11100165U CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDI ESS: 10174 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 11100165
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 1528 S MATHILDA AVE STE 2 1 DATE ISSUED: 10/24/2011
Q
"R'S PHONE: 6509618330
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #-&7 �6 J16
Contractor 54 Q — CG'00 ce L Date C)
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.
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-ponAt source regulations per the Cupertino Municipal ode, Section
9.18. � /_-) F
Signature�--- Datet{ v r7
L OWNER -BUILDER DECLARATION
I hereby affirm that 1 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)
I, 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.
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.
I certify that in the performance of the work for which this permit is issued, l 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
indAmnify and keep harmless the City of Cupertino against liabilities, judgments,
c .nd expenses which may accrue against said City in consequence of the
gi. _ .ag 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
SUNNYVALE, CA 94086 ' PHONE NO: (408) 806-9145
BUILDING PERMIT INFO: BLDG r ELECT F PLUMB f—
MECH I— RESIDENTIAL I— COMMERCIAL I—
JOB DESCRIPTION: REPLACE 30 WINDOWS AT EXISTING APT. COMPLEX
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32627037.10174 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: J mate: ��� �►_
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.
Owner' d nt:
Date: 6 �
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
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627037.10174
DATE ISSUED.......: 10/24/2011
RECEIPT #.........: BS000015127
REFERENCE ID # ...: 11100165
SITE ADDRESS 10174 PARKWOOD DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER AVERY GLENBROOK LP
ADDRESS ..........: 130 E DANA ST
CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94041-1508
RECEIVED FROM ....: STEVE P PLEVANCIC
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
30.00
782.00
0.00
782.00
0.00
TOTAL PERMIT
----------
785.00
----------
0.00
----------
785.00
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
785.00
---------------
785.00
REFERENCE NUMBER
--------------------
VISA
CUPERTINO
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)) 777-3228 • FAX (408) 7777-3333 - buildingecuoertino ora
F-1 I ADDITInN I I -AT TFR ATTON / TT I 1 D Ctrrcrn*t i ntrrn n. -r,
PROTECT ADDRESS / ,-
I L_ [� ,� I C
f / �
) _ APT' * �v_j
rLiV'U.L M
^ 1 0 3-7 y f 1 -7
{/
OWNER NAME V02 /
PHONE -1
T v
E-MAIL ,A, ,C� �S
fV
STREET ADDRESS
30 ��� ��
CITY.
l �E
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
I XJ
M DWELLING UNITS: IS A SECOND UNrT YES SECOND STORY YES
CONTACT NAME 1 C ✓ C `sU A t3 C 1 C.
r
PZl ON k- p' O (> 7 `+�'
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES
PLANNING ADPL / ❑NO PLANNING APPROVAL LETTER EICID.ER HOME? ❑ NO
Lo..J &,13-
n,13_STREET
STREETADDRESS
4a CITY. STATE. ZIP
By My 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
g
c tion. I authorize representatives of Cupertino to enter the abovdentified property for inspection purposes.
Signature of Applieant/Agmt
1e-
L
❑ OwNE t ❑ OwNER-BUILDER ❑ OWNER AGENT LIYCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME '. t?l C n C{ \C
`-
LICENSE NUMB �-f%6
LICENSE TYPE j'Z
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BUS. LIC N
COMPANY NAME
e•� n N
E-MAIL
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STREET ADDRESS a
.STATE, I
Yl u le C. a
❑ MORESS ❑ PLANMG PLAN REvMW
ONE
_ s
ARCHITECT/ENGINEER NAME L )
(�
LICENSE NUMBER
BUS. LIC
COMPANY NAME
-ubmittal of Building Permit application.
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�.
k j
BUSTING USE PROPOSED USE CONSTR TYPE x STORIES
I
USE TYPE OCC. SQ.FT. VALUATION (S)
E7GSTC NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
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 UNrT YES SECOND STORY YES
BWG ADDED? ❑NO ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES
PLANNING ADPL / ❑NO PLANNING APPROVAL LETTER EICID.ER HOME? ❑ NO
RECEIVID BY: TOTAL VALUATION:
/ r
J
By My 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 a vided 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 abovdentified property for inspection purposes.
Signature of Applieant/Agmt
1e-
L
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE G SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
°_moo Bvn.DnvG PIAN REviEw
permit for new building.
❑ MORESS ❑ PLANMG PLAN REvMW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11STANDARD ❑ PUBUCwORKB
form. if any Hazardous Materials are being used as part of this project
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE ❑ FIRE DEPT
-ubmittal of Building Permit application.
❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
M
�' CITY OF CUPERTINO
rV_M__ 11 FFF. FRTIMATOR — BUILDING DIVISION
kal10/24/2011
ADDRESS: 10174 parkwood dr.
DATE:
REVIEWED BY: bobs.
APN:
BP#:
VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
3 Stories 0 Yes (F) No
PENTAMATION 1GENRES
PERMIT TYPE:
wORK
replace 30 windows at existing apt complex.
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, etre,,'anuary Jewer uistrict, 3cnool
�.,. Th.,o., f'.,-ro h -d nes Oho .,ral:..d""my infinrs»atinn availahlo and aro nnly an octimaty_ Cowart the Dent far addn'l info.
FEE ITEMS (!ee Resolution 11-053 Elf 7111,;11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
L 30 1 #
$782.00
Window / Sliding Glass Door
1WINREP Replacement
Suppl. PC Fee: (F) Reg. Q OT
Fo7o
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.S Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (F) 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
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.00
$782.00
TOTAL FEE:
$785.00
Revised: 10/01/2011
'UPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: U L
Car 2 c� : c
PERMIT #67
OWNER'S NAME: ale v' ..
PHONE # y S
GENERAL CONTRACTOR:
�,-� �`�c, ``
BUSINESS LICENSE #
ADDRESS: � S. i r
',�� c �ti `,c,�� _
CITY/ZIPCODE:
*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.
I am not using any subcontractors: � -�. r'(✓� cj`Z-
////
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
0 Do /)/ I -
D to
CUPERTINO
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)) 777-3228 • FAX (408) 7777-3333 - buildingecuoertino ora
F-1 I ADDITInN I I -AT TFR ATTON / TT I 1 D Ctrrcrn*t i ntrrn n. -r,
PROTECT ADDRESS / ,-
I L_ [� ,� I C
f / �
) _ APT' * �v_j
rLiV'U.L M
^ 1 0 3-7 y f 1 -7
{/
OWNER NAME V02 /
PHONE -1
T v
E-MAIL ,A, ,C� �S
fV
STREET ADDRESS
30 ��� ��
CITY.
l �E
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
ATTACH
I XJ
M DWELLING UNITS: IS A SECOND UNrT YES SECOND STORY YES
CONTACT NAME 1 C ✓ C `sU A t3 C 1 C.
r
PZl ON k- p' O (> 7 `+�'
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES
PLANNING ADPL / ❑NO PLANNING APPROVAL LETTER EICID.ER HOME? ❑ NO
Lo..J &,13-
n,13_STREET
STREETADDRESS
4a CITY. STATE. ZIP
By My 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
g
c tion. I authorize representatives of Cupertino to enter the abovdentified property for inspection purposes.
Signature of Applieant/Agmt
1e-
L
❑ OwNE t ❑ OwNER-BUILDER ❑ OWNER AGENT LIYCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME '. t?l C n C{ \C
`-
LICENSE NUMB �-f%6
LICENSE TYPE j'Z
(�
BUS. LIC N
COMPANY NAME
e•� n N
E-MAIL
S 2 v Lu
%1a� �.Cc��►t
F df'vt
STREET ADDRESS a
.STATE, I
Yl u le C. a
❑ MORESS ❑ PLANMG PLAN REvMW
ONE
_ s
ARCHITECT/ENGINEER NAME L )
(�
LICENSE NUMBER
BUS. LIC
COMPANY NAME
-ubmittal of Building Permit application.
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�.
k j
BUSTING USE PROPOSED USE CONSTR TYPE x STORIES
I
USE TYPE OCC. SQ.FT. VALUATION (S)
E7GSTC NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
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 UNrT YES SECOND STORY YES
BWG ADDED? ❑NO ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES
PLANNING ADPL / ❑NO PLANNING APPROVAL LETTER EICID.ER HOME? ❑ NO
RECEIVID BY: TOTAL VALUATION:
/ r
J
By My 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 a vided 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 abovdentified property for inspection purposes.
Signature of Applieant/Agmt
1e-
L
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE G SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
°_moo Bvn.DnvG PIAN REviEw
permit for new building.
❑ MORESS ❑ PLANMG PLAN REvMW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11STANDARD ❑ PUBUCwORKB
form. if any Hazardous Materials are being used as part of this project
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE ❑ FIRE DEPT
-ubmittal of Building Permit application.
❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
M
�' CITY OF CUPERTINO
rV_M__ 11 FFF. FRTIMATOR — BUILDING DIVISION
kal10/24/2011
ADDRESS: 10174 parkwood dr.
DATE:
REVIEWED BY: bobs.
APN:
BP#:
VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
3 Stories 0 Yes (F) No
PENTAMATION 1GENRES
PERMIT TYPE:
wORK
replace 30 windows at existing apt complex.
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, etre,,'anuary Jewer uistrict, 3cnool
�.,. Th.,o., f'.,-ro h -d nes Oho .,ral:..d""my infinrs»atinn availahlo and aro nnly an octimaty_ Cowart the Dent far addn'l info.
FEE ITEMS (!ee Resolution 11-053 Elf 7111,;11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
L 30 1 #
$782.00
Window / Sliding Glass Door
1WINREP Replacement
Suppl. PC Fee: (F) Reg. Q OT
Fo7o
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.S Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (F) 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
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.00
$782.00
TOTAL FEE:
$785.00
Revised: 10/01/2011
'UPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: U L
Car 2 c� : c
PERMIT #67
OWNER'S NAME: ale v' ..
PHONE # y S
GENERAL CONTRACTOR:
�,-� �`�c, ``
BUSINESS LICENSE #
ADDRESS: � S. i r
',�� c �ti `,c,�� _
CITY/ZIPCODE:
*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.
I am not using any subcontractors: � -�. r'(✓� cj`Z-
////
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
0 Do /)/ I -
D to