11100126 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10153 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11100126
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LI' 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011
dE S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT [_ PLUMB F
License Class Lic.# zf 6 Co
MECH f— RESIDENTIAL� COMMERCIAL
Contractor �ft_t_,XmYIC,Z Date :�()��d ��
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ALL UNITS--REPLACE 24 WINDOWS LIKE FOR LIKE
(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 Sq.Ft Floor Area: Valuation:$20000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:32627037.10153 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree tocomply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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. Issued by.
Signature DateAA5/0
RE-ROOFS:
. OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's O r ut i age.1t:
Compensation laws of California. If,after making this certificate of exemption,1 Date: it
become subject to the Worker's Compensation provisions of the Labor Code,I must 40�
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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 ARCHITECT'S DECLARATION
g+ ::ting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
'[I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • building(co cupertino.org I I
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI [:] REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS � S 3h r �,1 � fr 777
2(o• 2 3-7 . l 01 53
OWNER NAME �_N� PHONE E-MAILAveitf
STREET ADDRESS 3 O Po+/A s'�–, ctrY y✓ ! 4'.� c4q
corrrwcr Nar¢ 1(-,J L eVArJC,L P`trJ�'�a 6� � y-)' ES TC c= LQ..�I
STREET ADDRESS 4-1A CITY.STATE,ZIP p
❑OWNER ❑ OWNER-BUMDER ❑ OWNERAGENT WCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINM ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ^ e I C y CA`- LICENSE NUMB `-J f6 76 (
LICENSE TYPE f 3 BUS.LIC M
COMPANY NAMESL, E-MAII ( � F �&t-75,;l r^
2� n 2 u Lou h?ar zoyC t
STREET ADDRESS � ELATE,ZIP ONE
y► vu le L a -,For.^ S
ARCHITECT/ENGINEER NAME ► ) LICENSE NUMBER BUS.LIC
COMPANY NAME (� E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
DESCRIPTION OF WORK
e _W,v cL
EXISTING USE PROPOSED USE CONSTR TYPE A STORIES
USE TYPE OCC. SQ.FT. VALUATION(5)
STC+ NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
v
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
M DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES
BMG ADDED? []NO ADDMON? [3NO
PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THS BLDG AN ❑YES RECEIVED BY. TOTAL VALUATION
PLANNING APPL A VALUATION-
[3 PLANNING APPROVAL LETTER EICHLER HOME? [3 NO -
b 1 za,000_=
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I ha avided 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-i ti$ property for inspection purposes.
Signature of Applicant(Agent I
Date:
SUPPLEMENTAL INFORMATION REQLMED PLAN CHECK TMG SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for -
eXdsting building(s). Demolition permit is required prior to issuance of building `L7-�.R-TBE-COUN M BUILD H4G PLAN REVIEW
permit for new building. Cl MORM ❑ PLAMUNG PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ❑ PUBLICwORKB
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
Ibmittal of Building Permit application. ❑ MAJOR ❑ SANTTARY SEWER DISTRICT
❑ K"MONMENTAL HEALTH
31dg,4pp_Z011.doc revised 06/21/11 6/
�J
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32627037.10153
DATE ISSUED. . . . . . . : 10/24/2011
RECEIPT #. . . . . . . . . BS000015126
REFERENCE ID # . . . : 11100126
SITE ADDRESS . . . . . : 10153 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
'[I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • building(co cupertino.org I I
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI [:] REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS � S 3h r �,1 � fr 777
2(o• 2 3-7 . l 01 53
OWNER NAME �_N� PHONE E-MAILAveitf
STREET ADDRESS 3 O Po+/A s'�–, ctrY y✓ ! 4'.� c4q
corrrwcr Nar¢ 1(-,J L eVArJC,L P`trJ�'�a 6� � y-)' ES TC c= LQ..�I
STREET ADDRESS 4-1A CITY.STATE,ZIP p
❑OWNER ❑ OWNER-BUMDER ❑ OWNERAGENT WCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINM ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ^ e I C y CA`- LICENSE NUMB `-J f6 76 (
LICENSE TYPE f 3 BUS.LIC M
COMPANY NAMESL, E-MAII ( � F �&t-75,;l r^
2� n 2 u Lou h?ar zoyC t
STREET ADDRESS � ELATE,ZIP ONE
y► vu le L a -,For.^ S
ARCHITECT/ENGINEER NAME ► ) LICENSE NUMBER BUS.LIC
COMPANY NAME (� E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
DESCRIPTION OF WORK
e _W,v cL
EXISTING USE PROPOSED USE CONSTR TYPE A STORIES
USE TYPE OCC. SQ.FT. VALUATION(5)
STC+ NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
v
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
M DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES
BMG ADDED? []NO ADDMON? [3NO
PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THS BLDG AN ❑YES RECEIVED BY. TOTAL VALUATION
PLANNING APPL A VALUATION-
[3 PLANNING APPROVAL LETTER EICHLER HOME? [3 NO -
b 1 za,000_=
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I ha avided 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-i ti$ property for inspection purposes.
Signature of Applicant(Agent I
Date:
SUPPLEMENTAL INFORMATION REQLMED PLAN CHECK TMG SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for -
eXdsting building(s). Demolition permit is required prior to issuance of building `L7-�.R-TBE-COUN M BUILD H4G PLAN REVIEW
permit for new building. Cl MORM ❑ PLAMUNG PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ❑ PUBLICwORKB
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
Ibmittal of Building Permit application. ❑ MAJOR ❑ SANTTARY SEWER DISTRICT
❑ K"MONMENTAL HEALTH
31dg,4pp_Z011.doc revised 06/21/11 6/
�J
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32627037.10153
DATE ISSUED. . . . . . . : 10/24/2011
RECEIPT #. . . . . . . . . BS000015126
REFERENCE ID # . . . : 11100126
SITE ADDRESS . . . . . : 10153 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