11100121• CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10230 PARKWOOD DR
CONTRACTOR: STEVE PLEVANCIC
PERMIT NO: 11100121
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP
528 S MATHILDA AVE STE 2
DATE ISSUED: 10/24/2011
ER'S PHONE: 6509618330
SUNNYVALE, CA 94086
PHONE NO: (408) 806-9145
i
❑ LICENSED CONTRACTOR'S DECLARATION
�
BUILDING PERMIT INFO: BLDG F
ELECT PLUMB
License Class Lic. #
F F F
�
l
MECH RESIDENTIAL COMMERCIAL
-ontractor. �eL�_ear It I1 C ( Z Date IQ,& �/#
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.
1 hereby affirm under penalty of perjury one of the following two declarations:
have and will maintain a certificate of consent to self-insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
)erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $20000
lection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32627037.10230
Occupancy Type:
)ermit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
;orrect. I agree to comply with all city and county ordinances and state laws relating
o building construction, and hereby authorize representatives of this city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
ipon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
:osts, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
,ranting of this permit. Additionally, the applicant understands and will comply
vith all non-po' t urce regulations per the Cupertino Municipal Code, Section
Issued by Date�2� G�
).18.
signature r Date (C)
_
RE-ROOFS:
OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
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
he following two reasons:
inspection.
, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
✓ill do the work, and the structure is not intended or offered for sale (Sec.7044,
lusiness & Professions Code)
, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
onstruct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
eclarations:
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
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
ompensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
erformance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
ection 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
crmit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
X employ any person in any manner so as to become subject to the Worker's
Owne • auth ed agent: /
ompensation laws of California. If, after making this certificate of exemption, 1
Date: r / l/
-come subject to the Worker's Compensation provisions of the Labor Code, I must
((( l
)rthwith 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.)
certify that I have read this application and state that the above information is
Lender's Name
xrect. I agree to comply with all city and county ordinances and state laws relating
building construction, and hereby authorize representatives of this city to enter
Lender's Address
)on 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
-aiming of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
ith all non-point source regulations per the Cupertino Municipal Code, Section
18.
Licensed Professional
gnature Date
CCUPERTINO
1-7 wmv/1nxTeTDT Tf-MnAI
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(@cupertino.org
n e T -,r rTTnN n AT TPR ATnN / TT 17 RFVTSttON / DETERRED
(IlvG�a-1
ORIGINAL PERMIT #
PROJECT ADDRESS
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ARCHITECT/Et IGINEER NAME ► i ,�L
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LICENSE NUMBER
REMODEL AREA
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
PORCH AREA DECK AREA
CITY, STATE, ZIP
GARAGE AREA DETACH
PHONE
DESCRIPTION OF WORK
L l I 1
i
BldgApp_ Ol Ldoc revised 06/21/11
L
,7
EXISTING USE
PROPOSED USE CONSTR
TYPE
I N 5 RTES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
�C
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA DETACH
ATTACH
I
# DWELLING UNTTS:
IS A SECOND UNIT YES
SECOhD STORY OTES
BEING ADDED? ❑NO
ADDMON? [3NO
PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF
PLANNING APPL f ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICBLER SOME? ❑ NO
RECEIVED 4X;-
JJOTAL VALUATION: _
i
G
Z
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr9perty owner's behalf. I have read this
application and the information I ha a vided 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
-i
to enter the abWliLsl
tiEfd property for inspection purposes.
Signature of Applicant(Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYYE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER-Txe-COUNTER
BVII TNG PLAN REVIEW
permit for new building.
❑ EXPRM
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
C3sTArmmw
C1PVBLIC WORKS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
❑ Fina bm-r
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DLS-IRICT
ubmittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_ Ol Ldoc revised 06/21/11
L
,7
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627037.10230
DATE ISSUED.......: 10/24/2011
RECEIPT #.........: BS000015126
REFERENCE ID # ...: 11100121
SITE ADDRESS .....: 10230 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
CCUPERTINO
1-7 wmv/1nxTeTDT Tf-MnAI
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(@cupertino.org
n e T -,r rTTnN n AT TPR ATnN / TT 17 RFVTSttON / DETERRED
(IlvG�a-1
ORIGINAL PERMIT #
PROJECT ADDRESS
cr
_ �. - �`+ ` i
APN 7F ^ .
rJ t r] 2
o3-7.
OWNER NAME i /f✓� / ,_ "aoo j L, /J
PHONE6 j ..O - Q 61_
I N 5 RTES
E-MAIL A ei- t s �s LL•lQ�r
STREET Ss u
['30
� �
CTI Y.
J+✓ i
/! a
l_.I `
CONTACT NAME
St(. ✓(,
FvP,I),c%C_
t�
P` 0ff-8'O6� j �})'
tom,
ES►TC L� LCL /LCft-
STREET ADDRESSS.4-1
CITY, STA V61e
T
v
F
[3OWNER [3OWNER-BurLDER 13OWNER AGENT @ CONTRACTOR 13CONTRACTOR AGENT 13 ARCHITECT 13 INGIlIEER 13 DEVELOPER 13 TENANT
CONTRACTOR NAMEe r
I
�^
LICENSE NUMB %�
�•(
T.ICENSE TYPE j5
(�
BUS. LIC #
COMPANY NAME
Q Jf' n
[►
t E-�-� Q U V
yy-� /
! [GC N I L
F /r
? V6 737%;1 C4 kc.0
STREET ADDRES!Q 6
7Y, STATE 13? is le C. u
ONE 6^ S
ARCHITECT/Et IGINEER NAME ► i ,�L
(� 1, _
LICENSE NUMBER
REMODEL AREA
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
PORCH AREA DECK AREA
CITY, STATE, ZIP
GARAGE AREA DETACH
PHONE
DESCRIPTION OF WORK
L l I 1
i
BldgApp_ Ol Ldoc revised 06/21/11
L
,7
EXISTING USE
PROPOSED USE CONSTR
TYPE
I N 5 RTES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
�C
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA DETACH
ATTACH
I
# DWELLING UNTTS:
IS A SECOND UNIT YES
SECOhD STORY OTES
BEING ADDED? ❑NO
ADDMON? [3NO
PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF
PLANNING APPL f ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICBLER SOME? ❑ NO
RECEIVED 4X;-
JJOTAL VALUATION: _
i
G
Z
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr9perty owner's behalf. I have read this
application and the information I ha a vided 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
-i
to enter the abWliLsl
tiEfd property for inspection purposes.
Signature of Applicant(Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYYE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER-Txe-COUNTER
BVII TNG PLAN REVIEW
permit for new building.
❑ EXPRM
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
C3sTArmmw
C1PVBLIC WORKS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
❑ Fina bm-r
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DLS-IRICT
ubmittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_ Ol Ldoc revised 06/21/11
L
,7
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32627037.10230
DATE ISSUED.......: 10/24/2011
RECEIPT #.........: BS000015126
REFERENCE ID # ...: 11100121
SITE ADDRESS .....: 10230 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