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07050136;ccZ eZ a �qU e p, [- :Oa q�N.h Lp0' �zr EFG i CITY OF CUPEKHM-) BUILDING DIVISION "'I"MITI"bARKWOOD DR OWNER'S NAME: GLENBROOK APTS NE: ARCHITECT/ENGINEER: PERMIT LICENSED CONTRACTOR'S Uht:LAKAh tun 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license i in full force , cc ect f� ct _ �j License asssLic. # Cld__% Date Contractor ARCHITECTS DECLARATION 7 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, impmvc, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Liccnse Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ 1, 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 does 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U. cense taw 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 Contractor's 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: I have and will maintain a Certificate of Consent to self-insum for Workers Compcn- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I 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 Worker's Compensatich Insurance carrier and Policy numobe� O Carrier. ti ` Polity Na ri CERTIFICATE OF EXEMFI70N FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars ($100) or less.) 1 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 Workers' Compensation Laws of Califomia. 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 I certify that I have read this application and state that the above information is correct, l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby rice representatives of this city to enter upon the above-mentioned property for i tion purposes. (We) agree to save, i n"I and keep harmless the City of Cupertino against liabilities, judgments, cos d expenses which may in anyway accrue against said City in consequence ofngi - oihi it. APPLICA STANDS AND W COMPLY WITH,ALL NON -POINT SOU RE TIONS. Stgnaturc of A hcantlConlractor Dam 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)? ❑Yes %-9440- 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 rc hai s main ' requirements under Chaptcr 6.95 of the Califon nia Health & y tions 25505, 533 and 25534.1 understand that if the building does t c nt h a Icnant, that it is y responsibility to notify the occupant of the �� n c afa'CCN(?ca(rpLOc7p.ancy S Owner or authorized agent Date ' PERMIT NO. AVERY CONSTRUCTION 1 07050136 PERMIT ISSUE DATE 130 E1,ST DANA ST 05/16/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO REPLAC17 WINDOWS LIKE FOR BLDG ELECT PLUMB MECH T TI T r -AL _ Job Description Sq. Ft. Floor Area Issued by: Re -roofs Type of Roof umber Required Inspections uccupancy type 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: B11:: Lot: APN ........: 32(27037.13 DATE ISSUED.......: 05/16/2007 RECEIPT #......... BS(00001350 REFERENCE ID # •..: 07050136 SITE ADDRESS .....: 10,234 PARKWOOD DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER ............: GLENBROOK APTS ADDRESS ..........: 10:.00 MARY AVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1502 RECEIVED FROM ....: BR --AN AVERY/MATT CONTRACTOR .......: AVERY, BURT LIC # 12134 COMPANY ..........: AVERY CONSTRUCTION ADDRESS ..........: 130 EAST DANA ST CITY/STATE/ZIP ...: MT11 VIEW, CA 94041 TELEPHONE ........: (900)961-8330 FEE ID UNIT QUANTITY kMOUNT 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 C TY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 'N # L j) Date: 7 N ailing Address (if different from building address): Building Ac1eirPcs: C ther Appliances Z _j `-V PrC�_ V_ .� v �� _� 2 �r�E' BBOILERI Owner's Name: - �_`.:�'v Phone #: - Z. `-I - ` 3 6 Vt_ Licel�se #: MECHANICAL BBOILER3 - _- — -- -- Phone ��` �` Cupertino BusinessUcenseli: Contact: •.- Fax k Building Permit Info: �;,t �I�+� BBOILER5 /�/- 11 tet'✓ _f. MECHANICAL Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential F)4 -A/ � /3c' � (L �•� - o � f�{�e Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Proje- ` Occupancy Group: BUILDING BCONSTAXH ]hotel and Motel Please check this box if the project is a Type of Construction: second -story addition: ❑ BUILDING BELEC 1000 r-1 t o n 1Vial I-1 ELECTRICAL rotect Size: Standard u LCU r,v Quantity Fee ID F'ee Description Fee Group BAPPLOTHER C ther Appliances MECHANICAL BBOILERI Boiler <= 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 Ele c 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA ]nvestigation fee BUILDING 1 of 3 CITY OF C UPERTTNO ;may, �ITYo� PERMIT APPLI(�:��I®� F CUPtkl INU Quantity Fee ID F,�e Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. 1,ee -DUt11L11VV BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New "-omm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING _-- � 1�T''TiAC'T�FT,CJ�h7 /�,tt��c�s��l�elic `,TacL�un�. _ PLLTMBINCS _-, — -- - BPCBSSPOOL, cessp---. - --- - - BPERMFEE BldgPermit�Fees IIUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re pipe Of Fixtures PLUMBING BPSEWAGE S,�wa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawli Sprinkler/Backflo PLUMBING BPSTORM Sion- /Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT At: of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Writer Heater/Vent PLUMBING BPWSVCS M;dn Water Service PLUMBING BREINSPECT Reinspection. Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMA KHAN A/C lJnits <= 10,000 cfm MECHANICAL BppLl appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel( Furnace > l OK btu MECHANICAL BREMHEAT 11 eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Po .e/Platform Fixture ELECTRICAL BREMPOWER PowE r Device/Apparatus ELECTRICAL BREMRECEPT Rc rl, Switch & Outlets ELECTRICAL BREMRELOCA R -,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY -F CUPER�TINO CITY C P )` N PERMIT APPLICATION FORM Quantity Fee ID fee Description BREMSIGNAD Rind _ Signs Add Branch Fee Group ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S :b Specific Plan BUILDING I l S� ISI ✓tl� «) � cl <rTii±c C'nIT! t1rfc3! <°i 21 - - -- -- BSEISMICRE Seismic Fee Res Wiff }�t!rW1 BuILDIN\G BSPECIAL Special Inspection BUILDING BSWIM lz,wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS "emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec. Permit Issuance ELECTRICAL MPERMFEE Mochanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plu nbing Fee sq foot PLUMBING PLLONGRNGC Plannin :LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning -Long Range Residential PLANNING ZADDCHG Jiddress Change BUILDING 3 of 3