12090015CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21317 GLEN PL CONTRACTOR: STEVE PLEVANCIC PERMITNO: 12090015
CONSTRUCTION
OWNER'S NANIE: AVERY GLENBROOK LP 528 S AIATIIILDA AVE. SIT 2 DATE ISSUED: 09/042012
OW'NER'S PIIONF,: 6509618330 SUNNYVA LTi, CA 94086 PHONE NO: (408)8069145
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor C?UtXw—IrDate
hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations
I 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 permit is issued.
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.
APPLICANT CERTIFICATION
I certify that 1 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 hereby authorize representatives of this city to enter
upon the above mentioned property 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
granting of this permit. Additionally, the applicant understands and will comply
with all non-poilftourcc regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER-RIIILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Laefor one of
the following two reasons:
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 & Professions Code)
1, as owner of the properly, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
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 permit is issued.
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.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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
upon the above mentioned property 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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulation per the Cupertino Municipal Code, Section
9.18.
Signature Date
BUILDING PERMIT INFO: BLDG r ELECT (_ PLUMB -"
MECII [ RESIDENTIAL r COMMERCIAL ri
JOB DESCRIPTION: UNIT 2- DECK REPAIR
Sq. Fl Floor Area:
Valuation: $5000
APN Number: 32627036.21317 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS OM LAST CALLED INSPECTION.
Iss ids/A( Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material bebg installed, If a roof is
installed without first obtaining an. inspection, 1 agree to remove all new materials for
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
IIA7.ARDOIIS MATERIA S DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code. Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino pl unicipal Code. Chapter 9.12 and the
Ilealth afrly Code, Sections 25505, 25533, and 25534.
Osrn r au i zed a m. /
Date:
CONST Rt1CI'ION LFNIIING AGENCY
I hereby af7irn that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITE' CI"S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO I
❑ NFW CONSTRUCT ON
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /� oo�
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10300 TORRE AVENUE • CUPERTINO, CA 9501 :-3255 �!M
(408) 777-3228 • FAX (408) 777-3333 • buildinecuoer5no.oro \ V
❑ ADDITION ❑ ALTERATION / M ❑ REVISION / D TRRID ORIGINAL PERMIT #
PROTECT ADDRESSAFN
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❑ EHGAEER ❑ DEVELOPER ❑ TENANr
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DESCP=, ON OF WORK - r
EXSTiNG USE PROPOSED USE CONSTIC TYPE 95 RGS
USE
TYPE
OCC. I
SQ -FT.
VALUATION (S)
EJOSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
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RFMODELAREA REMODEL AREA REMODEL AREA'cMAPORCHAREA
DECICAREA TOTALDECK/PORCHAREA GARAGEDETACHATTACH
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M OWELI,tNO UNTrS:
IB A SECOND UNTt ❑YES
SECOND STORY YESBEING
ADDED' OADDITION:ONO
PRE-APPLIGT[ON OYES IF YES, PROVIDE COPY OF
IB THE BLDG AN ❑YES
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TOTAL VALUATION:
PI.ANNINGMPLO ONO PLANNING APPROVAL LETTER
EICHLER HOME' 0 N
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By my signature below, I certify to each of the following: I am the property owner or authorized grn act on the prgpcny owner's behalf. I have read this
application and the truortnaaon I ha a rovided is cmrecL I have read the Description of V and v ry it is accurate.
I e to omply with all applicable local
Ordinances and sate laws relating u ding c tion. I authori= teptesenatives of Cupctino to enter the above-4ied ery for inspectionptttppses.
Signature of Apphcant/Agrnt Date:
SUPPLEMENTAL INFORMATION REQUIRED
CHECKTYPE
ROUTING SLIP
mG
New SFD or MultifunUly dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
THE -COUNTER
PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLINN-NG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STA.NDARD
❑ PUBLIC WORPLS
fort if any Hazardous Materials are being used as pan of LES project
❑
❑ LARGE
Fina uErr
Copy of Planning Approval Letter or Mecting with Planniag prior to
❑
❑ SANITARY SEWER
submittal of Building Permit application.
.woR
DtsrRtcr
❑ E.NVORON: [E.NTAL HEALTH
3/dgApp2011.doc revised 06/31/11
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[PRIM
CITY OF CUPERTINO
[ R'l//.I FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include jecv clue to otter Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
Mcrrirt otr 1 Thovo frac aro haver/ on flee nreliminan, information available and are only an estimate. Contact the Dept for aildn'I info.
FEE ITEMS (Fee Resolution 11-053 EIT 7111111
ADDRESS: 21317 GLENPLACE
DATE: 0 9104/2 01 2
REVIEWED BY: Sylvia
Neck Permic Fee:
APN;
BP#;
'VALUATION:
$5,000
*PERMITTYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
E1ce. insp. Fee:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
UNIT 2 DECK REPAIR
SCOPE
$0.00
NOTE: This estimate does not include jecv clue to otter Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
Mcrrirt otr 1 Thovo frac aro haver/ on flee nreliminan, information available and are only an estimate. Contact the Dept for aildn'I info.
FEE ITEMS (Fee Resolution 11-053 EIT 7111111
Much. Plan Check
Plumb. Plan Check
Flee. Plan Check
Neck Permic Fee:
Plumb. Permit Fee:
Blec. Permit Fee:
Other Much. In.sp,
Other Plumb Insp.Li I
Other Elce. Insp.
,blech. lap. Fac:
Plump. lay. Fee:
E1ce. insp. Fee:
NOTE: This estimate does not include jecv clue to otter Departments (i.e. Planning, Public IVorks, Fire, Sanitary Sewer District, School
Mcrrirt otr 1 Thovo frac aro haver/ on flee nreliminan, information available and are only an estimate. Contact the Dept for aildn'I info.
FEE ITEMS (Fee Resolution 11-053 EIT 7111111
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$467.00
Deck / Deck Railing
IDECKNOOD Deck (wood)
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
SuppI. Insp. Fee:Q Reg. () OT
0.0
1 his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tar:
Administrative Fee:
O
E)
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee:$0.00
Select a Non -Residential
Building or Structure
0
O
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $1.501
$467.001
TOTAL FEE:
$468.50
Revised: 07/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 1- G eut ate—
PERMIT #
OWNER'S NAME: v-, u,
PHONE # e -kD —
GENERAL CONTRALTO g� e nc�c�t Co tis
BUSINESS LICENSE #
ADDRESS:.] —
CITY/ZIPCODE: �+ `tU
*Our municipal code requires all businesses working in the city to have a City.of Cupertino business license.
NO'BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A L SUBCOiN'T! ACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.ida i t
1 am not using any subcontractors: /
Signature Date
a
Please check applicable subcontractors and complete the following information:
?'/� / �L— .
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
?'/� / �L— .
Date