFC -N)2010 CMC
2010 CPC (?-N)2010 NEC N)
California Green Building Standards Code 2010
Cots., t,dl TY! ^..rpt OPMFtJT DEPARTMENT ° 'O R-1-11-"Yi �-n
EuiLDiNG D;'.,' li t`!-Cl PERTINO
Effective 1/01/11 APPRICWED JAN 11, ?01/"
This c at of wr,c-nri F'a "ifications MUST b,3 kept at the a71
Itis uniawfui to mak any
ur t * -lt;r;ns on sarr,e,or to ooma4,e
v I nuu t sap piova!from the Build'ng Official.
^f this plan+ ,:nd specifications SHALL NOT
k °rYrt o tc,, r, -:n 7,1-, )rova1 of the vsola`bn
c x,, provi3ic:is^of w-y'``IOiiyO"rrdinance or State Law.
By u...,....a,.a�.,.�..�.a:., i -4
PEti,tl l NO.
Plan Review Process Work Book Page-8- Revised 12/21/10
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10224 parkwood DATE:.01/11/2012 REVIEWED BV: bobs.
APN: BP#: "VALUATION: $20,000
y PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1GENRES
USE: 1 >3 Stories 0 Yes (F) No PERMIT TYPE:
wORK re lace 320 s.f. of siding for multi-family dwelling.
SCOPE
7 7 77
Li
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelinina information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (1 ee Resolution 11-0531sT '.1,/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 320 1 s.f. Siding
Suppl.PC Fee: (D Reg. 0 OT 0.0 I hrs $0.00 $392.00 ISIDEOTHER I All Other
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OTF0,0Thrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? Yes (F) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
A
Strong;Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.00 $392.00 TOTAL FEE:'- $395.00
Revised: 1/01/2012
CONSTRUCTION PERMIT APPLICATION /�01 0
2 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228- FAX;nTlON/TI
3333• building(cDcupertino.org
CUPERTINO
❑NEW CONSTRUCTION El ADDITION -❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS D � (,UUCJ APN$ � ~ r �� `'/' ✓ i `-'
OWNER NAME��/ � /'/�N� PHONE - E-MAIL
STREET ADDRESS
3 O t ��A s� vy✓�v 1 t.`i
CONTACT NAME PHONE ,
s 1 ✓�- D I,e y A rJ C 1 L �C�S51-$O 6 j `�')'
STREET ADDRESS - CITY,STAZIP
179'e U F
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT W-ONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE NUMB J l� LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL F "r�a /3�"
Q n Uhc4 h6o
S .ev EU t0a. ��CC,�'►9
STREET ADDRESS �+ C1TY,STATE,ZIP PONE
b 01l 4 � s Yl vct le C. U -60ro
ARCHTTECTaNGINEER NAME ► ) LICENSE NUMBER BUS.LIC#
COMPANY NAME (� E-MAM FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRnMON OF WORK
EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES
USE TYPE OCC. SQFr. VALUATION(5)
AREA NEW FLOOR DEMO TOTAL
AREA
AREA AREA NEI'AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKAPORCH AREA I GARAGE Z0 7-0
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS TSE BLDG AN ❑YES RECEIVED BY: JJOTAL VALUATION:_
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �n z OO v u
J �
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prp perty owner's behalf. I have read this
application and the information I ha a rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ding c tion. I authorize representatives of Cupertino to enter the above-identified property for inspection proposes.
Signature ofApplicant/Agent Date: �--
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for [a- _TBT-CouNTER E–8 JNG PIAN Raw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PVBLIc womo
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DLS-TRICT
submittal of Building Permit application.
❑ ENVIItONMENTAL HEALTH
BldgApp 2011.doc revised 06121111