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07050143Joe ;W �Z� DCA CC .� jWU :Oa y7yN..t Lin0 -i L) -ze YFO BUILDING DIVISION PERMIT BUILDP8111DIjES PARKWOOD DR OWNERS NAME:: GLENBROOK APTS ,NE: ARCHITECT/ENGINEER: LICENSED CONTRACTfUR's DELLAKA1 tun I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code ,;ttd my license is in full force an a ct " 9 /v License Claw__ Lie, >! Date Contractor �^- ARCHITECTS DECLARATION I 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, improve, 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 License 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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.), ❑ 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 docs 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. ❑ L am exempt under Sec B & P C for this mason 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 Workers Cori 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 Worker's Compens 'on Insurance carrier and Policy number am: Cartier. C -e.. Policy li _ o 'ti SY Fj f 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a consirwition 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 hereb authorize representatives of this city to enter upon the above-mentioned property fo pection purposes. (We) agree to sav demnify and keep harmless the City of Cupertino against liabilities, judgments, c and expenses which may in any way accrue against said City in consequence of ranting of this rmit. APPLICANT RS COMPLY WITH ALL NON -POINT so R S. Signature of Applicant/Contractor 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 Cale, Section 25532(a)? ❑ 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 '1 I have mad hazardous materials requirements under Chapter 6.95 of the Califor- nia Health a Saf Code, Sccrions 25505, 25533 and 25534.1 understand that if the building docs not cua tcaanr it is my responsibility to notify the occupant of the re ich must be met r w issuance of a Certificate of Occupancy. T ii -r 7 Owner or aauthorized Date PERMIT NO. AVERY CONSTRUCTION 1 07050143 PERMIT ISSUE DATE 130 EAST DANA ST 05/16/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH Job Description ;;q. Ft. Floor Area Issued by: Re -roofs Type of R )of Number Required Inspections 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 m iterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better i� C1iY. F CUPEkT�INO CITY OF CUPERTINO PERMIT APPLICATION FORM -N#.� sties;. p Date. _—l��`��7 Fee Group MECHANICAL BAPPLOTHER BBOILERl 1vi ailing Address (if different from building address): Buildin. Acids -.ss: Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu Phone #: Owner's Name: Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Bciler > 1.75M Btu LICPl1Se #: BCONSTAX Construction Tax --------------- -. , r: i L. Phone Cupertino Business License Contact. : P Vx Fax: .. t6 BUILDING Building Permit Info: Con. Tax for BQ Zone BUILDING BCONSTAXH Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 19- 41 /3�� �L � '� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: BELEC1000 Occupancy Group: Cost of Proje-+-- 7 BELEC1001 El, -,c 600V > 1000A Please check this box if the project is a Type of Construction: second -story addition: El J� BENERGY M r f-1 R/fnirr n BUILDING ect Size: 5tandara u i mrQ " ­� J� Quantity Fee ID Fee Description Other Appliances Fee Group MECHANICAL BAPPLOTHER BBOILERl Boil --r <= 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 Bciler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Ilotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elea 600V <= 1000A ELECTRICAL BELEC1001 El, -,c 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 3f3 i lk" r�A cITv of CITY OF CUPERTINO PERMIT 3 ( f _ TION FORM Quantity Fee ID — BMISCELL - BMITIGATC BNUCOMME BNUCOMMM BNUCOMMP BOVERTIME I TP%_(_'KFO) V RL Ft a Description Mi;;cellaneous Fee Comm. Housing Mit. Fee Nev, Comm Electric New Comm Mechanical Mechanical New Comm Plumb Insf ection Overtime -tL�> >st�he.z c TacL�urn Fee Group BUILDING BUILDING ELECTRICAL MECHANICAL PLUMBING BUILDING PLiJ� B1NG E.PC;ESSPOOL - I' U1�1RiN(- BPERMFEE -- Blfi Permit. Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind'Waste Interceptor PLUMBING BPLANCHK P''.an Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BpREplpE Repi a Of Fixtures PLUMBING BPSEWAGE St wa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawr. Sprinkler/Backflo PLUMBING BPSTORM St :)rm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WE.ter Heater/Vent PLUMBING BPWSVCS Mz.in Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Romodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT H--ater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL _ BREMNRAPp Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc t1, Switch & Outlets ELECTRICAL BREMRELOCA Rclocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL r� —rf'l A'nn Tarr nrip] T? P,, Annliance ELECTRICAL tSI«1Vlit�.�t�r 1 � ..- 2 of 3 € kY OF E i PERMIT APPLICATION FORM Quantity Fee ID BREMSIGNAD Fa Description Rmdl Signs Add Branch Fee Group ELECTRICAL BREMSIGNS Remo jel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD I �l S �sM1C7 a! T, ( -(-- �$j� �liI,1SM1�.L�� Scb Specific Plan - QQ nn Evvppppqq�� jj.�� �jj liiLH�AYHA'i fl��.� �I`A f..� BUILDING PT Tff D.'lT\TC - _- jay jj j��s^I ����Jp d�ilV 6, BSPECIAL Special Inspection BUILDING BSWIN4 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC E ectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERNIITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC PlanningLR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannipy, 1,ong Ran a Residential PLANNING ZADDCHG Address Change BUILDING 3 c f 3 Cf OF CUPERTINO CITY PERMIT APPLICATION O quantity Fee ID Fee Descri tion Fee Group BREMSIGNAD Rmd Signs Add Branch ELECTRICAL BREMSIGNS Remcdel Signs, Marquee ELECTRICAL BREMTHEATR Thee trical Lighting Fix ELECTRICAL BREMVENFAN Ven t Fan Single Duct MECHANICAL BREMVENSYS Veattilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICRE S2asmic Fee lees - - — BUILDING _ BSPECIAL ST ecial hispection BUILDING BSWIlVI Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC B, jsiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mc chanical sq. foot MECHANICAL MPERMITFEE Mecli Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plwnbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning ong Range Residential PLANNING ZADDCHG Address Change BUILDING 3 cf3 CITY OF CUPERTINO x � , 4 ITEMS OF 56 PERMIT RECEIPT OPERATOR: suew COPY # c 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32627037.06 DATE ISSUED.......: 05/16/2007 RECEIPT #......... BS000001350 REFERENCE ID # ... 07050143 SITE ADDRESS .....: 10114 PARKWOOD DR SUBDIVISION ....... CITY CUPERTINO 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 ...: MTN VIEW, CA 94041 TELEPHONE ........: (960)961-8330 FEE ID UNIT QUANTITY FMOUNT 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