11100129CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10124 PARKWOOD DR I CONSTR CTOR:STEVE PLEVANCIC I PERMIT NO: 11100129 I
OWNER'S NAME: AVERY GLENBROOK LP
528 S MATHILDA AVE STE 2 1 DATE ISSUED: 10/24/2011
)R'S PHONE: 6509618330 I SUNNYVALE, CA 94086 PHONE NO: (408) 806-9145 I
Lai LICENSED CONTRACTOR'S DECLARATION
License Class 13 Lic. # 91(6%6
Contractor 1 eT a Date
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.
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.
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 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
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 -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date d
�ltl
LW 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
-unify and keep harmless the City of Cupertino against liabilities, judgments,
, 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.
Date
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH r RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: ALL UNITS- REPLACE 24 WINDOWS LIKE FOR LIKE
Sq. Ft Floor Area: Valuation: $20000
APN Number: 32627036.10124 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date: %a,Z `1_
z
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.
Ow • au or' ed agent;
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professi
CONSTRUCTION PERMIT APPLICATION
111 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
UPERTINO
(408) 777-3228 - FAX (408) 777-3333 - building(-cuoertino.oro
C^V I
F1 NEW CONSTRUCTION n ADDTTTnN n AT TFR ATTnN / TT n
PR07ECT ADDRESS % ` ( AFN ;* (.P ! V 3 10 124
OWNER NAME N�'"00I%J PHONEVJ O - T 61�k E M� �VLiL'',S ,
STREET ADDRESS
L30 �, �. A
,r-+.
CITY. TE. ZIP
m at✓4 ___J
Cf+
CONTACT NAME s I_ 1
✓
ev A t,% C% L
I PTC, Sr- rS d 6- 7 ��'
E
Sizla.J iuN_ �
STREEr ADDRESS
i_I CITY, STATE, ZIP
►� n e
v
F
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT D-CONTRACrOR ❑ CONTRACTOR AGENT
❑ ARCHITECT ❑ Ewwm ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME e f
r
C YJ C{ �C
LICENSE NUMB %�
`•/
LICENSE TYPE 45
BUS. LIC M
CDMPANY NAME
e•� ri
E-MAII
:. S Qu Qv
hr1a� I.Cvy►1
F1011-7 V -
STREET ADDRESS
S 6 a
CITY. STATE, ZIP
a
1(0
O
a- qpv
ARCHITECT/ENGINEER NAME ► )
(�
NET AREA
LICENSE NUMBER
BUS. LIC M
COMPANY NAME
E-MAIL
KITCHEN
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
AESCRUPIION OF WORK
_R
EXISTING USE
PROPOSED USE CONST"
TYPE
A STORUFS
USE
TYPE
OCC.
SQFT.
VALUATION (S)
E=TG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA OETACH
LJ ATTACH
I
N DWELLING UNITS: IS A SECOND UNIT YES
SECOND STORY YES
BEING ADDED? ❑NO
ADDITION- ❑NO
?"-APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL M ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
IES By: TOTAL VALUATION:
i
J,.
� �� a,00--`
13y my signature below, I c to each of the followin - I am theproperty
y g tee' Or authorized agent to act on the pr;nperty owner's behalf. I have read this
application and the information I haXe_provided 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 ding c tion. I authorize representatives of Cupertino to enter the above -id
ntifie property for inspection purposes.
Signature of Applicant(Agent
Date:
9
ST PLEIV[ENTAL INFORMATION REQUIRED
PLATY CHECK TYPE
ROUTMG SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
G�-TSO
Cl BUnZING PLATY REVIEW
permit for new building.
Cl EXPRESS
❑ PLAMUNG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11 STANDARD❑
form if any Hazardous Materials are being used as part of this project
PUBLIC WORIffi
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
Ibmittal of Building Permit application.
C1 MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRoNMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
't
f71
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627036.10124
DATE ISSUED.......: 10/24/2011
RECEIPT #.........: BS000015126
REFERENCE ID # ...: 11100129
SITE ADDRESS .....: 10124 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
111 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
UPERTINO
(408) 777-3228 - FAX (408) 777-3333 - building(-cuoertino.oro
C^V I
F1 NEW CONSTRUCTION n ADDTTTnN n AT TFR ATTnN / TT n
PR07ECT ADDRESS % ` ( AFN ;* (.P ! V 3 10 124
OWNER NAME N�'"00I%J PHONEVJ O - T 61�k E M� �VLiL'',S ,
STREET ADDRESS
L30 �, �. A
,r-+.
CITY. TE. ZIP
m at✓4 ___J
Cf+
CONTACT NAME s I_ 1
✓
ev A t,% C% L
I PTC, Sr- rS d 6- 7 ��'
E
Sizla.J iuN_ �
STREEr ADDRESS
i_I CITY, STATE, ZIP
►� n e
v
F
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT D-CONTRACrOR ❑ CONTRACTOR AGENT
❑ ARCHITECT ❑ Ewwm ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME e f
r
C YJ C{ �C
LICENSE NUMB %�
`•/
LICENSE TYPE 45
BUS. LIC M
CDMPANY NAME
e•� ri
E-MAII
:. S Qu Qv
hr1a� I.Cvy►1
F1011-7 V -
STREET ADDRESS
S 6 a
CITY. STATE, ZIP
a
1(0
O
a- qpv
ARCHITECT/ENGINEER NAME ► )
(�
NET AREA
LICENSE NUMBER
BUS. LIC M
COMPANY NAME
E-MAIL
KITCHEN
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
AESCRUPIION OF WORK
_R
EXISTING USE
PROPOSED USE CONST"
TYPE
A STORUFS
USE
TYPE
OCC.
SQFT.
VALUATION (S)
E=TG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA OETACH
LJ ATTACH
I
N DWELLING UNITS: IS A SECOND UNIT YES
SECOND STORY YES
BEING ADDED? ❑NO
ADDITION- ❑NO
?"-APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL M ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
IES By: TOTAL VALUATION:
i
J,.
� �� a,00--`
13y my signature below, I c to each of the followin - I am theproperty
y g tee' Or authorized agent to act on the pr;nperty owner's behalf. I have read this
application and the information I haXe_provided 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 ding c tion. I authorize representatives of Cupertino to enter the above -id
ntifie property for inspection purposes.
Signature of Applicant(Agent
Date:
9
ST PLEIV[ENTAL INFORMATION REQUIRED
PLATY CHECK TYPE
ROUTMG SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
G�-TSO
Cl BUnZING PLATY REVIEW
permit for new building.
Cl EXPRESS
❑ PLAMUNG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11 STANDARD❑
form if any Hazardous Materials are being used as part of this project
PUBLIC WORIffi
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
Ibmittal of Building Permit application.
C1 MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRoNMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
't
f71
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627036.10124
DATE ISSUED.......: 10/24/2011
RECEIPT #.........: BS000015126
REFERENCE ID # ...: 11100129
SITE ADDRESS .....: 10124 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