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07050145 77777 CITY OF CUPERTINO BUILDING DIVISION PERMIT +em r � T I } MAT�f�N BUILQ(Np�D� IT NO. trS11ARKWOOD DR AVERY CONSTRUCTION I ON PER 07050145 OWNER'S NAME: ME: Y PERMIT ISSUE DATE GLENBROOK APTS 130 EAST DANA ST 05/16/2007 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLACE WINDOWS LIKE FOR BLDG ELECT PLUMB MECH = D O C7 i p p LICENSED CONTRACTOR'S DECLARATION - - Job Description %u p 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,and my license is s y in full force andbfecL i j�? License Class_.,(,2___—Lam•# t- Date Contractor ARCHITECTS DECLARATION aa 1 understand my plans shall be used as public records )yU e U.y Licensed Professional O.< 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 <0 Kwhich requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation £_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .3q.Ft.Floor Area t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or u a 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(3500). ❑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 dues 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. cease 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 Contractor's License Law. ❑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: ❑1 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. ❑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 workees compensai Insurance carrier and Polity n herob Y 6 Carrier. t 0-t-IJ Policy No.: 0 14 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 �Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY [~i C/2 I hereby affirm that there is a construction lending agency for the performance of Q!> the work for which this permit is issued(Sec.3097,Civ.C.) WCL A Lender's Name 2 Lender's Address V O 1 certify that I have read this application and state that the above information is ►- correct.I agree to comply with al ty and county ordinances and state laws relating to Ubuilding construction.and he authorbe representatives of this city to enter upon the 0 W above-mentioned property f n' 'ion purposes. a (We)agree to sav fgdemmfyWf less the City of Cupertino against ham. r/) liabilities,judgments sfs and expenses which ma in any way accrue against said City U Z in consequence of ranung pf.thispermit:' Date ►' APPLICANT U RST NDS AN OMPLY WITH ALL NON-POINT Issued by: SOU Re-roofs Signature of Applicant/Conuactor Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Codc.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ihall be inspected prior to any roofing material being installed. C]Yes ,able-- Will 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 Area Air Quality Management all new materials for inspection. District? ❑Yes )EMIr— 1 have read haz cws materials requirements under Chapter6.95 of the Califor- nia Health&Sal C tioro 255f33r and?5534.I undcrstarhd that if the building docs not cu h a tenant)that it is my res ihility to notify the occupant of the reyui be met prior to issuance ofa cruficatc of�eu�. � Signature of Applicant Date i All roof coverings to be Class"B"or better Owner or authorizcd agent Date CITY OF CUPERTINO 4. ITEMS OF 56 PERMIT RECEIPT. OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot: APN . . . . . . . . : 32E27037. 04 DATE ISSUED. . . . . . . : 05/16/2007 RECEIPT 4. . . . . . . . . : BSC00001350 REFERENCE ID # . . . : 07C50145 SITE ADDRESS . . . . . : 10140 PARKWOOD DR SUBDIVISION . . . . . . CITY CUF'ERTINO 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 . . . : MTD• VIEW, CA 94041 TELEPHONE . . . . . . . . : (9( 0) 961-8330 FEE ID UNIT QUANTITY I,MOUNT 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 I CI'T'Y OF CUPER'TINO CITY OF PERMIT APPLICATION FORM CUPE TINO r _3N # ,(74 Date: f 1 Building AdrirPcs: ld[ailing Address (if different from building address): Owner's Name: _ Phone#: L Icense#: . rilltTnC1.0�_. ti .. j Phone.` ' ` Cupertino Business License#. Contact: Fax y f fLA Building Permit Info: Bldg ❑ Elect ❑ PI-imb ❑ Mech ❑ Job Description: Residential b�4 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Proje-+ Occupancy Group: Please check this box if the project is a Type of Construction: ,,,�,�J� �� second-story addition: roject Size: Standard ❑ Large ❑ Majcr ❑ Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 Con stax—Resi/Mobile BUILDING BELEC1000 Elea 600V <= IOOOA ELECTRICAL BELEC1001 EL:c 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Eaergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 )f3 �X 7 r. CITY OF CUPER TINO CITY O PERMIT tag LIE����®1`� �® CUPS INO Quantity Fee ID Faze Description Fee Group BMISCELL Miscellaneous Fee BUILDING ( BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERT11\4E Inspection Overtime BUILDING �17IOsp11eric V_acullIII PLUMBING ll'CESSPOOL _ Cesspool -- - ---- -- BPERMFEE Blig Permit Fees ---- BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas:3iping 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 Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT All of Drain &Vent PLUMBING BPWATER Insta:I/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCSMein Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIl2HAN A/C Units<= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R,-model Busways ELECTRICAL BREMFIXT I ighting Fixtures ELECTRICAL BREMFURN Rel cation of Furnace MECHANICAL BRERNOV Rele Furnace> IOK btu MECHANICAL MFU BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pol e/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc 11, Switch & Outlets ELECTRICAL BREMRELOCA R.-location of Hood MECHANICAL BRENIREPALT Repair/Alter Heating MECHANICAL BREMRESAPP I Ren►odel Res Appliance ELECTRICAL 2 of 3 CITY OF C PERTINO CITY OF PERMIT APPLICATION TION FO CUPEkTINO quantity Fee ID Pee Description Fee Group BREMSIGNAD Rind: Signs Add Branch ELECTRICAL BREMSIGNS Remc del Signs, Marquee ELECTRICAL BREMTHEATR Thezirical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S6 Specific Plan BUILDING R,STFISMI(1°0"l�T i e C`nnn) lr�'(.r-eia'I 113Tif L D T�TFl` j BSEISMICRE S Jsmic lee -k es -- - T UILDINci -- - BSPECIAL Special hlspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM TemE orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elea. Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mec i Permit Issuance MECHANICAL PPERMITFEE Pluff tbing Permit Issue PLUMBING PPLBG Plwnbing Fee sq foot PLUMBING PLLONGRNGC Plannin ],R Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 c f 3