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12050177 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10183 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12050177 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S NLNTHILDA AVE STE 2 DATE ISSUED:05/232012 OWNER'SPHONE: 6509618330 SUNNYVALE.CA 94086 PI ZONE NO:(408)8069145 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB.r License Class B Lie.q i /� � MECH r RESIDENTIAL r COMMERCIAL r Contractor /ex..a.L LcC C— Dal hereby affirm that 1 am licensed under the provisions of 1hapler 9 JOB DESCRIPTION: BLDG 52-DECK REPAIR AT BUILDING- 136 SQFT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penally of perjury one of the fallowing two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this peril is issued. Sq.Ft Floor Area: Valuation:55000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32627037.10183 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK I$ NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this crit. Additionally,the applicant understands and will comply with all non-poi source regper the Cupertino Municipal Codc,Section Issued by: /��`� /7/� Date:S.9.18. _ f Signature - Date- O'• RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material heug installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Low for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Dater will do the work,mid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Cenificalc of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505;25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code for the compliance with the Cupertino Municipal Cade.Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with The Cupertino Municipal Code,Chapter 9.12 and the I certifythat in the performance of the work for which This peril is issued,I shall Health&Safety Code,Sections 25505,2.5533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owr au ri �d agenl: Compensation laws of California. If,after making this certificate of exemption,I Dale: �-- become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C) I.certify that I have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned properly for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION 12ADDRESS: 10183 Parkwood#8 DATE: 05/23/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: wORK Deck repair at building#52. SCOPE ,l/rch. Plan(-hack Plumb. Plop Check 1Zlec. Plan Check d./rch. Pot mil Fee: Plumb. Permit Fre: lilac. P,?unit Fre: Other dlech. Imp, Other Plumb Insp. Li I Odle, tele".h1q), Lj :Ilach. bryt. Fre: Plumb. /rnp. Fee: /flee. In.y. Pee. NOTE: This estimate does not includejees due to other Departments(Le. Planning, Public Works, Fire,Sanimry Sewer District,School District,etc. . Thesefees are based on the prelindna in ormation available and are only an estimate Contact the De I or adds 7 info. FEE ITEMS (Fee Resolulian 11-053 E!L 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Deck/Deck Railing Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $457.00 IDECKIVOOD I Deck(wood) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeelD Reg. Q OT To.oThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cnnsiruclion Tux.- arllnhusuntiee Pec: Q Work Without Permit? Q Yes 0 No $0.00 E) Advanced PlanningFee: $0.00 Select a Non-Residential Building or Structure 0 Truro!Documentation Feer: A Strong Motion Fcc: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $457.00 TOTAL FEE: r $458.50 Revised: 04/01/2012 G2 �5G � � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinD(8cuoertino.oro❑NEW CONSTRUCTION ❑ ADDITION 2' ALTERATION/TI ❑ REVISION/DEFERRIDJ ORIGINJA�L PEI=# PAOIECi ADDRESS r] /` /(� �� fL OWNER NAME I APNLa II Lef�l7/,J � �i �/Q- a PHONELS O-9r//—Fl E MAI.�vL,n✓S( V I/ IJ SntEETADDRESS _ CTTY. $IIP F / i 30 �i a�A sf T®v.✓/,n__j <. i C4' CONTACT NAME 'Took ONE E-��••++��,, /' / St('✓ L- -7 CsLArJCtL. c7rs-$o6, ) 4)� STREET ADDRESS ()d-0, �t CITY,STATE IIPn F e k1 a ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGE NT G}_coNrancTDR ❑CONTRACTOR AGENT ❑ ARnmEcT ❑ENGmmt ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ,V I v nC-t �C LICENSE NUMB i /6 �� LICENSE TYPE BUS.I3Cp COI.4ANY NAME E-MAIL �'( e"e_ -Ian S ev eu tOa, 1,6C)M STREET ADDRESS STATE IIP ONE S a a S� ,1vuleL v 6- S ARCHTTECTIENOINEER NAME , ) .A_ LICENSENUMBER BUS.tIC0 COMPANY NAME ry Yc � E-MAIL FAX STREET ADDRESS QTY STATE,ZIP PHONE DESCRIPTION OF WORK ( / 6) FJ( fII+G USE PROPO 1)UaM� CONmIjyPE y USE TYPE OCC SQF-f. VALUATION(5) =0 NEW FLOOR I/r r/ DEMO !,///•/{'tTOTAL AREA AREA AREA NET AREA BATHROOM IQTC11EN OTBER _ REMODE.AREA REr1ODELAREA AREA PORCHAREA DECKAREA mTALO AREA GARAGEAREA H DETACH ATTACH e DWELLING UNITS: CONDUNTi OYES SECOND STORY ETM— MG ADDED? YESECNGADDRO? ONO ADDRIOM. ONO PRE-APPLIG ❑YES TYES,PROVIDEC%?YOP ISrERBLDGAN ❑YES RECEIVED Y: - TOTAL VALUATION: PL 5C PLI ONO PLANNING APPROVAL LETTER EICEL"ROME? 0N By Dry signature below,I certify to each of the following. I am the property Owner or authorized agent to act an the prpperty owner's behalf. I have read this application and the information I ha a vided is conect I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating ding tion. I authorize representatives of Cupertino to enter the above-identiffed property for inspection purposes. Signature ofApplicant/Agent Date: "r?3 '! �9—_ SUPPLEMENTAL INFORMATION REQUIRED '1 PLAN CHECKTYYE ROUTING SLEP New SFD or Multifamily dwellings: Apply for demolition permit for gL,ovER-Tz�ioDNTEa ❑ BUDDING PLAN RxMW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ moms ❑ PLANNmePLAY REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ Satz herr _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sANrrARY sEwvr DISTRICT of Building Permit application. ❑ ENVIRONMENTAL MUTH 81dgApp_2011.doc revised 06/21/11