12090013CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21317 GLEN PL
CONTRACTOR: STEVE PLEVANCIC
PERMIT NO: 12090013
CONSTRUCTION
OWNER'S NAM E: AVERY GLENBROOK LP
528 SMATI I I LDA AVE STE 2
DATE ISSUED: 09/04/2012
OWNER'S PHONE: 6509618330
SUNNYVALE, CA 94086
PIIONE NO: (408) 806-9145
❑ LICENSED CONTRAf-fOR'S DECLARATION
r ELECT r PLUMB r
License Class b Lic. q C -
BUILDING PERMIT INFO: BLDG
r r 17M11EC11
RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of biapter 9
JOB DESCRIPTION: UNITE- DECK REPAIR
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificate 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. FI Floor Area;
Valuation: $5000
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.
APN Number: 32627036.21317
Occupancy Type:
APILICANI' CIiRTIFIC,\TION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state Imes 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 1 0 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
]8O DAY F OM LAST CALLED INSPECTION.
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 -poi ource regulations per the Cupertino Municipal C de, S tion
9.18.
Issue b)' i /�6' ll� Date:
Signatu
Rh: ROOFS:
❑ OWNP:R-Rf ILDER DECLARA'T'ION
All roofs shall be inspected prior to my roofing material beteg installed. Ira roof is
installed without first obtaining an inspection; I agree to remove all new materials for
hereby affirm that I tall exempt front the Contractor's License Law for one of
Inspection.
the following hyo reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business B: Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS I'D BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business E Professions Code).
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
L have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Cenificate of Consent to self -insure for Worker's
California Ilealth 8 Safety Code, Sections 25505. 25533, and 2.5.534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth S
performance of the work for which this permit is issued.
SafetyCode, Section 25532(x) should I store or handle hazardous material.
I 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
pemlit is issued.
IlSafety Code, Se a 25505, 25533, and 25534.
1 certify that in the performance of the work for which this pemhit is issued, I shall
not employ any person in my manner so as to become subject to the W'orker's
Compensation laws of California. If, after making this certificate of exemption, I
Oww nu ri� ent: /
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.
CONSTRUCTION LENDING AGENCI'
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 1 have read this application and stale that the above information is
Lender's Name
correct. I agree to comply with all cit 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 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
ARCIIITIiCT'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
CUPERTINO I
F-1 unit rnwcre t trmnN
CONSTRUCTION PERMIT APPLICATION `3
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ^ (f�
(4088)) 777 T-3228 • FAX ((408) 777-3333 • buildi(dJ
ngcuoertino.org
1 ` V1
I 1 AnmmnN I ATRATif1N/T 1inI RFViCir1N /iIFFF"RRFiI \ nRmNAl_ PuRMiTR
PROJECT ADDRESS/
/a/�c,�� 3 — I AFN4
(//_
•I-Qn
OWNER NAME ✓1 i //.� Y ll C L ��"-s'(lIC L, P PHONEL-ES'O'
V
Aver
Bert
SKEET ADDRESS _L L fit ^
C"q
38 FL✓A s I • Ov� I "i
CONTACT NAME ( PHONE
Vv+s-$o6- Lo
S1-C:✓� 7(S�ILArJGL l`+1� S�7r
r L,
STREET ADDRESS %�
J/ CSEV1 ZhIP
G
_
❑ OWNER ❑ OWNV(-SUU.DE❑ OWNFAAGc —YN/CiOR ❑CONTRACTORADENT ❑ ARCFT:cT
❑ ENGtNEx ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME
L1t.�JSE NtlMB I // LICENSE TYPE
6
BUS. ISCtl
eR
COMPANY NAME E-MAIL
I
F %¢r�6 -73� l
2 2 7 Oh2u BV eVC, Mai
/CU•rX
STR'.>=FADDRESSS - - yt CfTY. SA'F IIP
le
PON''E
S
a7 uI S T, vu L v b
- G-
ARCHITEMENGINEERNAME L i .iL LICENSE NUMBER
1� 1'c
BUS. LICM
COMPANY NAME
E-MAIL
FAX
S'REEr ADDRESS CITY. STATE ZIP
PHONE
DESCRZF70N OF WORK )
EXISTING USE
PROPOSED USE CONSTR MB 9 STG=
USE
TYIE
OCC.
SQFT.
VALUATION (5)
EXLSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
-
BATHROOM MCHEN OTHER
REMODELAREA REMODELAKEA REMODELAREA
PORCHARFA DECXC - TOTAL DECK/PORCH AREA GARAGE. ARTA U DETACH
[]ATTACH
M DWEi G[NTTS:
ISAs£CONDUNTT ❑YES
SECOND STORY ❑YES
r� LIG
'
RELNCADDEDr ❑NO
ADDMON'. ❑NO
PRE-APPUCATION OYES T YES, PROVIDE COPY OF
LSTB£aLDCAN ❑YES
REC
I TOTAL VALUATION:
PIANNDJGAPPLY []NO PANNING APPROVAL LETTER
EICBLER SOME7 C] NO
� �
O
_--
e
By my signature below, I certify w each of the following: 1 an :he prepery owner or autho & ed t to act an the prppery awner's behalf. I have=d end this
application and the infomian. I ha a rovided is correct. I have tnul the Description of Work and verify it is accurate.
comply with all applicable local
ordinances and sate laws mlating - u ding c .. don. I authorize representatives of Cup c=. o to rota -lie al ) ro e 0pe:-y for inspection purposes.
Signature of Applictut/Agene Date:
SUPPLEMENTAL INFORMATION REQUIRED ,
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for dernolition permit for
existing building(s). Demolition permit is required prior to issuance of building
ovEx-Ttt&cOG:.TER
D-n.DiNG PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLA."MNG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ srMNz R
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑
❑ LARGE
FM DEPT
_ Copy of Planning Approval Letter or Meecng with Planning prior to
❑
❑
subtni—Lal of Building Permit application.
N JOR
SANITARY SEWER DISrRiCr
❑ ENVDRoN-N NTAL BYAI.TH
dldgApp_2011.doc revised 06/21/11
L
';(
CITY OF CUPERTINO
I(/I FEE ESTIMATOR - BUILDING DIVISION
JA[ADDRESS:
21317 GLENPLACE
DATE: ,09/04/2012
REVIEWED BY: Sylvia
blech. Permit Fee:
APN:
BPN:
'VALUATION:
1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex
USE:
Elco heap, Few:
PENTAMATION 1GENRES
PERMIT T\'PE:
WORK
UNIT 6 DECK REPAIR
SCOPE
$0.00
NOTE: This evtin are does not include jeer slue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addr;'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11)
Much. Plan Check
Plmub. Plan Check
Elee. Plan Check
blech. Permit Fee:
Plumb. Permit Fee:
rlec. Permit rue:
Other Afech. insp.
Other Plumb Insp.
Other Elec. Insp.
Alech. ltssp. rec:
Plumb. htep. ree:
Elco heap, Few:
NOTE: This evtin are does not include jeer slue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addr;'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-1-1 #
$467.00
Deck / Deck Railing
IDECKWOOD Deck (wood)
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0 T
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tac:
AdiniWsirative Fee:
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Q
Travel Documentation Fees:
Strong Motion Fee: 1BSE1SAHCR
$0.50
Select an Administrative Item
Bldg Sids Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$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: 9131-7 G evt
PJMLL
PERMIT #
OWNER'S NAME: a Cay , u,
PHONE # - 5
GENERAL CONTRACTO e,,e 6,S
BUSINESS LICENSE #
ADDRESS: -6,)[. — 0
CITY/ZIPCODE: t `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
GENL'RAL CONTRACTOR AND A L SUBCONTIjs1CTORS HAVE OBTAINED A CITY OP CUPERTINO
BUSINESS LICENSE. �� )
1 am not using any subcontractors: q41//
Signature Date
Please check applicable subcontractors and complete the following information:
--
Date
SUBCONTRACTOR
BUSINESS NAtNIE
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
Shect Rock
Tile
--
Date