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11090124 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10190 PARKWOOD DR CONTRACTOR: - PERMIT NO: 11090124 I)ETF� RMII D OWNER'S NAME: AVERY GLENBROOK LP p�-e V�zn Gl G DATE ISSUED:09/20/2011 OWNEL PHONE: 6509618330 ��• ��vns+–ri_tc+to Y1 PHONE NO: ov LICENSED CONTRACTOR'S DECLARATIONF F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 1— F_ MECH RESIDENTIAL COMMERCIAL Contractor._ '�C' C�/ I't C Date I herebyaffirm that I am licensed under the provisions of ha ter 9 JOB DESCRIPTION: ALL UNITS-MULTI-FAMILY REPLACE 24 WINDOWS p p 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 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 APN Number:32627037.10190 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 thisp mit. Additionally,the applicant understands an will comply Issued bV' Date: with all non-poi urce re ulations per the Cupertino Municipal ode,S ction 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. J 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 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 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. I 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 ay Are Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t perti Municipal Code,Chapter 9.1 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect on 5505 5533,and 25534. 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,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 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 upon the above mentioned property for inspection purposes.(We)agree to save '-�mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .s,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 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 32627037 . 10190 DATE ISSUED. . . . . . . : 09/20/2011 RECEIPT # . . . . . . . . . BS000014801 REFERENCE ID # . . - : 11090124 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 . . . . : AVERY CONSTRUCTION CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 20, 000 . 00 4 . 00 0 . 00 4 . 00 0 . 00 1BSEISMICR VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1WINREP EACH 8 24 . 00 1304 . 00 0 . 00 1304 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1310 . 00 0 . 00 1310 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 3 , 275 . 00 MC --------------- TOTAL RECEIPT 3, 275 . 00 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: (o cj o �w� -� b PERMIT# OWNER'S NAME: PHONE# Cr - tS . GENERAL CONTRACTOR:sic.,)t2- BUSINESS LICENSE # ADDRESS: uc CITY/ZIPCODE:S v r �j VU F C *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - -' 9X'2C)III I am not using any subcontractors: Signature ate Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting oleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature I Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10190 parkwood dr. DATE: 09/20/2011 REVIEWED BY: bob s. APN: I BP#: "VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Buildina is PENTAMATION 1 GENRES USE: Multi-Family Dwelling >3 Stories 0 Yes (F) No PERMIT TYPE: WORK multi-family replace windows non structural bedrooms to meet emergency rescue and escape. SCOPE Li LJ 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 onlE an estimate. Contact the Dept-for addn7 info, FEE ITEMS (Fee Resolution 11-053 Eff ? 7;'Il j FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 24 # Window/Sliding Glass Door Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $652.00 /wlNREP 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? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 i Strong.Motion Fee: IBSEISMICR $2.00 Select an Administrative Item BldL,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.00 $652.001 TOTAL FEE: $655.00 Revised: 09/02/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 - building(cDcupertino.org El NEW CONSTRUCTION ❑ ADDITION RATION/TIREVISION/ O�Z41❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS APN GW OWNER NAME X�� Y �L N►3(ZpOi� G PxoNE61_O-g b�—,�l E-MAIL � CTY, TATVSTREET ADDRESS OZ (� rn3 O FA [ — 94 CONTACT NAME + PRONE E_ S I ('✓C- > C;-VArJC� i l4 it Cg /I2�!- ' STREET ADDRESS #I CITY,STATE, ZIP F ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT WKCONTRACCOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEgiVC C_kLICENSE NUMB , / / LICINSE TYPE BUS.LIC# VCt COMPANY NAME E-MAIL F Y 1t /j� e.Je nvh �S e(I FL G r►?a, I,C� STREET'ADDRESS f� CITY,STATE ZIP P ONE ARCHITECTIENGINEER NAME ► ) n_ LICENSE NUMBER BUS.LIC# COMPANY NAME (� YT E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �\ t�'�J`A L C"w.. CJ f� f�3.1LE��0.U-`�. �j P`"�11 �P�vr EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES `� USE TYPE OCC. SQ.Ff. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL � AREA AREA NET AREA BATHROOM KITCHIN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: IS 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 APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO «J J By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I ha a rovided is correct. 1 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 abovejdentifled property for inspection purposes. Signature ofApplicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED -� PLA CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTER BUn DING PLAN REv>Ew permit for new building. ❑ EXPRESS ❑ PLANNING PIAN REvrEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srANDARD ❑ PUBLICwORKS 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 lbmittal of Building Permit application. ❑ MAJOR ❑ sANrrARy SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11