12010102CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10234 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 12010102
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 01113/2012
OWNER'S PHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806-9145
® I_JCENSED CONTRACTOR'S DECLARATION
License Class lbLic. # L
ContractoL�APN►w 2 i' Date
I hereby affirm that I am licensed under the provisions of hapter 9
(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
performance of the work for which this permit is issued.
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
permit is issued.
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
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
granting, of this permit. Additionally, the applicant understands and will comply
with all non -point sourc regulations per the Cupertino Municipal Code, Section
9.18. � 4�k
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (See.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
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.
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
Permit is issued.
BUILDING PERMIT INFO: BLDG f ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: 4 REPLACEMENT WINDOWS, EGRESS COMPLIANT
Sq. Ft Floor Area:
Valuation: $5000
APN Number: 32627037.10234 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bye!/ Date: f
RE -ROOFS:
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 rernove all new materials for
inspection.
Signature of Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 695 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to becorrre subject to the Worker's Owner a t e agent:
Corti pensation laws of California. If, after making this certificate of exemption, I Date:
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to dimply with all city aril county ordinances and state 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
indemnity 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
with all non -point source regulations per the Cupertino Municipal Code, Section
Q.18.
S ianature Date
I hereby affirm that there is a construction lending agency for the performance of vw)rk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FF,F, F.,qTIMATOR — RITILDING DIVISION
FADDRESS: 10234 parkwood DATE: 01/13/2012
LA
REVIEWED BY: larry s
APN:
I BP#:
TION: I
-VALIJA 1$5,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
1 >3 Stories 0 Yes (D No
PENTAMATION IGENRES
PERMIT TYPE:
WORK
4 re lacement windows, egress compliant
SCOPE
hrs $0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Fianning,,Vuouc works, rtre, aanirayy newer vistrict, acnoof
rl.,.- I—. __ L.. ".,I .— Ah? as actimato
FEE ITEMS 0 C 7'],j -1)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00#
F$ 3 9 2. 0 01
Window Sliding Glass Door
1T INREP Replacement
Suppl. PC Fee. (j) Reg. C
hrs $0.00
PME Plan Check:
$0.00
Permit Fee: $0.00
Suppl. Insp. Feei@ Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee: $0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? 0 Yes No $0.00
---------------
$0.00
Select a Non -Residential
Building or Structure
0
IBSEISMICR
$0.50
Select an Administrative Item
1. S, t ec I s Cc, IBCBSC $1.00
E
SUBTOTALS:
$1.501
$392.001
TOTAL FEE:
1 $393.501
Revised: 1 /01 /2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: /0,33 a woo
PERMIT # 0 2 -
OWNER'S NAME: AV ev
PHONE #
GENERAL CONTRACTOR: S Eve evctvt-c.l C�
BUSINESS LICENSE #
ADDRESS-) S- Mal l' c,(- ow -e
CITY/ZIPCODE: h4 V cc 1 � c 4r -
*Our municipal code requires all businesses working in the city to have a City of Cupertincibusiness license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
r 5 /),P—
I am not using any subcontractors: l
Signature liate
Please check applicable subcontractors and complete the following information:
ner / Contractor Signature
Date
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
121 O1 CZ-
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESSL4-1U
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AP # �� X _ 0
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OWNER NAME /' e7 Y L N�
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PHONE -
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E-MAIL
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STREET ADDRESS -
CITY. aTE ZIP n d
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CONTACT NAME
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STREET ADDRESS +1 CITY, STAT ZIPh (e
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT &--CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME v
LICENSE NUMB may+'%
LICENSE TYPE
BUS. LIC #
COMPANY NAMEE-MAIL
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Q� n r Uh Qu EV Ma,-1,60�'►1
STREET ADDRESS CITY, STATE, ZIPONE
Ira l i-? ' 1 le
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ARCHTTECT/ENGINEER NAME L j ^_
(� YT
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
1 # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION
(S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
I GARAGE AREA EIDETACH
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNIT []YES
SECOND STORY ❑YES
BEING ADDED? ❑NO
ADDITION? []NO
�1�,(J e)u
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
--E BY: TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
I EICHLER HOME? ❑ NO
FU
13y my signature below, I certify to each of the following. I am the property owner or authorized agent to act on the property 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 u ding c tion. I authorize representatives of Cupertino to cater the above -identified property for inspection purposes.
Signature of Applicant(Agent Date: �'" 3 -2-
10-
SUPPLEMENTAL INFORMATION REQUIRED
SUPPLEMENTAL
PLAN CTIECX TYPE
ROUTING SLIP
_TIS -cornu Iz Tt
C� BUUMDnvG PIAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
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
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑LARGE
❑ Fa DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
_
submittal of Building Permit application.
❑ MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_1011.doc revised 06/21/11
e-,71