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12040028 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10203 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12040028 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:04/05/2012 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)8069145 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License ClassLic.H rr MECH r RESIDENTIAL r COMMERCIAL r Contractor,lgoc�1$UGtr��w cc Date WAI' - I hereby affirm that 1 am licensed under the provisions of hapter 9 30B DESCRIPTION:APTb-DECK RAILING AND POST REPLACEMNET (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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. 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:32627037.10203 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct.1 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,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-p .nt source r ulalions per the Cupertino Municipa Code,Section Issued by: ./JD/� EAr✓ Date: 9.18. Signature Dale dt RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without fust obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Law for one Of inspection,. the fallowing two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Dale: 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). 1 hereby affirm under penalty of perjury One of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 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 ea I certify that in the performance of the work for which this permit is issued,I shall Hlth&Safety C de,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's O err, et r'.ed agent: . Compensation laws of California. If,after making this certificate ofexemption,l Date: become subject to the Worker's Compensation provisions of the Labor Code,1 muss 4- forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LF-NDING AGF,NC.V 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and slate 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 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32627037.10203 DATE ISSUED. . . . . . . : 04/05/2012 RECEIPT #. . . . . . . . . : BS000016458 REFERENCE ID # . . . : 12040028 SITE ADDRESS 10203 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 0.50 0.00 1DECKWOOD EACH 1.00 457. 00 0. 00 457. 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 458.50 0.00 458 .50 0 . 00 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10203 parkwood dr.#6 DATE: 04/04/2012 TREVIEWED BY: bobs. APN: BP#: 'VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Buildino is PENTAMATION 1GENRES USE: >3 Stories 0 Yes 0 No PERMITTVPE: WORK deck railing and post replacement. SCOPE r:. hi- ,llerlr. !'Inn(Tn:rk Plruub. l'Inu Clrcck l:lcr.. 1'lnn Check d-L•ch. Po oil Fee: t'hunh. Permit Fee, /ileo. Permit Fie: Odrer Meeh. Insp. Other Plumh Insp. El Other lace.In Jlech. hmp. Fee.' Plumb, N'P. re": Dec..Insp. rte: NOTE: This estimate does not includejees due to other Departments ilie. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prellmina information available and are only an estimate. Contact the Dept for addn'f info. FEE ITEMS (Fcc Resohuion 11-053 EO 7111112 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Deck/Deck Railing Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $457.00 IDECKIVOOD I Deck (wood) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT Fo.oThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.onsirnrtion Tax: Adinini.enr five Fee: 0 Work Without Permit? 0 Yes E) No $0.00 E) Advanced Plannine Fee: $0.00 Select a Non-Residential Trnrc!Unuuulenuniun / ees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $457.00 TOTAL FEE: $458.50 Revised: 1/19/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)M-3333•buildingAcuoerlino.orD CUPERTINO �� ❑NEW CONSTRUCTION [:1ADDITION ES- TSRATION/TI ❑ REVISION/DEFERRED EOUGINLA'LYLPE'fRSMIT k OECTADDRSAPNs 3 -,2:/ - 0 5 1 ' I (�OW :-) OWNER NAME V - / G sTEnEss _ ctrr. re F O$!i Z7 CONTACT NAME PONE E- /' sf(^✓�- CuAr�c.C- O!s-�So6- l AF1� S�'r r �J �y At os- (At -- IJ ADDRESS 1-t CTIY,STATE. ZIP F S. R P1 n e ❑OWNER ❑ OWNER-BUIDER ❑ OWNEIAGFNT 11YC581RACTOR ❑COM ACrORAGENr ❑ ARCMTECP ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME v V �t={ \^ LICENSE NUMB /� LICEN006 SE TYPE 45 BUS.LIC p COMPANY NAME C- `- EMAB.I e�-Vl LV IN/ICN I/CU x'1 F �Ud_73�^ l e� ti\ S STREET ADDRESS CTCV,STATE,ZIP P ONE Ira S � cl1C v 6- S ARCHTMCT/ENOINEEIINAMZ , ) LICENSENUMBER BUB.LICA COMPANY NAME /v E-MALL FAX 'STP=ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK - Q 00 EXLSTDNG USE PROPOSED USE CONSTR.TYPE OSTORIES `- USE TYPE OCC. SQF7. VALUATION(5) FR 0 NEWFLOOt DEMO TOTAL AREA AREA AREA NET AREA L.,1� `FoQ rD^2 D BATHROOM KITCTtEN OTHER REMODEL AREA RFMODELAREA REdODELAREA PORCH AREA DECICAREA TOTALDECWPORCHARFA GARAGE AREA DETACH - ATTACH 0 D WELLDNG UNTIS: LS A SECOND UNIT YES SECOND STORY YES BO314G ADDED? [:]No ADDITION? [:IND 1 -000�jv� J PRE-APPLICATION ❑YES tF YES,PROVIDE COPY OF IS TRE BLDG AN ❑YES RECEIVED BY: I TOTAL VALUATION: PLANNNGAPPLO []NO PLANNING APPROVAL LET= VCID.IDt ROME? ❑NO By my signanm below,I certify to each of the fbUawmg: I am the property owner or authorized agent to act an the prpperty owner's behalf. I have read this application and the infotmadOn I ha v'tied is eorrece I have read the Description of Work and verify it is accurate. I agree to comply with aU applicable local ordinances and state laws relating ding on. I authorize representatives of Cupertino to enter the above-identified property for inspection proposes. Signature ofAppEm —i nt/Agmt Date: /— SUPPLEMENTAL INFORMATION REQLMED PLANCHECKTYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 190i'�comrtza - �PLAN ,�, existing building(s). Demolition permit is requited prior to issuance of building permit for new building. ❑ Enwm ❑ PLANNING PLAN REva W 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 ❑ RtRa bPPr _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ nwoR ❑ SANITARY SEWQI DfSTRCCT submittal of Building Permit application. ❑ ItNVERON.AIENTAL HEALTH B1dgApp 2011.doc revised 06/21/11