13020023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10240 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 13020023
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MAT14ILDA AVE STE 2 DATE ISSUED:02/06/2013
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL0 COMMERCIAL
11
License Class Lic.# 1 BLDG#64**REMOVE& REPLACE 20(E)WINDOWS.
EGRESS
Contractor D ` Date 10 (21 TEMPERED WHERE REQUIRED
1 hereby affirm that I 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.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain acertificate 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 APN Number:32627037.10240 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY F PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY T CALLED INSPECTION.
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 ed by Date:
with all no-point source re latioas per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature e Dated l] I All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature ofApplicanC Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 exclusvely contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with t e Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' 5 25533,and 25534.
Section 3700 of the Labor Code,for Ane performance of the work for which this Owner or authorized agent: a Date• a O to
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person many manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION ENDING AGENCY
L
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 fa inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records,
granting of this permit.Additionally,the applicant understands and will comply
with all noo-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION vO
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING OMSION '/
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �O
(408)777-3228-FAX(408)777-3333•buildinGC5cuoertino.orn \
CUPERTINO
❑NEW CONSIAUCI2%0 4 ❑ ADDITION ❑ AL'TEELRATION 1 T, L❑ REVISION/DEJFII2�m OIUGGIINAL PMZWT 3
PROJECT ADDRESS IO G.q tib^ Q.'d wce, W �I�I CFS / APN" 3 (.amu Z % 0 3 } .
OWNER NAMfi AV&72Y 6-�ct-' agoj� 1, 10 1
PBONE6S-0-45/-a- sa+AR.i4vlsr-YS
TmEer ADDRESSJ+✓ l ^Q
3 0 �. q y P S I ' 4.1 W
CONTACT NAME PRONEi�
St(,'JL- 7 E"UArJC,IL, YOk-$o6- � A1�1' STC- r lin/ � P'N.As-
STREET ADDRESS V� i-I CTrY,SATE 73P F —141
S.
e u
7113
❑owma ❑ owNER-auazER ❑ OWNERAGENr LtYcwDawcroR ❑coNTR.AcroaAGENT ❑ A aarEcr ❑E CINIBA ❑ oEvnLoPER ❑tE Aw
CONTRACTOR NAaffi V _ LICENSE NUMB J /� Q/• LICENSE TYPE j5 BUS.UCR
COMPANYNAbni E-MAIL �-( /rD (J E '7 15
Maj'6C))'t
STREET ADDRESSGRY,SLATE,ZTPBOM
' ` S vE I'- C-44 qv 6- S•
ARCHITECTIFENGINEIMNAME , 7I� LICENSENUMBER BUS.LIC#
CAMPANYNAME Iv/ E-MAIL EAX
STREET ADE A CRY.STATE n? PHONE
DESCRIPTION ION OE WORK -
DO �IJ.ucQewvs
EIDSRNGUSE PROPOSEDUSE CONSTILTYPE SSTORIS
�� USE TYPE OCC SQ.FT. VALUATION(5)
EXS:T' NEW FLOOR DESNO TOTAL
AREA AREA AREA NET-MUTA C)
BATHROOM KITCHEN 01HER v/
REMODEL AREA REMOOELAR:A REMODEL AREA
PO0.IX AAFA OEQCARFA TOTAL OECKAgRCHAREA GARAGE AREA: DETAC4
ATTACH
IDWELLRIG UNITS: ISASECONDUNTr YES SECOND STORY YES
BEING ADDED' ONO ADDrlwir! ONO
PR&APKJCATMN []YES B'YMPROVIDECOPY OF LS TBB RLDG AN ❑YES BY- TOTAL VALUATION:
PLIMNBNGAPPL! pro Pr varve APrROVAtLEriER r?em-RR 10= p
Z"O'000 =
By my sigoanm below,I certify to each of the fbHowmg I am the prooetY GWRer or amh act Ga 4ofigerty owner's behalf. I have read this
aoplicatian and the information I "dad is correct I have read the Dewription of work and edfy it is accDnte. I agree to comply with all applioble local
atttinanees and state laws telafvlg dig "oa I amhotiaepr
Taatatives of Cupertino to tura the above-identified itLwpeLticn purposes.
Signature ofAppli®r/Agent Dam: 2 6
SUPPLEMENTAL INFORMATION REQUIRED PIAN Q�CRTYPE ROOITNG sI.>p
New SFD or Multifamily dwellings- Apply for demolition permit for ❑ GVIB-TEIR- a
CODen ❑ BDD.Da+G PUN Rav�w
eusmg btald'mg(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ Expwm Cl PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srwtmARD ❑ PODLICwoBIO
form if any Hazardo s Materials ate being used as part of this project. ❑ LARGE ❑ Pitt DWr
Copy of Plamming Approval Lever or Meeting with Planning prior to
❑ MAlOR ❑ SANITARY SEWER DISTRICT
submitral of Building Permit application. -
❑ ExvmormffivTAt HEALTH
21dgApp_ OlI.doc revised 06P-1171
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10240 PARKWOOD DR BLDG 64 1 DMELISSA
its APN: 326 27 037 BP#: "VALUATION: 1$20,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
Is PE TAMATION
MU ly Buildina is PENTAMATION 1GENRES
Stories
s 0 PERMIT
MIT TYPE:.
PRIMARY Multi-Family Dwelling (F) No E.
USE: >3 Stories 0) Yes PERMIT TYPE: A-
WORK REMOVE & REPLACE 20 (E)WINDOWS. (EGRESS &TEMP WHERE REQUIRED)
SCOPE
,:7]
E3
NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the Prelinina information available and are only an estimate. Contact the Dept for addnl Info.
FEE ITEMS (Fee 2esohdion 11-053 jff..7'1,'12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-2-0--1 # Window/Sliding Glass Door
Suppl.PC Fee: 0 Reg. 0 OT 0.0 Ins $0.00 $666.0T01WINREPReplacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. () OT 0.0 Ins $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00 T=
0
Work Without Permit? () Yes E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
77=
Strong Motion F IBSEISMICR $2.00 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.001
SUBTOTALS: $3.001 $666.00 TOTAL FEE:=$669.00
Revised: 01/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: oew, AA w0c) r LL(O' PERMIT#
OWNER'S NAME: I PHONE# a9: O I`f S
GENERAL CONTRACTOR: C c,,fs BUSINESS LICENSE#
ADDRESS: a-h CITY/ZIPCODE:S�.t nn v.,,4, ,c 4/o ?.6
*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 ALL S CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �n
I am not using any subcontractors: y. �'
Signature Date
Please check applicable subcontractors and complete the following information:
t/ 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
0944aG/ -
Owner/Contractor Signature Date