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07050148BUILDING DIVISION BUiLTHgDMARKWOOD DR OWNER'S NAME: GLENBROOK APTS NE: ARCHITECT/ENGINEER: PERMIT !00 LICENSED CONTRACTOR'S DECLARATION U p 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing E Z _ with Section 7000) of Division 3 of the Business and Professions C and my license is s H in full force and4kCCL j � ? License Clara Lic. # 3 [-Date Contractor W 00.'x`9 cwt ARCHITECTS DECLARATION U1 understand my plans shall be used as public records C a U. in Licensed Professional y OWNER -BUILDER DECLARATION 1 hereby atTirm that 1 am exempt from the Contractor's License Law for the no following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure Z } prior to its issuance, also requires the applicant for such permit to file a signed statement e that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 xF= (commencing with Section 7000) of Division 3 of the Business and Professions Codc) 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 not more than five hundred dollars ($500). ❑ 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 and Professions Code: The Contractor's License Law dots not apply to an owner of 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 completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 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 contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 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: �z O z� ►-+ P4 Q az UO w E. OV >�a " C4 U I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. 711 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 Worlds Consa ' n Insurance carrier and Policy nttmber y� Carrier. T Policy No.: 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, 1 shall not employ any person in any mutter so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 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 ercby authorise representatives of this city to corer upon the above-mentioned proper for inspection purposes. (We) agree to ve, indemnify and keep harmless the City of Cupertino against liabilities, judgmen costs and expenses which may in any way accrue against said City in consequence o c gZ., ' If this permit. APPLICANT f7ERSTAN ND WILL COMPLY WITH ALL NON -POINT SOU E L ONS. -/ Signature of ontractor Date 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)? ,�,s��'% ' [I Yes Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes I have read hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & SakteCodc. Sections 25505.25533 and 25534.1 understand that if the building docs n yljyyaa:tcnut,-�hai ii -is my ihility to notify the occupant of the req whit ust be met prior to issuance a Certificate o Owner or authorized agent Date AVERY CONSTRUCTION 130 EltST DANA ST REPLACE WINDOWS LIKE FOR Sq. Ft. Floor Issued by: Re -roofs PERMIT NO. 07050148 PERMIT ISSUE DATE 05/16/2007 SANITARY NO. CONTROL NO. Job Description Required Inspections BUILDING PERMIT INFO ELECT PLUMB MECH Type of Roof All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date CITY OF CUPERTINO 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ........: 32(27037.01 DATE ISSUED.......: 05/16/2007 RECEIPT #......... : BSC00001350 REFERENCE ID # ...: 07C50148 SITE ADDRESS .....: 10364 PARKWOOD DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GLFNBROOK APTS ADDRESS 10300 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 ...: MT11 VIEW, CA 94041 TELEPHONE (9(0)961-8330 FEE ID UNIT QUANTITY lMOUNT 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 CUPEkTINO CITY ,, ,:' 1' - ,O, PERMIT is FORM Y t �. IN # 1 �" Date: Mailing Address (if different from building address): Buildin. AddrPss: MECHANICAL BBOILERI 1301,er <= 100,000 Btu Owner's Name: Phone #: Boiler > 100K to 500K Btu LiCe11Se #: n Boiler > 500K to 1M Btu G Phone: ` ` Contact: `' Cupertino Business License#: %. FaYi Building Permit Info: Bailer > 1.75M Btu L-, BCONSTAX Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential %_ .411 41 T ' Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Pro) e-+- Occupancy Group : Hotel and Motel BUILDING Please check this box if the project is a Type of Construction: second -story addition: ❑ BELEC 1000 Elec 600V <= l OOOA _A n T o I-1 Mninr F-1 BELEC1001 roject size: Standard u LcugV, u Quantity Fee ID F'ee Description Fee Group BAPPLOTHER C ther Appliances MECHANICAL BBOILERI 1301,er <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Bailer > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cor. stax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 OWOF CUPS INN CITY OF CUPERTINO F(. -e Description Miscellaneous Fee Comm. Housing Mit. Fee New Comm Electric New i--omm Mechanical Neav Comm Plumb Insvection Overtime h,�ti175��heJ�C ��I2cttuTTi, Cress pool — BI [Ig Permit Fees Pbig Fixture Gas =3iping System Fee Ind Waste Interceptor Plan Check Fee Plan Check Add Multi Plan Check Repeat Fee S1 e Of Fixtures ige Disposal Sewers Lawn Sprinkler/Backflo Storm/Rain Water Kitchen Trap All of Drain & Vent InstaFI/A ter Water Pipe Writer [eater/Vent Main. Water Service Reinspection Fee A/C Unit > 10,000 cfm A/C limts <= 10,000 cfT Appliance Install Remodel Busways Lighting Fixtures Relocation of Furnace Relc Furnace > l OK btu Beater Installation Installation of Hood Misc Apparatus Rem Non -Res Appliance Po .e/Platform Fixture Pow(.r Device/Apparatus Rcp1, Switch & Outlets R -.location of Hood Repair/Alter Heating Remodel Res Appliance 2 of 3 Fee Group BUILDING BUILDING ELECTRICAL MECHANICAL PLUMBING_ BUILDING PLS NBWC PLUIN/1I3IiyG -- - -- BUILDING-- - PLUMBING PLUMBING PLUMBING BUILDING BUILDING BUILDING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING PLUMBING BUILDING MECHANICAL MECHANICAL MECHANICAL ELECTRICAL ELECTRICAL MECHANICAL MECHANICAL MECHANICAL MECHANICAL ELECTRICAL ELECTRICAL ELECTRICAL ELECTRICAL ELECTRICAL MECHANICAL MECHANICAL ELECTRICAL C1 OF CUPEk INO CITY OF CUPERTINO PERMIT APPLICATION E � -it l quantity Fee ID f'ee Descri tion Fee Group BREMSIGNAD Rmd . Signs Add Branch ELECTRICAL BREMSIGNS Remc,del Signs, Marquee ELECTRICAL BREMTHEATR The�frical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S, -,b Specific Plan BUILDING f -BSEISMICR e I,n, t191Lmc.r(,-i"I Se sink }gee RC, s T ' k�iJl I]yCs BSPECIAL Special Inspection BUILDING BSWIM wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elegy: Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plunbing Fee sq foot PLUMBING PLLONGRNGC Planning -LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning 1,ong Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3