The URL can be used to link to this page

12020040 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10215PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12020040 CONSTRUCTION OWNER'S NAME: AVERY 6LENBROOK LP 528 S NIATHILDA 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 5 L i c.# 716v MECH 11r-- RESIDENTIAL COMMERCIAL Contractor 1( CC O-JACIDate -1h ') I hereby affirm that I am licensed tinder the provish its of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE218 WtNDOWS;NON- STRUCTURAL FOR (commencing with Section 70001)of Division 3 of the Business&Professions EXISTING APT.C'Ol!%4PLEX Code and that My license is in full force and effect. I hereby affirm tinder 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32627037.10215 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 property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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-poin hsource re ulations per the Cupertino Municipal Code,Section Issued Date: Sip-nature Date.L 0 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for One Of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to rernove 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 the 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(Sec.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& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit 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(he 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 25537� Compensation laws of California. If,after making this certificate of exemption,I 0 d went: become subject to the Worker's Compensation provisions of the Labor Code,I must Ow 0 1;tt = forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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 wirk's correct.I agree to comply with all city aix-I 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 indemnify and keep harmless.the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may,accrue against said City in consequence of the, granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand rny 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. 10215 DATE ISSUED. . . . . . . : 02/09/2012 RECEIPT #. . . . . . . . . : BS000015976 REFERENCE ID # . . . : 12020040 SITE ADDRESS . . . . . : 10215 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 20, 000 .00 1.00 0. 00 1.00 0.00 1BSEISMICR VALUATION 20, 000 .00 2 . 00 0 .00 2 .00 0.00 1WINREP EACH 8 28 .00 782 .00 0. 00 782 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 785 . 00 0. 00 785 .00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -__-__-__-__-__-__-_ CREDIT CARD 1, 178.50 VISA --------------- TOTAL RECEIPT 1, 178 .50 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 07 ,r� PERMIT# �C) '-f G% OWNER'S NAME: PHONE# 1(0� - & 9 PL( GENERAL CONTRACTOR:�'��,� ,<< BUSINESS LICENSE# ADDRESS: W7,^-,(/j(tu C �i.e CITY/ZIPCODE: G� *Our municipal code requires all businesses working in the city to have a City of Cupertino siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB ONTRACTORS 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: 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 CUPERTINO f - FEE ESTIMATOR- BUILDING DIVISION S i ADDRESS: 10215 parkwood dr. DATE: 02/09/2012 REVIEWED BY: bob s. APN: 7BP#: 'VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or DuplexPENTAMATION 1 GENRES USE: PERMIT TYPE: WORK remove and re lace win ows non structural for existing apt. complex. SCOPE NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the relinina in ormation available and are o2lE an estimate. Contact the Det or addn'l in o. FEE ITEMS :e Re.,,1 -4 1, ' ,_ ij FEE ( TY/FEE MISC ITEMS Plan Check Fee: $0.00 I= # Window/Sliding Glass Doer .'uppl.PC Fee: Reg. 0 OT L hrs $0.00 $782.00 1IVINREP Replacement PME Plan.Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT L0j hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ej 0 Work Without Pen-nit? 0 Yes No $0.00 G _ Y..._" '_:._ 3::..: `%. $0.00 Select allon-Residential Building or Structure j IBSEISMICR $2.00 Select an Administrative Item I RCRSC $1.00 SUBTOTALS: $3.00 $782.00 TOTAL FEE: $785.00 Revised: 1/19/2012 / )�;2 C)U �v CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333- building(M-cupertino.org CUPERTINO I AL�� ❑NEW CONSTRUCTION ❑ ADDITION L� TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNUT it PROJECT ADDRESS /0,4r7 APN* ��"Y O, 7 1 0-215 OWNER NAME PHONEE-MAII44v4t I.Vel` 6� DQ br" j AvL��S S'T'REET ADDRESS CITY, ATE,ZIP CIA CONTACT NAIL PF�ONE E- �-fC-j L=-- 7 C-~UAiJGt L. TCS Ss-'r'C>(0 7 4)� S TLS tz A LL 1) G ILC !- STREET ADDRESS �'�sT� fe-LA U W09 ^/ 1:1 OWNER ❑ OWNER-BUILDER 13 OWNER AGENT W CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE NUMB LICENSE TYPE 45 BUS.LIC# �v � VC�YJC COMPANY NAME E-MAIL F `l�g'73� �re C4 JZ; u Lau j�'?a�.I.Co)`►'t STREET ADDRESS CrrY,STATE,ZIP ONE of 7'�? "Ida S c/a 1e C� a (� S' ARCHITECT/E11GINEER NAME w ) LICENSE NUMBER BUS.LIC# COMPANY NAME f E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK - lG1 r�A EXISTING USE PROPOSED USE CONSTR.TYPE #STORRIIES USE TYPE OCC. SQ-FT. VALUATION(S) EMSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 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 ADDMON? []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 I I O�J Z•c�f oo0 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prr6aperty 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 property for inspection purposes. Signature of Applicant/Agent: Date: Z, SUPPLEMENTAL INFORMATION REQUIRED CHECK TYPE ROUTING SL1P New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TI37.-COUNTXR 'b---B-�UnXING PLAN REVIEW 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 ❑ F=DiPr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ErrvmorrMErrTA.L BMALTl3 B1dgApp 2011.doc revised 06/21/11