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07050144 CITY OF CUPERTINO BUILDING DIVIS.^ON PERMIT � ` r � �WORMA►�I(JN PERMIT NO. BUILDji�{Q�Dp "bARKWOOD DR AVERY CONSTRUCTION 07050144 'OWNER'S lJNA,}ME: PERMIT ISSUE DATE GLENBROOK APTS 130 EAST DANA ST 05/16/2007 )NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH r D D D O 1 p 0 LICENSED CONTRACTOR'S DECLARATION , _ Job Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing 4 z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is "4 y in full force ah ecL j�2? License Class Lie.8 3 t-tnu Date -Contractor V�.-...�1 ARCHITECTS DECLARATION a I understand my plans shall be used as public records )yU i.e. D.H Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county <$ which requires a permit to concoct,alter,improve,demolish,or repair any structure a z y prior to its issuance,also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 )q.Ft.Floor Area Valuation YF=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 9 p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of compaction,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant w the contractors License Law. 0 I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I]I have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workees Compens n Irhsurarice carrier and Policy number are: / Cartier.r7_ -1-� T. Policy No.: �C)4 06 6 F Sr 6 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Worked Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workcr s Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z 2CONSTRUCTION LENDING AGENCY (~•h V) I hereby affirm that there is a construction lending agency for the performance of a, n7' the work for which this permit is issued(Sec.3097,Civ.C.) Wfs.A Lender's Name ►`D z Lender's Address V O I certify that 1 have read this application and state that the above information is LL, -r correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned property r inspection purposes. a (We)agree to indemnify and kccp harmless the City of Cupertino against ham.,V) liabilities,judgments, is and expenses which may in any way accrue against said City V Z in consequence of granting of this permit. Date h APPLICANT U E TAND3- ILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R NS. _s—_7 "'7 Re-roofs Signature of Applicant/Contractor DateType of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes 0 Y the applicant or future building occupant use equipment or devices which If a roof i.;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes 1 have read ardtws materials requirements under Chapter 6.95 of the Califor- nia Health&Safct Sectio 25505,25533 and 25534.1 understand that if the building does not cu n nant that it y responsibility to notify the occupant of the rcquircmc bcmetprior uanceofaCertificateor upancy. Signature of Applicant Date Jctz d All roof coverings to be Class "B"or better Owner or authorized agent Date CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 32627037.05 DATE ISSUED. . . . . . . : 05/16/2007 RECEIPT #. . . . . . . . . BS000001350 REFERENCE ID # • . . : 07C50144 SITE ADDRESS . . . . . : 10134 PARKWOOD DR SUBDIVISION . . . . . . . CITYCUPERTINO . . . . . . . . . . . . . . IMPACT AREA . . . . . . OWNER GLENBROOK APTS ADDRESS 10100 MARY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1502 RECEIVED FROM . . . . : BRIAN AVERY/MATT CONTRACTOR . . . . . . . : AVERY, BURT LIC # 12134 COMPANY AVERY CONSTRUCTION ADDRESS 13C EAST DANA ST CITY/STATE/ZIP . . . : MTr VIEW, CA 94041 TELEPHONE (9E0) 961-8330 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 147.96 71. 02 • 0.00 71. 02 0. 00 BPERMFEE VALUATION 7, 785 .00 147. 96 0 .00 147. 96 0. 00 BPLANCHK PERMIT FEE 147 .96 197.45 0 .00 197.45 0. 00 BSEISMICRE VALUATION 7, 785 .00 0 .80 0 . 00 0 . 80 0.00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 417.23 0 .00 417 .23 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH CITY OF CUPE TIN CITY. PERMIT APPLI(,A'TION FORM CUPEkTI O Date: Building AddrPcs: Mailing Address (if different from building address): Owners Name: Phone#: �C111tTnC�Ch � i `,- i Phone ` ` `` Cupertino Business license, Contact- Fax: _ Building Permit Info: ,t =t �- Bldg ❑ Elect ❑ PI- mb ❑ Mech ❑ Job Description: Residential r Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Proje^*-'' Occupancy Group: 1717-3 e,6 Type of Construction: Please check this box if the project is a � J� � second-story addition: ❑ W i—:tk nv ;--� oject Size: Standard ❑ Large ❑ Majcr ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boile,-> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Bciler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 El�c 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 76 , 1 :)f 3 CITY OF CUPERT INO CITY OF PERMIT APPLICATIONFORM CUPEkTINO Quantity Fee ID Fee Description Fee Gr®u BMISCELL Mi3cellaneous Fee BUILDING r BMITIGATC Comic-.Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New -omm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection.Overtime BUILDING U:tin-)s��hesic `�lactlu�n PLUMBING --- - BPERMFEE BI Ig Permit Fees — - BUILDING BPFIXTURE Plblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Xaste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Reps a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Starm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Mein Water Service PLUMBING BREINSPECT R eins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRIHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R,.-model Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rel 3cation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc 11, Switch & Outlets ELECTRICAL BREMRELOCA R,-.location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CST �' JPERTINO C11Y of PERMIT APPLICATION FORM CUPEkTINO 9uantity Fee ID Fee DescriptionFee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ven---1 Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Seb Specific Plan _ BUILDING US)",VSl�fi ("I0AIT �crsrrl�:c C'n v�rnnnf:tr°� �; rtJ�F 71'T�IC j BS>EISMICKE S isynic Fee kes — BSPECIAL Sf ecial hispection BUILDING BSWINI Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM --Temporary Bldg Permit BUILDING BTEMPSVCS T emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mc chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plwnbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 cf3