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13020025 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 13020025 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:02/062013 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ OMMERCIAL 11 License Class___ � L'ic.p l 3 UNIT 64-4**DECK REPAIR * Con[racor `�� UrVDate I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 1000)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 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. Sq.Ft Floor Area: Valuation:$5000 I have avid 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 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITI-IIN 180 DAYS O ' IT 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 DAYS FR CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accme against said City in consequence of the SOe Date: granting of this ennit. Additionally,the applicant understands and will comply with all noa-p rlations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature l Date�� 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 of Applicant: 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 sal;(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 695 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 05, ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: Qd U�q 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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 for 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 non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18, Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION VVIIA IF dim ADDRESS: 10240 PARKWOOD DR#64-4 DATE: 02/06/2013 REVIEWED BY: MELISSA MIN. APN: 326 27 037 BP#: -VALUATION: 1$5�'000 � "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 11GENRES I USE: >3 Stories 0 Yes (j) No PERMIT TYPE: WORK DECK REPAIR SCOPE NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliniina information available and are only an estimate. Contact the Dept for addnl infix FEE ITEMS (Fee Resolution 11-053 E(J TT'12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F1 # Deck/Deck Railing Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $467.001 IDECKWOOD I Deck(wood) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (E) No $0.00 (F) Advanced PlanninV Fe $0.00 Select a Non-Residential E) Building or Structure 0 Strong_Motion Fee- IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $467.001 TOTAL FEE: Revised, 01/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESSPERMIT# OWNER'S NAME: hu2.r CC4- PHONE#110 — 6 U — cj 1 GENERAL CONTRACTOI --. �e� jeu�L Cuh BUSINESS LICENSE # ADDRESS: -6dQ CITY/ZIPCODE: V hon g 4017 f, *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND A L SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile"C' wner/Contractor Signature D ite CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DMSION 10300 TORRE AVENUE a CUPERTINO,CA 95014-3255 �� V CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(&cuoertino.ora \ ❑NEW CONSTRUCRON ❑ AD,D/I,MON ❑ ALT RATION/TI [IREVISION/DEFE�RfR�ID ORIG`IIN-AL rT R PMAr PROJECT ADDRESS.! O ZYD . / _/J� AFNY O OWNERNAMEj4V/ 2 y �CLl(��" PN76-o-961-a- E'MAD'/t•A,VZ'• kit's" ItBT •Ck(• STREET ADDRESS C[TY• A�+✓ 1 Co 38 pLa st 0 gal Yv CONTACT NAMEM�, S�'L✓c- C'UAr�ctL- �vfs-$o6� � V•ll �STc r IJL.✓ 4v STREET ADDRESS �-- //'l2 CTfY.SI'A N h e U F ❑owNER ❑ owNER-BUnAER ❑ OWNERAGENr tWCOrrRACTOR ❑ODNTIALeTOR AGENT' ❑ ARr�TE's.T ❑ENGINEtac ❑ ER ❑DEVELOPTENANT CDNTRACTOA NAME ( LICENSE NUMB —f 6 56 LICENSE TYPE }'Z Bus.IIC9 COMPANY NAMEH (,J qGa-7 � i ,e Y EMAzS 2u By 4V6 Na 1r60», F STREET ADDRESS �Y•sTAT�Zn' ONE Ij a aye f vu le v 6- ..5 ARC7DTFLTJENGINIDtIJAME J .A_ LlCaiSENUMBER Bus.LIC# COMPANY NAME (� 1'c &MALL FAX STREET ADORE" QTY.STATE.ZIP PHONE DFSCRD•nON OF WORK EDm TWG USE PROPOS®USE C USE TYPE OCC. SQF'T. VALUATION(S) EXESTO NEWFLOOR DEMO TOTAL AREA AREA AREA NET.ARE1 BATHROOM RECQfftI OTHER REdODELAREA RIDAODE.AREA REMODEL AREA PORCRAREA OECXAREA 1 TOTALDECRVPORCHAREA GARAGE ABtA DETACR ATTACH aDWELTRrGUNnS: WASBCONDUNIT YES 'GARAGE YES Fv.� BMGADUED? ❑No wDDMON? ❑NO PRE-APPLICATION ❑YES T YES,PROVIDE COPY OF I ISTNEBLDGAN ❑M B AI7 VONT/ PLANNMG APDL/ ❑No PLANNNGAPPROVALLETIER I MCm.ERBOMW ❑ND By my signature below,I ceTCfy to each of the following: 1 am the property ovmer w aNhwized agent act 0o'h-p36x6y owner's behalf. I have read this application and the information I ba vWed is correct. I have read the DeSmPtion of Work and verify it is . I agree to comply with allapplicable local ordinances and state laws redatmg ding on. I amLia otrepresentatives of Capertmo to enter the above-identified property for inspection purposes. Sigasture of Appli®t/Agent Date: SUPPLEM WrAL INFORMATION REQUMED PLAN- cEzcx Ty¢E ROTRnSG sr.� New SFD or Multifaffily dwellings: Apply for demolition permit for ❑ ovmT.zrrou T zR ❑ RmLDiNG PIAN REv[Rw eDostmg building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ PLANNING PLAN REVMW Commercial Bldgs: provide a completed Hazardous Materials Disclosure ❑ STANnARD ❑ rvar.re wows form if any Hazardous Materials are being used as part of this pmjat ❑ rAaca ❑ Prasnar Copy of Planning Approval Lcaw or Meeting with Planning prior to ❑ MAJOR ❑ sANTIARY sEwm UmtuCT submittal of Building Permit application. ❑ EmmarmuNTAL mrALaa -31dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10240 PARKWOOD DR#64-6 DATE: 02106/2013 REVIEWED BY: MELISSA its APN: 326 27 037 BP#: "VALUATION: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair PRIMARY Multi-Family Dwelling Buildina is T_PENTAMATION 1GENRES I USE: >3 Stories 0 Yes (F) No PERMIT TYPE: WORK �DECK REPAIR SCOPE E L J NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the preflain infornwtation available and are aid),an estimate. Contact the Dept for addnl infa FEE ITEMS (L�ecl?esoluflon 11-053 Eff 7'1'L3)_ FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 F1 -1 it Deck/Deck Railing Suppl.PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $467.001 IDECKWOOD Deck(wood) PME Plan Check: $0.00 7771 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OTT07 ,0 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Yes Q No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Strong Motion Fe(r IBSEISMCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC , $1.00 SUBTOTALS: $1.50 $467.001 TOTAL FEE: 7 $468750] lk\ I Revised: 01/01/2013