12040029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10203 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12040029
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S IHATHILDA AVE STE 2 DATE ISSUED:04/05/2012
OWNER'S PHONE: 6509618330 SUNNYVALE.CA 94086 PRONE NO:(408)806.9145
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_ Lia 8
MECH r RESIDENTIAL r COMMERCIAL r
Contmctor.�" P1OK VLr&.. Date
1 hereby affirm that I am licensed under the provisions of 'hapter9 JOB DESCRIPTION:APT 8-DECK RAILING AND POST REPLACEMENT
(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 peril is issued. Sq.FI Floor Area: Valuation:55000
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 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,mid 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 abuts per the Cupertino Municipal Code,Section Issued by: �G / �Fi�/� Date:
9.18.
Signature ` Date _J
RE-ROOFS:
❑
OWNER-BUILDER DECLARATION All roofs shall he 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
1 hereby affirm that l am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,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).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I 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. 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(x)should 1 store or handle hazardous material.
1 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
I certify that in the performance of the work for which This perHealth&Safety Code,Sections 25505,25533,and 25534.il is issued,I shall )
not employ any person in any manner so as to become subject to the Worker's 1ho Yed agent:
Compensation laws of California. If,after making this certificate of exemption.1 Dale:
become subject to the Workers Compensation provisions of the Labor Code,1 muss
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 work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and stale 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
9.18. 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 # . . . : 12040029
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
12SEISMICR 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.#8 DATE: 04/04/2012 TREVIEWED BY: bobs.
APN: I BP#: 'VALUATION: $5,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1GENRES
USE: 3 Stories () Yes (F) No PERMITTVPE:
WORK deck railing and.post replacement.
SCOPE
,llr,:b. I'fan Check Plumb. Plun Chuck Elm. Plan Chrek
,llrrh. Permit Fee: Plumb.Permit Fec: lilec. A!,"rir Fee:
Odw, ,11m ll. lnrp. Other Plumb Insp. Oth r face.It
d-h•ch. /n,p. Fee: Plumb. hr..p.Fee: glee.Insp. Fec. .
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on file relimina information available and are only an estimate Contact the De f or addn'l info.
FEE ITEMS (Fee Resohilion 11-053 Elf. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Deck/Deck Railing
Suppl. PC Fee: Q Reg. O OT0.0 hrs $0.00 $457.00 1DECKWOOD I Deck(wood)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT O,Qhrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cun.siruclitm Tax
Adiniaisntnive Few
Work Without Permit? 0 Yes r!) No $0.00 G
Advanced Planning, Fee: $0.00 Select a Non-Residential (7
Travel Docurnenlaliun Fens': Building or Structure 0�
Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg,Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $457.00 TOTAL FEE: 1 $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)777-3333•buildinge-cuoertino.orn
CUPERTINO
❑NEW CONSTRUCrION ❑ ADDITION EyJ TERATION I TI ❑ REVLSION I DUERRM ORIGINAL PERMIT IF
PROJECT ADDRESS
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DwNERNAMVe/] 2� 2--7-EM2--7-II _ \ 37
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STREET ADDRESS Cnr. re
CONTACT NAME S to,/✓L LTL A"J c' YD k-$0 6- 7 4 1{` ES TLS ti L-
✓ t,g A•L n- '*tom
STREETADDRESS Z i1 CITY.STA N � e W U F
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13 OWNER 11OWNER-BUILDER 13 OWNER ADEM (WCONTRACOR ❑CONTRACTOR AGENT ❑ MCarrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME e n G`C LfCFNSE NUMB A // Q� LICENSE TYPE BUS.LAIC M
COMPANY NAME `- EMAIL
2� s
SIRFJ:TT ADDRESS Q yT .STATE IIPµIQ CJ 6- S
ARCHITELVINOINEERNAME a ) .iL T LICENSE NUMER BUS.LICA
COMPANY NAME l� Y` E-MAIL FAX
STREET'ADDRESS CITY.STATE ZIP PHONE
DESCR=ON OF WOR&
Q C P aZ
EXISTING USE PROPOSED USE CONSTRTYPE MSTVRIES
'Z-1 USE TYPE OCC. SQ.FT. VALUATION(3)
E1mTG NEW FLOOR DEMO TOTAL My.14 t - ^^
AREA AREA AREA NET.ARFA .`
Gw ; V
BATHROOM KITCHEN
MODE REMODEL
REMODEL AREA REMODEL AREA RFIAOOEL AREA
PORCHAREADECKAREA TOTAL DECKPORCH AREA GARAGE AREA DETACH
ATTACH
e DWELLING UNITS: is A SECOND UNIT 0YES SECONV STORY YES
BEING ADD®' ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES ff YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECE'M BY: I TOTAL VALUATION:
PLANNING MPLP []NO PLANNINGAPPROVALLETTER EICHLER ROME? ❑NO -
By ury sigoaxm below.I certify to each of the following r am the property owner or author'izeci agent to act on the pWcrty owaers behalf. i have read this
application and the informatioD I ha a -ded is correct I have read the Description of Work Bad verify it is actuate. I agree to comply with all applicable local
ordinsoca and state laws relating ding c tion I eurhorize representatives of Cupertino to corer the above-identified property for inspection proposes.
Sip tae ofAppGmre
Applicant/Agent Da : ti/ / )-'
SUPPLEMENCALINFORMATION REQUIRED PLANCaCKTYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ygR-THE.comrTEx DDDate PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRFSS ❑ PLArrHmc PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORIL9
Tom if any Hazardous Materials are being used as part of this project
❑ LARGE ❑ FIHE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MArox ❑ SANITARY sEWEx DISTRICT
of Building Permit application.
❑ EM/IXONMENTAL HEALTH
B1dgApp_2011.doc revised 06/31/11