11090198 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10190 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11090198
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:09/28/2011
''BIER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clasg' ]`-1 C �e Lic.# ri,Z
/ ; r MECH RESIDENTIAL COMMERCIAL
Contractor J�E'�i C'- P(C Vc (11 r, c C Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DECK REPAIR AND REPLACEMENT
(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. 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
permit is issued. APN Number:32627037.10190 Occupancy Type:
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 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 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM 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-point source regulations per the Cupertino Municipal Code,Section Issued by� Date:
-
9.18.
Signature Date �.,
RE-ROOFS:
OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I 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
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Ownpr or aut orized agent. /
Compensation laws of California. If,after making this certificate of exemption,I = - Dater
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 AGENCY
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 I have read this application and state that the above information is Lender's Name
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 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,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
z; mg 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627037. 10190
DATE ISSUED. . . . . . . : 09/28/2011
RECEIPT #. . . . . . . . . : BS000014882
REFERENCE ID # . . . : 11090198
SITE ADDRESS . . . . . : 10190 PARKWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : AVERY GLENBROOK LP
ADDRESS 130 E DANA ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041-1508
RECEIVED FROM . . . . : STEVE P PLEVANCIC
CONTRACTOR . . . . . . . : STEVE PLEVANCIC LIC # 32967
COMPANY . . . . . . . . . . : STEVE PLEVANCIC CONSTRUCTION
ADDRESS 528 S MATHILDA AVE STE 2
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 806-9145
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 20, 000 . 00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0. 00
1DECKWOOD EACH 1. 00 457. 00 0 . 00 457. 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 460. 00 0. 00 460 .00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 460. 00 VISA
---------------
TOTAL RECEIPT 460. 00
CONSTRUCTION PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228- FAX(408)777-3333• building(EDcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROIECT ADDRESS._ .. - =� APN S -7 '7 t 71
OWNER NAME i I&� y �/ N� PHONE6s _FE-MAIL�vC
�Jaao;C L N
STREET ss C , TE,Z✓�30 pvI'('J C'o
CONTACT NAME
S (, ✓(. �U A rJ C L P`tC�fs- O 6 y)' E S rL fv LLL L
STREET ADDRESS i( CITY,STATE ZIP F
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT a CONTRACTOR 13 CONTRACTOR AGENT 13 ARCFUTECT ❑ENGWEER 13 DEVELOPER ❑TENANT
e LICENSE NUMB / a
CONTRACTOR NAME LICENSE TYPE BUS.LICf0
_TJ
COMPANY NAMES�L E-MAIL F
(4 k6w
Lic 406 Ma
STREET ADDRES!Q c STATE,ZIP ONE
b A Vu le L U - !o " -S
ARCHITECT(ENGWEER NAME iL LICENSE NUMBER BUS.LIC N
COMPANY NAME Y E-MAM FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIIMON OF WORK
EXISTING USE PROPOSED USE coNSTL TYPE N STORIES
USE TYPE OCC. SQ.Fr. VALUATION(S)
ExISTG FLOOR DEMCP TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
M DWELLING UNITS: IS A SECOND UNIT YEs SECOND STORY YES
BMG ADDED? ONO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS TEE BLDG AN ❑YES RECEIVED BY:1 /-1,6 TZOTAL VALUATION:
PLANNING APPL I ❑NO PLANNING APPROVAL LETTER EICHLER SOME? ❑NO �'-
d�0 0 0
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 information I ha a vided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with allapplicable local
ordinances and state laws relating ding c tion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant(Agent: Date: Z �F-1I
SUPPLEMENTAL INFORMATION REQUIRED PIAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for [I-0yff-THE-COUNTER [�-g45nnvG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ MRESS ❑ PLANMG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3STANDARD ❑ PUBLIC wORICS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal Of Building Permit application.
❑ ENVIRONMENTAL RZALP
31dgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10190 parkwood dr. apt#2 DATE: 09/28/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$20,000
;�PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-Famil Dwelling Building is PENTAMATION 1GENRES
USE: Y g >3 Stories 0 Yes (F) No PERMIT TYPE:
WORK deck repair and replacement.
SCOPE
Lj
NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fez'Resohition 11-053 LI 7`1/1 F FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Deck/Deck Railing
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $457.00 IDECKwooD Deck(wood)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? Q Yes No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
A
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
L
dg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: j $3.00 $457.00 TOTAL FEE: $460.00
Revised: 09/02/2011
Building Department
City Of Cupertino
LM 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: (` t C v . 'C)o PERMIT# f '
OWNER'S NAME: v o r- i? L PHONE#� C� ��> —C
GENERAL CONTRACTOR: S�e'!e BUSINESS LICENSE#
ADDRESS: 5 Vr cZ v ' �� CITY/ZIPCODE: << n ri /C- P U
*Our municipal code requires all businesses working in the city to have a City of Cupertino firusiness license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. ..`
1 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
�r Owner/Contractor Signature ate