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11100122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10245 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11100122 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011 1ER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 LICENSED CONTRACTOR'S DECLARATION n BUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class Lic.# r , ^ MECH RESIDENTIAL COMMERCIAL Contractor" �'3'-e&AJ _ k U GI?G c Date 0 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. I 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:32627037.10245 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM 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 Issued 9.18• Date Signature Date G 1� RE-ROOFS: OWNER-BUILDER DECLARATION 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 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 Ow ize gent: Compensation laws of California. If,after making this certificate of exemption,I Date: r become subject to the Worker's Compensation provisions of the Labor Code,I must VAW 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 Hork'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 i-'-mnify 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 CONSTRUCTION PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 • building(d)cupertino.org I /�, ?i2 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI [IREVISION/DEFERRED ORIGINAL PERMIT# lJ�' PROIECT ADDRESS / C);� 5 L 1APN* 3 21G. OWNER NAME LJlfl�� / �`�i N� / Nv►"H'r'r' P/ �/ a00I� 1 p PHONE��_O-a��_� E-MAIL ,AvL�L S STREET ADDRESS "vCJ h r T Ir 3 O Ac,✓A �-�. CrrY. �./ � 14,j ,Ce F .l'- 0��I i 7r CONTACT NAME S�s1'C:✓t,� C'v Ani c�C.. P�r?fs-�061 1 `F�' E_S7 c r La.J tit n- 4v STREETADDRESS +1 CIT Y,STATN >1 e CA U F - 141(64 A7$C❑OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT LIICONTRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEgJ e I \./Ci C ✓1 C{ \C LICENSE NUMB J l 6 (7� LICENSE TYPE f Z BUS.L/ITC M ? COMPANY NAME E-MAII �-( (� F '(�6'7J� e,,e n S Qv eu hr1aN 1,Cv)wLZW STREET ADDRESS 6 CITY,STATE.ZIP PONE - a va le- L a S ARCHITECTIENGINEER NAME ► 9 iL LICENSE NUMBER BUS.LIC# COMPANY NAME (� Y` E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �e_J(4' L( EXISTING USE PROPOSED USE CONSTR TYPE #STORIES `Z_0 USE TYPE OCC. SQ.FT. VALUATION(S) EIGSTG NEW FLOOR DEMO TOTAL y AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER 1 REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH ATTACH #DWELL NG UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ONO ADDMOK7 []NO PRE-APPLICATION ❑YES IFYES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEDjED HY TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO t By 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 on. I authorize representatives of Cupertino to enter the above-iof perry for inspection purposes.I r Signature of Applicant(Agent Date: C 5 t SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for Iy ovER TIS-couNTER LJ suit nnvG PLAN xEviEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLAmq NG PLAN Rrvmw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3 STANDARD C1PUBLICwORICB form if any Hazardous Materials are being used as part of this project. ❑ caRGE ❑ nRz bm-r _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MANOR ❑ SANrrARY SEWER DISTRICT abmittal of Building Permit application. ❑ ENVIRONMENTAL BEAT T8 BldgApp_201 Ldoc revised 06/21/11'/ UIP CITY OF CUPERTINO 3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32627037.10245 DATE ISSUED. . . . . . . : 10/24/2011 RECEIPT #. . . . . . . . . : BS000015126 REFERENCE ID # . . . : 11100122 SITE ADDRESS . . . . . : 10245 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