11100132CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10114 PARKWOOD DR I CONTRAC TOO STEVE PLEVANCIC I PERMIT NO: 11100132 I
NAME: AVERY GLENBROOK LP
528 S MATHILDA AVE STE 2
DATE ISSUED: 10/24/2011
)&R'S PHONE: 6509618330 1 SUNNYVALE, CA 94086 1 PHONE NO: (408) 806-9145
O, LICENSED CONTRACTOR'S DECLARATION
License Class 15 Lic. # qf-fG 26r
r
Contractor Q (e Lf AGc Date CJ d
I 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.
1 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.
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.
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 ource regMWiong per the Cupertino Municipal Code, Section
9.18. /) ,�..11 ,)C�
Signature Date 1 V c 1 1(
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
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.
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.
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 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,
, and expenses which may accrue against said City in consequence of the
gr., sting 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
BUILDING PERMIT INFO: BLDG r ELECT f— PLUMB r—
MECH F RESIDENTIAL I— COMMERCIAL
JOB DESCRIPTION: ALL UNITS- REPLACE 24 WINDOWS LIKE FOR LIKE
Sq. Ft Floor Area: Valuation: $20000
APN Number: 32627036.10114 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued killir'-: Date�� 2
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. I 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
OA"LU061d
agent:
` Date: J
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 Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1s 1 (408) 777-3228 - FAX (408) 777-3333 • buildingna.cupertino.org
CUPERTINO I I l M � 3�
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
1
DDRESS(�U
PROJECT ADDRESS/(-
C7
TYPE
� *
✓ 27 3C 0 . / V II
V _ n ^^! ` p
OWNER NAME� e7 / , N�
PHONE�� _O _ Q
E-MAIL
STREET D SSv !a
s'{ -
CITY, 1 CAJ l -n
DEMO
AREA
CONTACT NAME (' ✓
6
E i La
STREET ADDRESS#
1 CrTY, STATE, IIP
►� n e
v
F
❑ OWNER ❑ OWNER-B=ER ❑ OWNER AGENT 5K CONTRACTOR ❑ CONTRACTOR AGENT
❑ ARc=cT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Ll
�
c rlC{ C_
LICENSE NUMB
56
LICENSE TYPE
BUS. LIC M
COMPANY NAME
Q� mn
E-MAII.
S' 2u Cu
lY1a� I.CC��►1
F 'r a6 " 73-A �
If
STREET ADDRES!Q C a
CITY, STATE, ZIPONE
vale L
0
6- S
ARCHITECT/ENGINEER NAME ► ) iL
l� YT
TOTAL DECK/PORCH AREA
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
ATTACH
I
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
ff
N DWELLING UNITS:
EXISTING USE
PROPOSED USE CONSTR.
TYPE
A STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA. DETACH
I
ATTACH
I
N DWELLING UNITS:
IS A SECOND UNIT YES
SECOND STORY YES
BE 14G ADDED? ❑NO
ADDMON' ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS TBE BLDG AN ❑ YES
RECEWED BY:
TOTAL VALUATION:
PLANNING APPL! ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NOv'-
/, _J
Zd OoU�
By my signature beIow, I certify to each of the following: I am the property owner Or authorized agent to act on the pWarty owner's behalf. I have read this
application and the information I ect 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rslatingtion I authorize representatives of Cupertino
�ding
to enter the above -i
ti property for inspection purposes.
Signature of Applicant/Agent
Date: }
SUPPLEMENTAL INFORMATION REQUIRED
PLS COCK TYPE
ROVMG SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
�--
❑
lJ-BUUMING PLAN
existing building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUNTER
REVIEW
permit for new building.
❑ EXPRESS
❑ PLANMV-C 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
❑ Fmz DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
C1 MAJOR
❑ SANITARY SEWER DISTRICT
ibmittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldgtlpp Z011.doc revised 06/21/11
S)
%(
6c,
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627036.10114
DATE ISSUED.......: 10/24/2011
RECEIPT #......... BS000015126
REFERENCE ID # ...: 11100132
SITE ADDRESS .....: 10114 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 ....: ACCO MANAGEMENT CO
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
1WINREP EACH 8
24.00
652.00
0.00
----------
652.00
----------
0.00
----------
TOTAL PERMIT
----------
655.00
0.00
655.00
0.00
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 • buildingna.cupertino.org
F1 rrcW rnW.RTRT IrTION n ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
ORIGINAL PERMTT #
PROJECT ADDRESS 1
C/
TYPE
AFN *
%J /u� ' /% -7 3Co . l 0 II
V _ n ^^! ` p
OWNER NAME � e7 / �` �, N�
PHONE�� _O _ Q
E-MAII AvCryL s
/
STREET ADDRESS v !a
[30
s'{ -
CITY, l -n
0
F � -,
CONTACT NAME S.. (' ✓ C D
FU A t,> C t �..
TO ff - s' O to - % y) �
E j Tl � LL � /I•C �=_
STREET ADDRESS#
1 CITY, STATE, IIP
o n e
v
F
❑ OWNER ❑ OWNER-BUI mt ❑ OWNERAGENT D CONTRACTOR ❑ CONTRACTOR AGENT
❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NnLlLICENSE
CONTRACTOR NAME
�
c ✓ c-,
NUMB
LICENSE TYPE
BUS. TIC M
COMPANY NAME
Q,JP- mn ,
S' 2u Cu
lY1a� I.CC��►1
STREET ADDRES!Q C a
CITY, STATE, ZIP
vole L
0
ONE
6- S
ARCHITECTIINGINEER NAME ► ) iL
l� YT
TOTAL DECK/PORCH AREA
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
ATTACH
I
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
-i�
ti ,-io
(r)
N DWELLING UNITS:
EXISTING USE
PROPOSED USE CONSTR.
TYPE
A STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA. DETACH
I
ATTACH
I
N DWELLING UNITS:
IS A SECOND UNIT LI YES
SECOND STORY YES
BE 14G ADDED? ❑NO
ADDITION' ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS TBE BLDG AN ❑ YES
RECEII/ED BY:
TOTAL VALUATION:
PLANNING APPL! ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NOv'-
/, _J
Zd OoU�
By my signature beIow, I certify to each of the following: I am the property owner Or authorized agent to act on the pWarty owner's behalf. I have read this
application and the information I ect 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rslatingtion I authorize representatives of Cupertino
�ding
to enter the above -i
ti property for inspection purposes.
Signature of Applicant/Agent
Date: }
SUPPLEMENTAL INFORMATION REQUIRED
PLS COCK TYPE
ROVMG SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
�--
❑
u-BUUMING PLAN
existing building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUNTER
REVIEW
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
❑ Fmz DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
C1 MAJOR
❑ SANITARY SEWER DISTRICT
ibmittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldgtlpp Z011.doc revised 06/21/11
S)
L
' 7(
M
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627036.10114
DATE ISSUED.......: 10/24/2011
RECEIPT #......... BS000015126
REFERENCE ID # ...: 11100132
SITE ADDRESS .....: 10114 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 ....: ACCO MANAGEMENT CO
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
1WINREP EACH 8
24.00
652.00
0.00
----------
652.00
----------
0.00
----------
TOTAL PERMIT
----------
655.00
0.00
655.00
0.00