12040031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10195 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12040031
CONSTRUCTION
OWNER'S NAh1E: AVERY GLENBROOK LP 528 S h1ATHILDA AVE STE 2 DATE ISSUED:04/052012
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)8069145
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r
License Class Lic.p
M ECH RESIDENTIAL COMMERCIAL
Contractor -Owel "C— Date
lzs�1 hereby'affirm that l am licensed under the provision Of hepter 9 JOB DESCRIPTION:APf 6-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.
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:$6000
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:32627037.10195 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 hamtless the City of Cupertino against liabilities,judgments, 18� DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this rtnit. Additionally,the applicant understands and will comply
with all non-po urea r ions per the Cupertino Municipal Code,Section Issued by: "3- po / / /✓ Date:
9.18.
Signature Dale
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that I 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 Appl inant: 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 properly,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 h1ATERIA1 S 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. 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 1 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 Ouality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Heallh&Safety ode,Sections 25505,2553342—
forthwith
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 become subject to the Worker's Own r t rized agent:Compensation laws of Cali fomia. If,after making this certificate of exemption,I Dale:become subject to the Worker's Compensation provisions of the Labor Code,I must comply with such provisions or this permit shall be deemed revoked. CONSTRII(TION LENDING Afh;NC\'
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..10195
DATE ISSUED. . . . . . . : 04/05/2012
RECEIPT #. . . . . . . . . : BS000016458
REFERENCE ID # . . . : 12040031
SITE ADDRESS . . . . . : 10195 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 6, 000 .00 1 . 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 6, 000 .00 0.60 0. 00 0 .60 0 .00
1DECKWOOD EACH 1.00 457. 00 0. 00 457 .00 0 .00.
---------- ---------- ---------- ----------
TOTAL PERMIT 458.60 0.00 458 .60 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 3,207.70 VISA
---------------
TOTAL RECEIPT 3,207.70
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10195 parkwood#6 DATE: 04/04/2012 REVIEWED BY: bobs.
APN: BPp: 'VALUATION: $6,000
°PERMITTYPE: Building Permit =
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1GENRES
•
USE: >3 Stories 0 Yes � No PERMITTYPE:
WORK deck railing and post replacement.
SCOPE
Plnmh. Platt Check £Ire. Plan Check
,lh•elr, Perna Fere P lumh. Parma Fre: /ileo. leo mit Fre:
Odrac•I1ech. Insp, Odor Plumb Insp. Li Ocher Elec.In,11,
llceh. lay. Fr(:: Plumb. Im l). Fre: Klee.Insp. Fre:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prefinddna information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 LPL' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Deck/Deck Railing
Suppl. PC Fee: Q Reg. O OTT 0.0 hrs $0.00 $457.00 IDECKWOOD I Deck(wood)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C'ansiruwiun Tar: `
ilclmini.vmative Fec: O
Work Without Permit? O Yes 0 No $0.00 E)
Advanced Planning. Fcc: $0.00 Select a Non-Residential 0
Truro!Docnmm�/urinn Fees: Building or Structure Q
A
Strong Motion Fec: IBSEISMICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.60 $457.00 TOTAL FEE: 1 $458.60
Revised: 1/19/2012
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)T77-3228•FAX(408) -3333•buildinG(Mcuoertino.orG
❑NEW CONSTRUCTDiI'[ON ALTERION ❑ ADATION/TI ❑ REVISION/DEFEtRID ORIGINAL PERMIT M
PROTECT ADDRESS a Q APN-777 -
277
OWNER NAME 4VtnY GCtNa2ooj( ` /- PHONE
E-AR.,4L/L'n
STREET ADDRESS CIrY, TE,ZIP
30 . �a�a .5:+- p �.✓Lne� Iw G l
CONTACT NAMEONE
S1'C' ✓L- CSI ArJ Ca L. Dfl-$o b' 7 `+)— STC t= A LO.t/ MN±-
MEET ADDRESS Z;?g'S, i-I CTTY,SrA N e-
13
❑OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT Q-COM-RACrmt ❑CONTRACTOR ADEM ❑ ARCETECr ❑ENOINEED ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME eUeP n CA\C LICENSE NUMB / // <7(,ALICENSE TYPE BUS.TIC N
COMPANY NAME E-MAIL �-/1Q ` 1
STREET ADDRESS i1 Cf�"Y.STATF,IIP ONE
r S U', le, v 6-
ARCIGTECUENGINFER.NAME , J .p_ LICENSE NUMER BITS.LIC O
COMPANY NAME ,v 1'c E-MAD. FAX
STREET ADDRESS QTY,STATE,ZIP PHONE
DESCRDTION OF WORK - -
-�
EXISTING USE PROPOSED USE CONSTILME NS ORIS
USE TYPE OCC SQTr. VALUATION(S)
E=G NEWPLOOR DEMO TOTAL 1^/
AREA AREA AREA NE'T AREA V}`- v� 1_- � I �
BATHROOM MCHEN OTHER L CJ
REMODELAAEA REMODELAREA REMODEL AREA
PORCH AREA DEOCAREA MTALDECIOPORCHAMA EXEAGE AREA DETACH
ATTACH
R DWELLING UMTS: 6 A SECOND UNIT YES SECOND STORY Lj YES
BEING ADDED? ❑NO ADDMON? ❑NO Oen
PRE-APPLICATION OYES IF YES,PROVIDE COPY OF Is TBE BLDG AN ❑YES RECEIV DBY: TOTAL VALUATION:
PLANNING"PLO []NO PLANNING APPROVAL LETTER aMB1Ja SOME? ❑NO (
U✓ V�
By my signature below,I certify to each of the following: I am the property owner or authorised agent to act on the prpperty owner's behalf. I have read this
application and the informeDon I ba vided is carted I have read the Description of Work and verify it u accurate. I agree m comply With all applicable local
ordinances and state laws relating ding -on. I aothorim representatives of Cupertino to mter the above(/id/mtificd pmpaty for inspection papaws.
Signature of Appliram/Agent Dare:
SUPPLEMENTAL INFORMATIONREQUIRED Pt t�cxTYre mfmcsLv
New SFD or Multifamily dwellings: Apply for demolition permit for .OVER-T[iECODNTFA BUDDING PLAN REVIEW
existing building(s). Demolition permit is reyLrited prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1STANDARD 11PUBLIC WORKS
form if any Hazardous Materials are being Used as part of this project -
❑ LARGE ❑ PmanFpr
_Copy of Planning Approval Letter or Meeting with Planning prior to El MA.roR ElaANrrARY SEWER DISTRICT
of Building Permit application.
❑ ENVIRONNOINTAL EMALTH
B/dg4pp_2011.doc revised 06/21/11