12090011CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21317 GLEN PL CONTRACTOR: STEVE PLEVANCIC PERMIIT NO: 12090011
CONSTRUCTION
OWNER'S NANI E: AVERY GLENBROOK LP 528 S M ATHILDA AVE SPE 2 DATE ISSUED: 09/042012
OWNER'S PRONE: 6509618330 SUNNYVALE, CA 94086 PIIONENO:(408) 806-9145
❑ LICENSED CON TRACTOR'S DECLARATION
License Class Lic. N__�
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
I 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.
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.
APPLICANT CERTIFICATION
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 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 -poi ource re il. 'r>rI per the Cupertino Municipal Code, Section
9.18.
Signatur Date
❑ OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
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.
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, 1 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 acerae against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
BUILDING PERNIFF INFO: BLDG r ELECT r PLUMB r"t
NIECII I✓ RESIDENTIAL IJ CONINIERCIAL ri
JOB DESCRIPTION: APT 1-8 - REMOVE AND REPLACE 28 WINDOWS
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32627036.21317 OccupancyType:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS,FROM LAST CALLED INSPECTION.
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of
Date:
AL1, ROOF COVERINGS TO BE CUSS "A" OR BETTER
IAZARDOUS MIATFRUNLS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I [INC equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Mlanagement District I will
maintain compliance with the Cupertino Mlunicipal Code, Chapter 9.12 and the
Ilealth & Safetz Code. Sections 25505, 25533, and 25534.
CONSTRUC'"ON LENDING AGENCY
I hereby affirm 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
ARCIBTF.CT'S DECLARATION
I understand m)• plans shall be used as public records.
Licensed Professiona
9 c> <D 1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 55014-3255
(408) 777-3228 - FAX (408) 777-3333 • building0cuoertino.oro
CUPERTINO I-00
❑ Nr'.W CONSTRUCTION I—I ADDITION F1(y/^�` ALTERATION / TI ❑ htF.VISION / DEFER.RM ORIGINAL PERbIIT #
PROJECTADDRESS
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OWNER ❑ OWNER -BUDDER ❑ OWNAGETr (W//CONTRALTOR 11 CONTRACT, AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TDJANT
CONTRACTOR NAMES1
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LICENSE NUMB I // (7(
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LICENSE TYPE 15
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DUCREMON OF WORK
EXISTING USE
PROPOSED USE
CONSTR. TYPE »5 Aft
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TYPE
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VALUATIONS)
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NEW FLOOR
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TOTAL
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REMODEL AREA RFNODEL AREA REMODEL AREA
PORCH AREA DECKAREA TOTALDECVPORCHAREA GARAGEAREA DETACH
❑ATTACH
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BELNGAn DEDr ONO
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PRE -APPLICATION ❑YES OF YES. PROVIDE COPYOF
LSTIEDLDGAN ❑YES
RECEIVED BY:
TOTAL VALUATION:
PLANNLNGAPPL» ONO PLANNING APPROVAL LETTER
EICBLER ROME' ONO
Zdr C>00 -
By my signaNte below, I certify to each of Lie following: I am the property owner or authorized agent m act on the prpperry, owner's behalf.I have :cad this
application and the informan. I ha a rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply wirb all applicable local
ordinances and =to laws relating • u ding c ,. tion. I autborim representatives of Cuperc o to inter the above -i nti5 property for inspection purposes.
Signam of Applicant/Agerm Date: –1 Q 1"12_
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
.rltE-comaEx
New SFD or Multifamily dwellings: Apply for demolition permit for
building(s). Demolition permit is required prior to issuance of building
'
unDcvG Purr REVIEWexisting
permit for new building.
❑ e(?REss
❑ PLANXMC PUN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
13STM\HARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑
❑GE
Erna uErr
_ Copy of Planning Approval Letter or Meeting wits Planning prior to
❑
❑
subini.al of Building Permit application.
MA.JOR
SA.NTTAAY SEWER DLSTR1Cr
❑ E.NVIRONI XTAL HEALTH
BldgApp_101 Ldoc revised 06121111
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71
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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: 0 13 e"I
PERMIT #
OWNER'S NAME: v 6
PHONE # ke - 60r.- Z
GENERAL CONTRACTO ee_ JPJL� S
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE: r �t0
*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 SUBCON"1'IjACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �� J Q
am not using any subcontractors: —� / G
Signature Date
Please check applicable subcontractors and complete the following information:
Date
SUBCONTRACTOR
BUSINESS NANIE
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
Date
CITY OF CUPERTINO
ICY(/I FEE ESTIMATOR—BUILDING DIVISION
jAIADDRESS:
21317 GLENPLACE
DATE: 09/04/2012
REVIEWED BY: Sylvia
Alech. Perini! Fee:
APN:
BP#:
'VALUATION:
$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex
USE:
Elec. Insp. Fee:
PENTAb1AT10N 1GENRES
PERMIT TYPE:
WORT:
BLDG 39 REMOVE AND REPLACE 28 WINDOWS
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the relindnat3 information available and are onl p an estinmte. Contact Ilse De t or addn'I info.
FEE ITEMS (Fee Resohuion 11-053 E(! 7/1/11)
Alech. flan Check
Plumb. Plan Check
Elec. Plan Cheek
Alech. Perini! Fee:
l'hun6. Permil Fee •
Flee. Permit Fee:
Other Alech. lay.
Other Plumb Insp.Li
Other Flee. Insp.
Alech. /n.,p. Fec:
Plumb. hr.sp. Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the relindnat3 information available and are onl p an estinmte. Contact Ilse De t or addn'I info.
FEE ITEMS (Fee Resohuion 11-053 E(! 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$799.00
Window / Sliding Glass Door
I JVINREP Replacement
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. OT
0.0
Ins
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consn-uction Tax:
Administrative Fee:
0
�
Work Without. Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure 1-7
0
i
Travel Doutonenlation Fees:
Strong Motion Fee: IBSEISAAICR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $3.00
$799.00
TOTAL FEE:
$802.00
Revised: 07/01/2012