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11090122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10180 PARKWOOD DR CO'cTRACTOR:TB" -+Q6BE PERMIT NO: 11090122 OWNER'S NAME: AVERY GLENBROOK LPTEVE DATE ISSUED:09/20/2011 NER'S PHONE: 6509618330 CONSTRUCTION PHONE NO: LICENSED CONTRACTOR'S DECLARATIONr— �� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# F MECH RESIDENTIAL COMMERCIAL Contractor .5 IE'lx eqpli<< C— Date I herebyaffirm that I am licensed under the provisions oXChptr 9 dOB DESCRIPTION: ALL UNITS-MULTI-FAMILY REPLACE 24 WINDOWS PNON-STRUCTURAL BEDROOMS TO MEET EMERGENCY RESCUE (commencing with Section 7000)of Division 3 of the Business&Professions AND ESCAPE. 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. 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:32627037.10180 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 DAYS OF 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 DAYS FROM LAST 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 ermit. Add' ally,the applicant understands a d will mply Issued Date: with all non-p source r ulations per the Cupertino Municip Code, ection RE-ROOFS: Signature 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. Ll 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 I,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 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 I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Ai Quality Management Dis rict performance of the work for which this permit is issued. will maintain compliance withPthertino nicipal Code,Chapter 9 2 an 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec5,25 3,and 2534. Section 3700 of the Labor Code,for the performance of the work for which this / permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued,1 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 CONSTRUCTION LENDING AGENCY 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 for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ndemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1 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 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: 161 ,s-0 PERMIT# OWNER'S NAME: Avmy (c�r�• ur` �- PHONE# 4Y --g06, GENERAL CONTRACTOR: S�j i:-! J AQ,aG�C CCo,�. BUSINESS LICENSE# ADDRESS�j S` r��7 « # CITY/ZIPCODE:<-A)� v u o *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 SUBCON'T'RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -+ C!"1 am not using any subcontractors: - --� Signature bate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR 13USINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry tiPainting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 0 Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10180 parkwood dr. DATE: 09/20/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: $20,000 — J PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Famil Dwellin Buildina is PENTAMATION 1 GENRES USE: Y g >3 Stories 0 Yes (F) No PERMIT TYPE: WORK multi-family replace windows non structural bedrooms to meet emergency rescue and escape. SCOPE 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 ormation available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Et'. L'I1) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 $652.00 IWINREP Replacement 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 0 Work Without Permit? 0 Yes G No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $3.00 $652.00 TOTAL FEE: $655.00 Revised: 09/02/2011 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333- building(cDcupertino.org ( ) O 9 AL�� ❑NEW CONSTRUCTION ❑ ADDITION !.� TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS \1 APN# 2 _ �-1 0 27 . 0 � (i ( / ) (�(�/ J OWNER NAME ( N-6a00iC PHONE6�_O-g 6�-�l E-MAIL Avll)t ys ��r. STREET ADDRESS CITY, ATE,ZIP F CONTACT NAME _ PFjONE E- A�, StL Jl 7 ( UArJC�L 6- 47 `� )- S7`L �" �! a Cg R2�- STREET ADDRESS !( CITY,STATE, ow S. /W r -, CONTVt Vl ❑ OWNER ❑ OWNER-BUILDER 11 OWNER AGENT 5;I RACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME / ` LICENSE NUMB ) / LICENSE TYPE BUS.LIC# E'�1 1 V C4✓1 C-c �j(6 tq COMPANY NAME 1, E-MAIL F Y UB^75,;t�.� l n Ch s �� F� G ma, l,cvl STREET ADDRESS CITY,STATE ZIP p ONE fi o17`) " a v S z vu ie o -go 41S ARCHITECT/ENGINEER NAME f LICENSE NUMBER BUS.LIC# COMPANY NAME 6� E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK `� t`� X1-2 J-^�. pA'/+1'�- - lJ �-a�-✓u.� G_S wl�s•N/C 1_2 L✓V\S lC��t 1 N-/ l"_V. L AA- ` C. �� - EXISTING USE PROPOSED USE CONST?.TYPE #STORIES USE TYPE OCC. SQ Fr. VALUATION(S) ExLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH []ATTACH #DWELLING UNITS: IS A SECOND UMT ❑YES SECOND STORY 0 BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - �♦ Z'c��o00"` By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pry perry owner's behalf. I have read this application and the information I ha a rovided 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 laws relating u ding c tion. I authorize representatives of Cupertino to enter the abovedentifid property for inspection purposes. Signature of Applicant/Agent: Date: 91?_DZ SUPPLEMENTAL INFORMATION REQUIlMED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for � �ouN IEx C`�'suII nn,,G PLAN REyrEw 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 WORM 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 ❑ sANYTARY SEWER DISTRICT ,ubmittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06/21/11 1