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11090123 rIT7V r-17 rTTV7PTTNTn CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10184 PARKWOOD DR CuNTRACTOR:TB$ 9-BE PERMIT NO: 11090123 D OWNER'S NAME: AVERY GLENBROOK LP STEVE PLEVANCIC DATE ISSUED:09/20/2011 'NER'S PHONE: 6509618330 CONRUCTION PHONE NO: LICENSED CONTRACTOR'S DECLARATION f— F_ 6? BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# % tO le F_ F_ F - ,7 MECH RESIDENTIAL COMMERCIAL Contractor ,`/7�-t.C./'IE''✓<i n C-1 CDate gAllp I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ALL UNITS-MULTI-FAMILY REPLACE 24 WINDOWS NON-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: 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 APN Number:32627037.10184 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I 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 th' permit. Additionally,the applicant understands and ill comply Issued b Date: / [/ with all no of fsourc lations per the Cupertino Municipal ode, ection 9.18. 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 1 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 which this permit is issued. will maintain compliance with the ertino M i ' I Code,Chapter 9.12 d 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5 05,2553 ,and 534. Section 3700 of the Labor Code,for the performance of the work for which this / Owner or authorized agent: Date: 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,1 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 1 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 ,loon the above mentioned property for inspection purposes.(We)agree to save emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,sts,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 ADDRESS: 10184 parkwood dr. DATE: 09/20/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 GENRES USE: >3 Stories 0 Yes (F)) No PERMIT TYPE: WORK multi-family replace windows non structural bedrooms to meet emergency rescue and escape. SCOPE Li NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Theseees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolutioir 11-053 E('. ?'L'11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 24 # Window/Sliding Glass Door Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $652.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. OT 0.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes (F) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure i Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $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 (408)777-3228• FAX(408)777-3333 • building(ccupertino.org ' O' ^ CUPERTINO S ❑NEW CONSTRUCTION ❑ ADDITION RATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS J / u Y^ APN# C)3-7. b OWNER NAME 4 V �/L r y n PHONE61 O-9�(_� E-MAII ,�TAvev_,fS STREET ADDRESS _ \ ( K vV ( (/ ( CITY. 4TE ZIP n 7/ 3� ,J l�.v R S�, f�J J"✓�/1�J 1.til �I.,-� w CONTACT NAME > U A(Q,C L P`ko 15-- STREET ADDRESSi J CITY,STATE, ZIP FIX ,� n e c� -M 712 ❑OWNER ElOWNER-BUILDER ❑ OWNER AGENT 5CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEv v / LICENSE NUMB �("/ LICENSE TYPE BUS.LIC# C. 1 uc4✓l C,'C- /� COMPANY AME E-MAIL F N `1�� 3� e.� l n '� �h ,E. s Qu F� ma, 60'm STREET ADDRESS, c -�l CITY,STATE,ZIP P ONE V S ,1 . Vct �� L• C1 - C�(o ARCHITECT/ENGINEER NAME ► ) �t_ LICENSE NUMBER Bus.LIC# COMPANY NAME 6v YT E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK G^{J`�L C�`^•�'�" v� �k]-.�¢,J--., �llA"�1'L- I J tC..e.�-.tiI•�, � �-/i�r�'V tL L ��C•10 EXISTING USE PROPOSED USE CONST R-TYPE #STORIES USE TYPE OCC. SQ.FI'. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL / AREA AREA AREA NET AREA NIAk, �� —1 ,^ b/2- BATHROOM KITCHEN OTHER L REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA LIDETACH ❑ATTACH #DWELLING UNITS: LS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING ADPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO r +" By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prsrperty 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 above-id fled perty for inspection purposes. Signature of Applicant/Agent4 Date: Z 0 // SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE �-- ROUIING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for THE couNTER BUILDING PLAN REVIEW 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 C3STANDARD ❑ PUBLIC WOPM form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ PE bM _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT lbmittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11