The URL can be used to link to this page

11090121CITY OF CUPERTINO BUILDING PERMIT IBUILDING ADDRESS: 10170 PARKWOOD DR I CONT DETER NED BD - TO BE I PERMIT NO: 11090121 OWNER'S NAME: AVERY GLENBROOK LP NER'S PHONE: 6509618330 LzY LICENSED CONTRACTOR'S DECLARATION License Class 18 Lic. # �G 96 Contractor /�eJc(k c L Date G 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: 1 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 source regulations per the Cupertino Municipal ode, S tion 9.18. Signature Date 0 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 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 ndemnify 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date DATE ISSUED: 09/20/2011 PHONE NO: F_ BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: ALL UNITS- MULTI -FAMILY REPLACE 24 WINDOWS NON-STRUCTURAL BEDROOMS TO MEET EMERGENCY RESCUE AND ESCAPE. Sq. Ft Floor Area: Valuation: $20000 APN Number: 32627037.10170 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Date: '�'~ 2-1– L,_ RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino unicipal Code, Chapter 9.1 and the Health & Safety Code, Secti 25505, 33, and 25534. Owner or authorized agent: Date: CONSTRUCTION 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professi 3 ITEMS OF 12 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32627037.10170 DATE ISSUED.......: 09/20/2011 RECEIPT #......... BS000014801 REFERENCE ID # 11090121 SITE ADDRESS 10170 PARKWOOD DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: AVERY GLENBROOK LP ADDRESS 130 E DANA ST CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA OPERATOR: SylviaM COPY # : 1 94041-1508 RECEIVED FROM AVERY CONSTRUCTION CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........ FEE ID UNIT QUANTITY --------------------------------- 1BCBSC VALUATION 20,000.00 1BSEISMICR VALUATION 20,000.00 1WINREP EACH 8 24.00 TOTAL PERMIT : AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 2.00 0.00 2.00 0.00 652.00 0.00 652.00 0.00 ---------- ---------- 655.00 ---------- 0.00 ---------- 655.00 0.00 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: IC) 1 7 6 PERMIT # OWNER'S NAME: Hvt=-P-Y CA Ler v3z-,,;c L 1 PHONE # GENERAL CONTRACTOR: 5T" BUSINESS LICENSE # ADDRESS: ,,S- k C;' u C I v� CITY/ZIPCODE: 0►1 r1 *Our municipal code requires all businesses working in the city to have a city or Uupertmo business ucense. 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 �! , I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature / ate SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting inoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature / ate CITY OF CUPERTINO l i r, rr rcrrTNir A Wnu - 111 J1111 . ITN(- DIVISION r EAU L' v 111V1A 1 Vi_ DDRESS: 10170 parkwood dr. - - - DATE: 09/20/2011 - - REVIEWED BY: bobs. &AAPN: BP#: 'VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: Multi -Family Dwelling Buildinca is >3 Stories Yes No jTiNTAMATION 1 GENRES PERMIT TYPE: WORT{ SCOPE multi -family replace windows non structural bedrooms to meet emergency rescue and escape. hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Fee Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 i Strom Motion Fee: 1BSEISMICR ., _ .. .. ... .., _. ^---e._W. Li e........_ nJ_4_:../ Q..l.nnl ofr 1 NOTE: This estimate does not include fees due to other Depts (i.e. 1'11DUC works, Jurlllury ac wei "wa, 9a., -------- ____ ....a .l.l . -i o y,i„ "" octnmato- Contact the Dent for addn l info. Thesefees are based on the prearrunury u[ vrneuuvii FEE ITEMS (I'ee Resohrtion 11-053 BjJ' %1.'11) uvuscu•isc .�••....•� FEE �••- -••- QTY/FEE �__.._____ _______ MISC ITEMS Plan Check Fee: $0.00 24 # $652.00 Window / Sliding Glass Door 1 wINREP Replacement Suppl. PC Fee: E) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Fee Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 i Strom Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Ii1d4�Stds Commission Fe.: IBCBSC $1.00 SUBTOTALS: $3.00 $652.00 TOTAL FEE: $655.00 Revised. 09/02/2011 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cr7,cupertino.org 71 X-17 r nATCTDT Tr InTT I I AT)nTTTnN F— ALTERATION / TI ❑ REVISION / DEFERRED �IbOtWOI ORIGINAL PERMIT # PROJECT ADDRESS I APN # OWNER NAME X ilii R Y C.J` CI� Y�Q..OpjC � ! PHONE 6s -o - 96/-,7�- E-MAIL STREET ADDRESS CITY, vZ/ n FA�F CONTACT NAME S (' ✓ L 7 L U Ata 1 L C.. P - D 6 � �'4' �O � o - l � E .i / L C' A b Li STREET ADDRESS x I CITY, STATE, ZIP fF ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR 1:1 CONTRACTOR AGENT ARCHITECT ENGINEER DEVELOPER ❑ TENANT 1 I / G� LICENSE TYPE 15 CONTRACTOR NAME )eve I nC-, C_ BUS. LIC # *LICIENBS VC:1 COMPANY NAME / L s c loo, I. �Cin'1STREET F 4C -S - 73; (4661 -Qre. 1 v- , Uh 1, ,eFu ADDRESSr+ STATE, ZIP - ('G{ P ONEYl ARCHITECT/ENGINEER NAME 1 i �,/L LICENSE NUMBER (� Y c BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK _ ♦ A+ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA y ,(�G� i►� 1 v L/ 9 BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES BEING ADDED? []NO SECOND STORY ❑YES ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN F]YES EICHLER HOME? ❑ NO RECEIVED BY: TOTAL VALUATION: t. _ p By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prrperty owner's behalf. I have read this application and the information I ha e rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local property for inspection purposes. tion. I authorize representatives of Cupertino to enter the above-i�ienti2// ordinances and state laws relating t u ding c g Signature of Applicant/Agent: Date: 1 w SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK nTE ROUTING SLIP TE �-COUNR EHIVING PLAN REVIEW �ILD- 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ 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 HEALTH BldgApp_2 011. doc revised 06/21/11 %t `2c,