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09050130 CITY OF CUPERTINO PERMIT # BUILDING DIVISION PERMIT NO. BUILDING ADDRESS: 10100 MARY AVE BLD AVERY COVSTRU pERWrisSUEDATE OWNER'S NAME: S 9 9 CONTROL NO. o4t0 (960) 9.61-83 3 0 BUILDING PERMIT INFO ARCHITECi/ENGiNEER: BLDG ELECT PLUMB MECH �� Z p C LICENSED CONTRACTOR'S DECLARATION Job Description w I he affirm that I am licensed under provisions of Chapter 9(commencing Mwith Section 7000)of Division3oftheBusinessandProfessinosCode,andmylicenseis REPLACEMENT OF WEATHERED SIDING & TRIMS GLEN$ROOK a,<a. in full force and effect 3v�2 License Class Contractor ERMIT. APTS. BLDG 1-DOUBLE FEES-WORK STARTED NO 3 Date ARCHITECTS DECLARATION 4< l understand my plans shall be used as public recordsyU r-O H Licensed Professional OWNER-BUILDER DECLARATION n I hereby affirm that I am exempt from tho Contractor's License Law for the p O 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 Valuation prior w its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area —Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9F32627033 .BLD1 <fl 3000 000 Yr (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y�-. that he is exempt therefrom and the basis for the alleged exemption.Any violation ofAPN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500)• O 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 property who builds or improves thereon,and who does such work himself or through his own emPloytxs,provided that such improvements are not intended or offered for sale IC, 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.). b1,as owner of the property,am exclusively contracting with licensed contractors to constrict the project(See.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Controctot s License Law. B&P C for this reason 0 1 am exem l undeFsec— _ Owner Date S-7 WER�OPENSATIONDECLARATION 1 U'e hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- m,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 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 Compensation Insurance carver and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work f or w�bh tthis tide Workers'C m shall tio not employ any person in any�nanr so as�_� Ice Laws of Caliror�ia — Appfican v NOTICE TO a r makin is 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 CONSTRUCTION LENDING AGENCY 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.) W Q Lender's Name f 6 Lender's Address U 0 I certify that I have read this application and state that the above information is LL correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against HCA liabilities,judgments,costs and a crises which may in any way scenic against said City Date U 2 inconsequence of the grand f this permit' APPLICDDS AND'WiLT WITH ALL NON-POINT Issued by: ►� ANT ERS SOU 'LA C•<i S , � rRe-roofsSignature pplicant/Conuactor Dateloof HAZARDOUS MATERIALS DISCLOSURE Will Ilse applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chaptcr 9.12,and the Health and Safety Code,Section 25532(a)? i shall be inspected prior to any roofing material being installed. C]YesNo pa(yp If a roof is installed without first obtaining an inspection, agree to remove Will the applicant or future building occupant use equipment or devices which all new materials for inspection. ,it hazardous air comarrim rNo ncd by the Bay Area Air QualityManagement ;fist? 0Yes 1 have read the hazardous material uirements under Chapter 6.95 of the Califer- LnijaHcalth&Safety Sections 255 4.1undcrssndthatirthcbuifdiiig �— not curie h a tcnan at ii is my ms;.i y to notify the occupant of the _ Date iremc whit must et sires of a C ficatc of Occas $ignatul a of Applicant All roof coverings to be Class'n"or better ner or authorized agent Date a-�t CITY OF C'UPERTINO CUPEkTINO GENERAI. BUILDING PERMIT APPLICATION FORM 0 50 0�� APN # v� 0,3 3 . SIL DatS _ z L) - Building Address: Vag, , yr 0'% `' t`%j -Ij ",, -a- i Mailing Address (if different from building address): Owner's Name: A �-� Phone#: 6 s v- 96/- 6) y� HOA: (Exterior Vb rk only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: �✓,��=� `��=� Phone: Fax: 6S`v -4E �'- � 'Z7 / Contractor License#: Cupertino Business License#: Contact: 11/1✓} t r L A Phone: Fax: Residential Q" Commercial � Job Description: R-��(�V A% `""`�` &W)Ib yk,�) � Building Permit Info: Bldg 9---- Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B D,--" 0 -- i . Valuation: Square Footage: Project Size: Express Eg--Standard ❑ Largs; ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: (j For help, contact Build it Green at www.builditreen.or Revised 02/05/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEk ANO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard (uI, to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 5_O `) B 1 RETSP 10 Special Desi gn, over 10' high (up to B 50') 1RETCRB< Gravity/Crib Wall, 0-1O'high (up to B 50 ft) 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft) SIDING 1 SIDEST/BK Siding, Stone & Brick Veneer B (interior/exterior) �; 60c) 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight le:s than 10 sf B 1 SKYL>l OSF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Raz.ks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st) 4of5 a�( _ CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Wir Ldow-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechani gal Permit Fee M 1 PPERMITFEE Plumbin,;Permit Fee P 1 ELCPLNCK Stand AJ one Electric Pln Ck (hourly) E 1 MECPLNCK Stand A:one Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand A.one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bld; Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B 5 of 5 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family ;parent,spouse or child) will perform: A. � ''All the work autho3ized by this permit B. A portion of the we rk C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # —[-State License # Type of work to 3. _ I will utilize unlicensed person(s`, other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City Phone Number Type of work to be erformed ............. ................................................................. . ........................•--.............. I declare under penalty of perjury that tie aYiove is tr_,)an correct. I have read and understand the Owner-Builder Information(revers __.__....__- Date: Property Owners Signature: S job Address: /D l U tiI �' ✓ "�'� �. Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. GLENBROOK Garden Apartments 10100 Mary Avenue • Cupertino, California 515014 Telephone 408-253-5800 • Fax 408-253-0107 10210 10204 10194 1 184 10180 10174 -- 10200 3 1 63 10220 N58 56 55 P4 53 ]32 1017030 10224 1 - 0 61 root 6FL, Doti P6 10203p WOOD 29 jo 0193 C ffl � 10164 © 50 ,L0 33 0 10160 10230 �62 5 10215 47 49 10175 10195 51 52 Lit m,dl9: F9UI 10235 10205 = 10183 10154 f 48 sN s 3 46 l G TENNIS SP P5 10185 27 10245 -10243 22113t�-�1_�1 O ,0 44 I -40- 21317 s F 10163 ALL YE 10240 102 3 1337 POOL W 26 �0 L D �3 39 10144 10150 64 10244 0 d 43 ® � L6 � 21307 10145 Q 25 �� �� 38 p �r 5 1� 10255 F 7 3 101 42 GLEN p A R 97 24 10250 4 10254 M IL ILI IU 13 1 21316 10125 10134 23 12 � � a 21326 O Eil � 10124 10260 �� PI 14 10130 I P21 11 ( „ \ 10275 10120+ 2 10265 IE 2 1 TENNIS 5 L2 10264 9 15 4 � Aq�� 10115 0 od 10268 dpj 10285 6C.D 1 6 o A A '1 10113 10114 10280 MANAGEMENT GLEN BROOK 10270 � 10274 O A P A R T M E N T 5 18 MAR`'AVENUE 1'] 10110 10104 LEGEND S Social Room P Pools PY Pilates/Yoga BOULEVARD Room SP Spa TOOUSTEVENS P Putting Green D Driving Range CL Children's Library GR Guest Room CREEK BLEVV ARD CS Cybex Strength Center V Sand Volleyball CW Car Wash L Laundry CF Cardiovascular Fitness B Billiards SN Sauna G Garages mw 5/14/09