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11100070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10194 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11100070 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/11/2011 C -R'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 15 Lic.# MECH RESIDENTIAL COMMERCIAL r Contractor e,,Jp 0Vc-1rI C% <Z— Date 1 CJ hl I//�__1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ALL-UNITS REPLACE MULTI-FAMILY 19 WINDOWS (commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL TO MEET EGRESS,RESCUE&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. 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:32627037.10194 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 1 0 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DA M LAST CALLED INSPECTION. 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: ^`J Date: Signature Date L OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being 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. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air 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 Compensation laws of California. If,after making this certificate of exemption,I Ob+ r r au rized agentT r, become subject to the Worker's Compensation provisions of the Labor Code,I must _ Date: V forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of"ork's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address r -nnify 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"a;iting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION IM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333- buildingQcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESStLl �t� "), 0 1APN# - / _ /1 -7 I OWNER NAME / Y �/L PHONE - E-MAIL ,ANL STREET ADDRESSCITY, ATE,ZIP4VL4AJ C44 F CONTACT NAME L ✓�, LSL A/J CA L PTCI,�-$ `�) d 6 STREET ADDRESS 7MTF- ZIP U IKE va ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT L.11-CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` LICENSE NUMB �j LICENSE TYPE BUS.LIC# e V Cl✓1 G-c C COMPANY NAME E-MAIL F �Ua 752 C4 g"o Q� n � h S t u E V I'1?a, I.CCJ y►1 STREET ADDRESS CITY,STATE,ZIP P ONE a7'` cr c/u ARCHITEC(ENGINEER NAME ► ) LICENSE NUMBER BUS.LIC# COMPANY NAME (� E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK t✓'{��j1`L W-w.� a 0=- Ks-k�.�.e.tr--., I�p.-F�-� /Tb, Lfig ��►1U� VV EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FP. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA _ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I 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? E3 NO zae C>0 13y my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pWerty owner's behalf. I have read this application and the information I ha a rovided is correct. I 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-identified property for inspection purposes. Signature of Applicant(Agent R Date: SUPPLEMENTAL INFORMATION REQUIRED CHECK TM ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for VER-THE-COUNTER ❑ BUILDING PLAN RLrviEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ E 7REss ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAMARD C1PU13UCgORKS 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT :bmittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: /Z PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: Qe� Jc+�t Gt` St. BUSINESS LICENSE# ADDRESS: ,(/yam CITY/ZIPCODE: QgOg'j(-- *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 CONTR TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature t 4 Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum / Wood Glass / Glazing Heating Insulation F- Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 04 It—owner/Contractor Signature Date