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07050140 CITY OF CUPERTINO BUILDING U'IVISION PERMIT C� `I'JEt� T INMAT�ON : BUIL 1 D ESS: PERMIT NO. �( / PARKWOOD DR AVERY CONSTRUCTION 07050140 OWNER'S NAME: PERMIT ISSUE DATE GLENBROOK APTS 130 E2= DANA ST 05/16/2007 _)NE: SANITARY NO. CONTROL NO. ARCHI FCr/ENGINEER: BUILDING PERMIT INFO REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH © O D D LIKE 21k ? 6LEMf(50f) !00 0LICENSED CONTRACTOR'S DECLARATION Job Description %v p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z wfih Section 7 )of Division 3 of the Business and Professions Code,and my license is H in full fore.and c L & p 9 �v Z License Gass Lic.# 3 E np Dato Contractor t?��✓ ARCHITECTS DECLARATION a U 1 understand my plans shall be used as public records e n,H Licensed Professional H OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the C COO 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 u Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation _< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area xt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or S3 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). ❑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.MU,Business Required Inspections and Professions Code:The Contractors License Law docs not apply to an owner of q 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 completion,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. terse 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 die Contractors License Law. C]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: 0 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. 0 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 CompensauInsurance carrier and Policy number are: Carrie, •v - Policy No.: e J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 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 ,J,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY F~.r V) 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 a z Lenders Address V C I certify that 1 have read this applic ' and state that the above information is ►'r correct.l agree to comply with all city an unty ordinances and state laws relating to O building construction,and hereby autho' representatives of this city to enter upon the ;>4 U above-mentioned property for inspec' n purposes. (We)agree to save,indem ' and keep harmless the City of Cupertino against ,Fy liabilities,judgments,Coss an nscs which may in any way urnte against said City V z inconsequent.of the g g f this permit. sOU�RCE ND COMPLY WITH ALL NON-POINT Issued by Date 6 lY . '� Re-roofslicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 shall be inspected prior to any roofing material being installed. ❑Yes No Will If a roof i s installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? El Yes u 1 have read thArdtws materials requirements under Chapter 6.95 of the Califor- niaHca,th&saru We.Sections 25 533 and 25534.1 understand thatif the building docs not cu ave a tenant,that it is rh ,responsibility to notify the occupant of the reya' ;tn stbcmetpriorwissu te.faCertificateoffOccupancy. Signature of Applicant Date I 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: B1}:: Lot: APN 32627037.09 DATE ISSUED. . . . . . . : 05,16/2007 RECEIPT #. . . . . . . . . : BS000001350 REFERENCE ID # . . . : 07050140 SITE ADDRESS . . . . . : 10::74 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 . . . : MTIJ VIEW, CA 94041 TELEPHONE (9(')0) 961-8330 FEE ID UNIT QUANTITY 1NOUNT 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 9 CITY OF CUPERTINO � � � � PERMIT APPLI��A'TI®I� FORM � G Date: 117 Building AdrlxPss: Mailing Address (if different from building address): Phone#: f Owner's Name: _ <� ._ /I �t i._� (.,,. •� `" � (��-o is`�' � L�' � 3 r'rn�tract_c�r Lice��se# f 4 Contact: Phone. `�` ` '` Cupertino Business License#: Fax 6!-- Building Building Permit Info: Bldg ❑ Elect ❑ Plamb ❑ Mech ❑ Job Description: t Residential %_ ��� /3�J�Y»� b Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Proje,+ Occupancy Group Type of Construction: Please check this box if t� project is a N J� ,� second-story addition: coject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID F'ee Description Fee Group BAPPLOTHER C ther Appliances MECHANICAL BBOILERI Boi',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 BBOILERS 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> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA investigation fee BUILDING 1 of 3 7 4 CITY OF CUPERTINO C1 YOF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Foe Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New i-omm Mechanical MECHANICAL BNUCOMMP Nev Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING - T PB _CKTI,O'� j A_ mos ]jez-ic `,Tactium PLTTI\,4BTNG - BPCESSPOOL Cesspool BPERMFEE Bldg Permit Fees - - ----- BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas ?iping 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 BpREplpE Re-:)ipe Of Fixtures PLUMBING BPSEWAGE Si�wa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain &Vent PLUMBING BPWATER Insta&Alter Water Pie PLUMBING BPWHEATER Waiter Heater/Vent PLUMBING BPWSVCS dn Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R.-model Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BRENI URN Relocation of Furnace MECHANICAL BREMFURNOV Relc Fuxnace> l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD In.,tallation of Hood MECHANICAL BREMMISC Visc Apparatus ELECTRICAL BREMNRApp Rem Non-Res Appliance ELECTRICAL BREMPOLE Po'e/Platform Fixture ELECTRICAL BREMPOWER PowE r Device/App aratus ELECTRICAL BREMRECEPT Rep:1, Switch & Outlets ELECTRICAL BREMRELOCA R-Ilocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 ow CITY OF C UPERTINO CI OF PERMIT APPLICATION FORM Quantity Fee ID Fee Descri tion Fee Group BREMSIGNAD Rmd. Signs Add Branch ELECTRICAL BREMSIGNS Remc,del Signs, Marquee ELECTRICAL BREMTHEATR TheE.trical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL. BSCBLVD S,-,b Specific Plan BUILDING 11 Lift I l"l'TNT G - f BSEISMICR- Seismic Fee Res +BUILDINU BSPECIAL Special Inspection BUILDING BSWIM S wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Teml,orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec.Permit Issuance ELECTRICAL MPERMFEE Wchanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning:'LJR Comme/Multi-Fam PLANNING PLLONGRNGR Planning 1�ong Range Residential PLANNING ZADDCHG Address Change BUILDING 3 cif 3