12120051I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10243 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 12120051
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 12/11/2012
OWNER'S PHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806 -9145
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class 5 r Lic. # � -f�P q / APT. 1 -8 REMOVE AND REPLACE 24 WINDOWS
Contractor a O�- - (�c.t-rr c. LC— Date
I 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 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 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 -po. t sourc r ulations per the Cupertino Municipal Code, Section
9.18.
Signature Date 1.� i
Im
CUPERTINO
M 'hJMU rnWQ'rot tr•rtrnv
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - buildinaCa)cuDertino.ora ` !/
M ATnnrrtnw I-1 AT_TFRATION ITT F1 REVISION / 139P EB ORIGINAL PERMIT #
PROJECT ADDRESS
ti
OWNER NAME % .
/ �
6S O' 7�I�Vi�
2r
E-MAIL
/tVCryL`fS r7�t?d4cl
STREET ADDRESS?
+•
QTY. 4TE. ZIP C-44
F r
3 8 �� a s
, �
CONTACT NAME _o
St(, Jl' E'1�A/JGC_
P` c�is-$06� j 4)
EAU,
ES
STREET ADDRESS
f
CITY, SrA N n e U
F
❑ OWNER ❑ OWNER -Burr DER ❑ OWNER AGENT LY'CONlRACTOR ❑CONTRACCORAGENr ❑ ARCZRCEcT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
,
CONTRACTOR NA1gJ
LICENSE NUMB L %6 q�
�-(
LICENSE TYPE }�
BUS. LIC C
e U _
COMPANY NAME
E-MAIL r}MAII�
.� ` U
2U EU lYla, (.cvyN
STREET ADDRESS � 1 ,
CrrY. STATE, ZIP
le
ONE
!o S
Mot rY� tr
YJ vot C- v
-
ARCHn=/FNGINEFR NAME
LICENSE NUMBER
BUS. UC i
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS CITY. STATE. ZIP PHONE
DESCRIPTION OF WORK ` ' /1 G�K (A-C) e a 6>,J jJ �� ( r do UJ-5
EXISTING USE
PROPOSED USE
CONSTR. TYPE
Y STORIES
_
USE
TYPE
OCC.
SQ FT.
VALUATION (S)
MMG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
-
BATHROOM
KINHE V
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
I
Y DWELLII4G UNM:
IS A SECOND UNIT YES
swoRD STORY YES
BEING ADDED? []NO
ADDITION? 13NO
PRE-APPLICATION OYES IF YE$ PROVIDE COPY OF
is THE BLDG AN ❑ YES
RECEIVED BY: I
TOTAL VALUATION:
PLANNING APPL Y ❑NO PLANNING APPROVAL LE-[TER
ETcmm HOME? p NO
Zd, ooU "
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf I have read this
application and the informad I ha vided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laces relating dig -on. I authorize representatives of Cupertino to enter the above - identified property for inspection proposes.
Signature of Applic audAgent ` Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN C=CKlYyy
ROUr7NGSr.IP
❑ Ovn'THr- COUNTER
❑ BUnm2* 4C PLAN RXVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑
❑ PT:AN7WG PLAN REVII:w
— Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ Pumuc woaxs
Form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FM DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
p MAJOR
❑ SANITARY sxwaR DTSTTUcr
submittal of Building Permit application.
❑ ItI'IVIROM4WTAL HEALTH
BldgAppjOl Ldoc revised 06111111
L
!71
mac.,
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
111W':n/ vfn ► Thoca fnoc aro hacod on tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Ef' 711!12)
ADDRESS: 10243 parkwood dr
t (tua;h P.1,W1 {. irecl
DATE: 12111/2012
REVIEWED BY: mendez
1'�rtntT�. Prrr�att l ec�.
APN:
I BP #:
Window / Sliding Glass Door
1 WINREP Replacement
*VALUATION:
$20,000
FPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
P
PME Plan Check:
$0.00
PENTAMATION 1GENRES
USE:
Permit Fee:
$0.00
PERMIT TYPE:
WORK
hrs
$0.00
SCOPE
$0.00
PME Permit Fee:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
111W':n/ vfn ► Thoca fnoc aro hacod on tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Ef' 711!12)
14cdt. Plait ('hc(A
t (tua;h P.1,W1 {. irecl
A c N rt t`heck
Th,ch. P,,ot) t F"'
1'�rtntT�. Prrr�att l ec�.
L;lrc, f'arrnrr Fe"'
Other ,1kc h. Insp.
Window / Sliding Glass Door
1 WINREP Replacement
0/h, r 1'17ec. Mnjj.
Ilech. Insp. Fr'e_
P/71111h. hasp. FCC
Insp, Fcc:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
111W':n/ vfn ► Thoca fnoc aro hacod on tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Ef' 711!12)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$666.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.S Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.,onstruction 1 ff.
Adinhiistrative 1'e c:
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non - Residential
Building or Structure
0
Travel 1)tautr ix,11tation FcrCS.
Strong Motion Fee: IBSEISMICR
$2.00
Select an Administrative Item
Bldp- Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$3.00
$666.00
TOTAL FEE:
$669.00
Revised: 10/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS: 10 y'5 d mac! c) c N,
PERMIT #
OWNER'S NAME: v e r cvn
PHONE # o -$ l 'f
GENERAL CONTRALTO cr" F
BUSINESS LICENSE # c/Yw qw(K
ADDRESS: ,� rnci cue
CITY /ZIPCODE: ct r-e C
*Our municipal code requires all businesses working in the city to have a City of Cupertin'S business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU ONT ORS HAVE OBTAINED A CITY O C PERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Signature
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
Signature
Date