12020039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10235 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12020039
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:02/09/'2012
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO.(408)806-9145
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# —7 MECH F-1 RESIDENTIAL�r– COMMERCIAL F
Contracts a- e&A 1Aarr_PUc r__6�jatoff, 16�—
W JOB DESCRIPTION: REMOVE AND REPLACE 4 WINDOWS,-NON STRUCTURAL
I hereby affirm that I am licensed under the provisions of Chapter 9 FOR
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING APT.COMPLEX
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 Sq.Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:32627037.10235 Occupancy Type:
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 properly for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indernnify and keep harmless the City of Cupertino against liabilities,judgments,
cosLs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non-point so rce regulations per the Cupertino Municipal Code, ectiOn
9.18.
.............
Issued by Date:
Signaturezi Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt front the Contractor's License Law for one Of All roofs shall be inspected prior to any roofing material being installed.If a roof is
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the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and(fie structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(See.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm tinder penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
i Additionally,should I use equipment or devices which etuit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533.and 25534.,
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must 0wntr�aho * e gent:
forthwith comply with provisions or this permit shall be deemed revoked. Date:1)"Iq
li
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
i ndemn iA,and keep harmless the City of Cupertino against I iabil ities,judgments, Lender's Address
costs,and expenses which may accrue against said(--.ity in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all tion-pointsource regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY #
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037. 10235
DATE ISSUED. . . . . . . : 02/09/2012
RECEIPT #. . . . . . . . . : BS000015976
REFERENCE ID # . . . : 12020039
SITE ADDRESS . . . . . : 10235 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 UNIT 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 .550 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
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: ,j d!r- W�e�G PERMIT# �
OWNER'S NAME: Q;r PHONE# $ O - 91
-
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: �u G
*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 ANDA SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. %
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
Owner/Contractor Signature Date
CITY OF C;UPERTINO
EE ESTIMATOR—BUILDING DIVISION
ADD
RESS: 1023�!'parkwood dr. DATE: 02/0912012 RE'VIEW'ED BY: bobs.
APN: BP#: "VALUATION: $20
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY SFD or Duplex PENTAMATION 1 GENRES
USE: PERMIT TYPE:
WORK remove and replace Xwindows non structural for existing apt. complex.
SCOPE
N0TE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). TheseLev are based on the relinsna
information available and are onlyan estimate. Contact the De t or addn 7 ino.
FEE ITEMS _ <'yes.1'Ulli'fl 1-01"." E,/, FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1= # Window/Sliding Glass Doer
Suppl.PC Fee: 0 Reg. a OT 1 0.0 1 hrs $0.00 $782.00 1 UNREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee Reg. 0 OT O.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Ll
0
Work Without Permit`? 0 Yes 0 No $0.00
$0 Select a Non-Residential
00
Building or Structure 0 n
00,U
}:r %A`r rf Fee, 1BSEISA�IIf�'R $2.00 Select an Administrativ � o
._..�...�.�.v.........�__..._.__._.___.._._.
IBCBSC $1.00
SUBTOTALS: 1 $3.00 $782.00 TOTAL FEE: 85.00
Revised: 1/19/2012
CONSTRICTION PERMIT APPLICATION
191 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(a cupertino.org
(,- �, lV.23
CUPERTINO -
NEW CONSTRUCTION ❑ ADD ONALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS % APN* .1
owNEtt NAME a00 j� p PHONE J- _O-9 61- E-MAII. vl�2YSJ0 9
STREET ADDRESS CITY, ATE,ZIP I� Z 7
CONTACT NAME PRONE E-
;1'(;�✓�� j� 111 A n�C C_ `E c'Ss -�S 0 6- `�-) S 7`[� r= 4 LL u -
STREET ADDRESSCITY,STAT e F
IMA
❑OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT &-CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrfECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE NUMB )/ C/! LICENSE TYPE l.�4{ BUS.LIC#
1(4
�V � RC1✓l C-c ��
COMPANY NAMES�eOL)'reE-MAII. F 'T�� 73��'
_ R -_
U.0
STREET ADDRESS CITY,STATE,ZIP P74ONE
c
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
P 3
EXISTING USE PROPOSED USE CONSTR.TYPE #STORMS
USE TYPE OCC. SQFr. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL J�
AREA AREA AREA NET AREA l7� (jI �-Z7 l� l
BATHROOM KITCHEN OTHER j
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA DETACH
[]ATTACH
#DWELLING UNTrS: LSA SECOND UNU []YM SECOND STORY []YES
'
BEING ADDED? []NO ADDPIION' []NO wo
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
J
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty 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 enter the above-identified profperty for inspection purposes.
Signature of Applicant(Agent Date: r �"
SUPPLEMENTAL INFORMATION REQUIRED PLAN CMM TYpg ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for Dal6v�mT CoUNTER NG PLAN RL"VIEW
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 ❑ PUBLIcwoRm
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ 1IRE D'UT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DLSTRICT
submittal of Building Permit application. � .
❑ ENvmorrMErrrAL EMAi.rH
B1dgApp ZOl1.doc revised 06/21/11