12080171 CITY OF CUPERTINO BUILDING PERMIT
IIIIILDINCADDRESS: 10145 PARKWOOD DR CONTRAC'MR:STFVE PLEVANCIC PE Mff NO: 12080171
CONSTRUC(ION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATI I II.DA AVE STE 2 DA'Z'E ISSUED:08/152012
OWNI,R'SPIIONE: 6509618330 SU NYVALF,CA 94086 PRONESO:(408)806-9145
❑ LICr.NSED CO.FRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_ Lic.k G r r r
pIECH RESIDENTIAL COMMERCIAL
Contractor J-�p a✓c(y\. c— Date
hereby affirm that l ant licensed tinder the pruvisions of Chapter9 •JOB DESCRI PTION: BLDG 36-REMOVE AND REPLACE(16)WINDOWS
(commencing with Section 7000)of Division 3 of the Rusinem&Professions
Code and that my license is in fullforce and effect.
hereby alfvm under penaly of perju n'one of the following Ino declarations:
I have and will maintain a cenilicate 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 permit is issued. Sq. Ft Floor Area: Valuation:$20000
1 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. AI.N Number:32627037.00 Occupancy Type.
AI'I'LICA\1'CFR'I'IPIG\"I'IfIN
I certify that I have read this application and state that the above information is
correct, l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS 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
indenmity and keep harmless the City ot'Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,wall expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands mid will comply c
with all non-pad t source regulations per the Cupertino Municipal Code,Section Issued Date:
9.18. / i
Signature Dmc� J
RF-ROOFS:
❑ OWNER-BUILDER DI'CLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed withom first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that I am exempt front the Contractor's License Lan for one of inspection.
the fallowing mi)reasons:
L as owner of the property,or niy employees with wages as their sole conipensmiml, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&'Professions Code)
h as owner of the property,am exclusively contracting With licensed contractors to AL1.ROOF COVFRINCS TO BE CLASS"A"OR BETI'ER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penaltyof perjury one of the follon'ing three IIAZ,kltl)Ol1S\l,\99iIIIALS DISCLOSURE
Jccla rat ions: _ I have read the hazardous materials requirements under Chapter(.95 of the
I have and will maintain a Cenificate o(Consent to selfdnsure forWorker's California I Iea11h&Safety Coda 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 Jlunicipal Code.Chapter 9.12 and the Ilealth&
performance of the work for which this permit is issued. Safety•Code.Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment ordevices which emit hazardous air
Section 3700 ofthe Labor Code,for tic pertarnance of die work for which this conutniinants its defined by the Bay Area Air QualityManagement District 1 will
maintain compliance with the CupertinoMunicipal Code,Chapter 9.12 and the
Permit is issued.
Health&Safey Code.Sections_5505,.5533,and 25534.
I certifi•that in the performance of die work fonrhich This permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Ow'ne r_agihoriz�d a eat: /
Compensation laws of California. If,after making this cenifcaic of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deenhed revoked CONSTRUCTION LENDING ACFNCY
I hereby affirm that there is a construction lending agency for the performance of work's
AIT LICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application mid stale that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances mid 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 Iiabilities.judgmients, .\RCII I'1'I?CI"S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicanl understands and will comply I understand my plans shall be used as public records.
with all non-point source regulatims per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Dale
zsarsztucan r-mnuu luc r-cc. Z)U.UU IocmR m tvuu-ncatucuu ut �:/
7rore!Do on Fees: Building or Structure 0
Strong Motion Fee: IBSEISAHCR 1 $2.00 Select an Administrative Item
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10145 Parkwood Dr. (Bldg 36) DA'Z'E: 08/15/2012. REVIEWED BV: Sean
APN: RP#: *VALUATION: $20,000
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIIIARV Multi-Family Dwelling Buildina is PENTANIATION 1GENRES
USE: 3Stories Yes Q No PER111TT1'PE:
WORK Remove and replace 16 windows.
SCOPE
Mech. Plan Check Plumb. Plan Check Elec. Plan Check
M1tech. Permit Fee: Plnnh. Permit Fee: rlec. Permit Fee:
Other Afech.Insp. Other Planh Ince. Oilier Elec.Insp. L1 I
Afech.Insp.Fee: Plumb. hup. Fee: Elec.Insp.Fee:
NOTE: This atinutte does not includejees due to other Departments(i.e. Planning. Public Works. Fire,Sanitary Server District,School
District, etc.). These feev ore based on the prelhninurr information available and are onh,an estimate. Contact the De t or aildn7 info.
FEE ITEMS (Fee Resolution /1-053 E0: 7/1/1 U FEE QTY/F MISC ITEMS
Plan Check Fee: $0.00 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $533.00 1 mINREP Replacement
PME Plan Check: $0.00
Pennit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Pee: O
Work Without Pennit? O Yes Q) No $0.00 G
Advanced Planning Fec: $0.00 Select a_Non-Residential G
Travel Documentation Fees:
Building or Structure 0
Strong Motion Fee: 1BSEISAIICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $3.00 $533.001 TOTAL FEE: 1 $536.00
Revised: 07/01/2012
12o
-�}�,// CONSTRUCTION PERMIT APPLICATION
TJX COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408) 777-3333• buildinG(d)cuoertino.oro
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Tl ❑ REVISION/DEFERRED (ORIGINAL PERMIT p
PROJECT ADDRESS u /W r APN
owNm NAME 4 vin Y GC c%32aoil L P RONE6S O 46/--f E-MAIL -A
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sTREET30� _ t FL.uA S� OJ��R/a.s�/ , .t,�j LN
CONTACT NAME PaaONE E-A+AI, I
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STRFfTADDRESS M,
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❑OWNER ❑ OWNER BUILDER ❑ OWNER AGENT &-1CcNTRACT0R ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMB I /� LfC'ENSE TYPE BUS.tic 4
e� 1 nC.R 'c_ 9G f3
conaauY NAv¢ .�, E „5' 2u EV lYla,'1/CCJ%It FAX ¢c)d'732^ 1
Q.,e, > CJ
STREET ADDRESS L'rIV,STATE ZIP P ONE
S a k S vule L v -51s
ARCHITECTIE-NGAIEER NAME s ) ,t_ LICENSE NUMBER BUS.LICX
COMPANY NAME YC EMAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
DESCAIP ON OF WORK 1
EXISTING USE PROPOSED USE CONSTR.TYPE f STORIES;
USE TYPE OCC. SQ.FT. VALUATION(S)
EX1tG NEWFLOOR DEMO TOTAL
AREA AREA AREA NET.AREA -
BATHROOM I xILCKEN OTHER /
REM.ODELAREA REMODEL AREA REMODEL AREA
PORCHAREA DECXAREA TOTAL DECR/PORCHAREA I GARAGE AREA: DETACH
ATTACH
B DWELLING UNnS:. ISASECONDUNTT 0YEs SECONDSTORY ❑YES _
BEING ADDED' ONO ADDITION: ONO
PRE-APPLICATION ❑YES ff YES,PROVIDE COPY OF IS=BUG ❑YES RECEIVED TOTAL VALUATION:
PLANNIIGAPPLI ❑NO PLANNING APPROVAL LETTER EICHLER HOMET E]NO N ' T�Lr OOCJ _�
By my signature below,I cerdfy to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have cud this
application and the informarion I ha a rovided is COMCL 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 u ding c don. I authorize representatives of Cupertino to enter.the above-identifed property for inspection purposes.
Signature of App6eandAgent Daze: 2�1-/j -/9
SUPPLEMENTAL INFORMATION REQUIRED PIAN CHECK TYPE ROUTING52�
New SPD or Multifamily dwellings: Apply for demolition permit for OVER THY-COUPr= UILLING PLAN Rrvaw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAY REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 13 PUBLIC WORKS
forzn if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fm DST
_Copy of Planning Approval Letter or Meering with Planning prior to ❑ MAioR ❑ SA.NTTARY SEWER DISTRICT
of Building Permit application.
❑ ENVDRON.SE.NTAL HEALTH
d(dgApp_2011.doc revised 06/31/11