12010100 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10224 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12010100
CONSTRUCTION
OWNER'S NAME: AVERT'GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:01/13/2012
OWNER'S PHONE: 6.509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
LICENSED CONTRACTOR'S DECLARATIONIF-
BUILDING PERMIT INFO: BLDG' ELECT PLUMB '
License Class Lic.#
CO�S �� Z_ MECH RESIDENTIAL COMMERCIAL
COMMERCIAL
L D
Contractor , �i13 ccVLC. ate
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:4 REPLACEMENT WINDOWS,EGRESS COMPLIANT
(commencing with Section 7000)of Division 3 of the Business&Professions
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 the
performattce 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:32627037.10224 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 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,anis expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-p .it source regulations per the Cupertino Municipal Code,Section Issued by Date: /
Signatur Date
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am 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 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm tinder penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.9.5 of tile
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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(a)should I store ot•handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by 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 25534.
not employ any person in any manner so as to becorne subject to the Worker's Own r t ized gent:
Conipensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the p'orker's Compensation provisions of the Labor Code,I must
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,W)rk's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read Misapplication 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
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
9.13. Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037.10224
DATE ISSUED. . . . . . . : 01/13/2012
RECEIPT #. . . . . . . . . : BS000015752
REFERENCE ID # . . . ; 12010100
SITE ADDRESS . . . . . : 10224 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 U1`dIT 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
1WINREP EACH 8 4 .00 392 . 00 0 .00 392 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 393 . 50 0 .00 393 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 180. 50 VISA
---------------
TOTAL RECEIPT 1, 180. 50
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
j ADDRESS: 10224 parkwood DATE: 01/13/2012 REVIEWED BY: tarry s
APN: BP#: VALUATION: 1$5,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Multi-Family Dwelling Building is PENTANIATION 1 GENRES
i
USE: 3 Stories 0 Yes � No PERMIT TYPE:
WORK 4 replacement windows egress compliant
SCOPE
LI
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). TheseLees are based on the relimina information available and are only an estimate. Contact the Det or addn'l in o.
FEE ITEMS 10,ce Aqs °ion 11-053 . TV!1? FEE QTY/FEE MISC. ITEMS
Plan Check Fee: $0.00 F-T-1 # Window/Sliding Glass Door
Suppl.PC Fee: Q Reg. Q OT Q.® hrs $0.00 $392.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT EDhrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
O
Work Without Permit? 0 Yes Q No $0.00 0
$0.00 Select allon-Residential
Building or Structure Q
Fee: 1BSEISMICR $0.50 Select an Administrative Item
C>min-issi -l) FeeIBCBSC $1.00
SUBTOTALS: $1.50 $392.00 TOTAL FEE: $393.50
Revised: 1/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:10 C� PERMIT#
OWNER'S NAME: e PHONE#ZfO[s - C q' S
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: �z �, CITY/ZIPCODE: c t c
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL SUBCON CTORS HAVE OBTAINED A CITYCUPERTINO
BUSINESS LICENSE. 71 �1 am not using any subcontractors: /
Signature liate
Please check applicable subcontractors and complete the following information:
6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
l /3
ner/Contractor Signature Date
CZE t C)
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228- FAX(408)777-3333- building(a)cupertino.org
❑NEW CONSTRUCTION ❑ DIIION ❑ ALTERATION/-n ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ` �1 iI ��CK AFH$ n ' I 0-2-2-
OWNER
OWNER NAME 4J V e7a / �/e-,
�.��^h/C lJ PHONE`S O-Q � E-MAIL ,AvC
STREET ADDRESS (- K-`+V CITY, TEV IIP 7 n 0 7
3O P. s� 7bZ4v -� , Irl,
CONTACT NAME PRONE
-5�:1'6-,) l- 7 l V Arm c L `kO Ir-$a 6- 4)' S 7`c r" L-LJ
STREET ADDRESS 40 7 srATT- Va
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 19 CONTRACTOR 11 CONTRACTOR AGENT ❑ ARc=cT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME .v
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tic4✓lc LICENSE NUMB LICENSE TYPE BUS.LIC#
C_
COMPANY NAME E-MAII F Kot"73�"
e.� n s �� 100 L) ma, l,c�)m
STREET ADDRESSCITY,STATE,ZIP PONE
oily " tr S Wu le c. a - 6
ARCHTPECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK r '
W
EXISTING USE PROPOSED USE CONSTR,TYPE 1 #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHERL-
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH
❑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 THE BLDG AN ❑YES RECEIVED BY. TOTAL VALUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following. I am the property owner or authorized agent to act on tthheerprppeerty 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-ideldopd property for inspection purposes.
Signature of Applicant/Agent Date: J
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forET OV -THE couNTER G PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. Cl EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORxs
To—rm.if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DrSTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1.doc revised 06/21/11