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11100123CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10253 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 11100123 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011 VER'S PHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806-9145 ❑ LICENSED CONTRACTOR'S DECLARATION r r r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # /7 Co 96 911" f— � MECH RESIDENTIALr COMMERCIAL Contractors-�X•f DLV! G L_Date told 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. l 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 APN Number: 32627037.10253 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED [o 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. ;osts, and expenses which may accrue against said City in consequence of the ;ranting of this permit. Additionally, the applicant understands and will comply with all non-poi t rce regulations per the Cupertino Municipal Code, Section Issued x.18. Signature Date V / 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. , 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, 3usiness & 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE leclarations: I have read the hazardous materials requirements under Chapter 6.95 of the have and will maintain a Certificate of Consent to self-insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 lection 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 >ermit 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. iot employ any person in any manner so as to become subject to the Worker's :ompensation laws of California. If, after making this certificate of exemption, I O or ut zed ent: Date:l >ecome subject to the Worker's Compensation provisions of the Labor Code, I must brthwith 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 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 Lender's Address ipon the above mentioned property for inspection purposes. (We) agree to save - ' 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 ;i witing of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. vith all non-point source regulations per the Cupertino Municipal Code, Section 1.18. Licensed Professional ignature Date CITY OF CUPERTINO 3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32627037.10253 DATE ISSUED.......: 10/24/2011 RECEIPT #.........: BS000015126 REFERENCE ID # ...: 11100123 SITE ADDRESS .....: 10253 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildingQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED i i I Cu2,3 ORIGINAL PERMIT # C r PROFECT ADDRESS X -14 APN # 2 ?,7. . / U 2,S3 7• D 3-7. OWNER NAME 4V e7 Y N a4go;C 1_ ! PHONE6J D - Q 61_ k E-MAIL AVC.%L / SS STREET D Q SS �-/ A s'` -. TYPE J',/ xJ j C44 F14,- -• W O, �� CONTACT NAME S 1' L ✓ t, -T> 1LCVAt,-;-C% L �s - s�o 6 - 7 � �' E S 7zc r= �a. J tit N - STREET ADDRESS4-,A zp?r I CITYSTAT STA E. ZIP N (e -,6, N U F ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT a CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME A C n G j �^ C _7 LICENSE NUMB ) %6 �� LICENSE TYPE f'Z (�/ BUS. LIC N COMPANY NAME Q.►C n E-MAILE MAII� 2 v Ua yy� I i L v Y F STREET ADDRESS € ol CITY, STATE, ZIP vu �e C, c� ONE - 6 ARCYIITECTIEI OWNER NAME w j iL l v Y LICENSE NUMBER BUS. LIC M COMPANY NAME REMOOELAREA E-MAIL REMODEL AREA FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � � !1 d 31dg,4pp Z011.doc revised 06/21/11 r-!1 M MOSTING USE PROPOSED USE CONSTIL TYPE 1 4 STORRMS USE TYPE OCC. SQFT. VALUATION (5) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA ,� i.. --2-, 2 d BATHROOMKITCHEN OTHER REMOOELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ATTACH N DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? [3NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL S ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN IJ YES EICHLER HOME? ❑ NO RECEIVED BYi TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner Or authorized agent to act on the prrpperty 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 above -i ti$ property for inspection purposes. Signature of Applicant(Agent Date: r�l SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING ff" ❑ oVZR-TH"oma Cl BVII.DING PLAN REVIM New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl mol ass ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1srANDARD ❑ PUBUC WORxs form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FDZ DErr _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT ibmittal of Building Permit application. ❑ ENVIItONMaNTAL HEALTH 31dg,4pp Z011.doc revised 06/21/11 r-!1 M CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildingQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED i i I Cu2,3 ORIGINAL PERMIT # C r PROFECT ADDRESS X -14 APN # 2 ?,7. . / U 2,S3 7• D 3-7. OWNER NAME 4V e7 Y N a4go;C 1_ ! PHONE6J D - Q 61_ k E-MAIL AVC.%L / SS STREET D Q SS �-/ A s'` -. TYPE J',/ xJ j C44 F14,- -• W O, �� CONTACT NAME S 1' L ✓ t, -T> 1LCVAt,-;-C% L �s - s�o 6 - 7 � �' E S 7zc r= �a. J tit N - STREET ADDRESS4-,A zp?r I CITYSTAT STA E. ZIP N (e -,6, N U F ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT a CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME A C n G j �^ C _7 LICENSE NUMB ) %6 �� LICENSE TYPE f'Z (�/ BUS. LIC N COMPANY NAME Q.►C n E-MAILE MAII� 2 v Ua yy� I i L v Y F STREET ADDRESS € ol CITY, STATE, ZIP vu �e C, c� ONE - 6 ARCYIITECTIEI OWNER NAME w j iL l v Y LICENSE NUMBER BUS. LIC M COMPANY NAME REMOOELAREA E-MAIL REMODEL AREA FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � � !1 d 31dg,4pp Z011.doc revised 06/21/11 r-!1 M MOSTING USE PROPOSED USE CONSTIL TYPE 1 4 STORRMS USE TYPE OCC. SQFT. VALUATION (5) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA ,� i.. --2-, 2 d BATHROOMKITCHEN OTHER REMOOELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ATTACH N DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? [3NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL S ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN IJ YES EICHLER HOME? ❑ NO RECEIVED BYi TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner Or authorized agent to act on the prrpperty 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 above -i ti$ property for inspection purposes. Signature of Applicant(Agent Date: r�l SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING ff" ❑ oVZR-TH"oma Cl BVII.DING PLAN REVIM New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl mol ass ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1srANDARD ❑ PUBUC WORxs form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FDZ DErr _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT ibmittal of Building Permit application. ❑ ENVIItONMaNTAL HEALTH 31dg,4pp Z011.doc revised 06/21/11 r-!1 M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10253 PARKWOOD DR CONTRACTOR: STEVE PLEVANCIC PERMIT NO: 11100123 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011 VER'S PHONE: 6509618330 SUNNYVALE, CA 94086 PHONE NO: (408) 806-9145 ❑ LICENSED CONTRACTOR'S DECLARATION r r r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # /7 Co 96 911" f— � MECH RESIDENTIALr COMMERCIAL Contractors-�X•f DLV! G L_Date told 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. l 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 APN Number: 32627037.10253 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED [o 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. ;osts, and expenses which may accrue against said City in consequence of the ;ranting of this permit. Additionally, the applicant understands and will comply with all non-poi t rce regulations per the Cupertino Municipal Code, Section Issued x.18. Signature Date V / 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. , 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, 3usiness & 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE leclarations: I have read the hazardous materials requirements under Chapter 6.95 of the have and will maintain a Certificate of Consent to self-insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 lection 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 >ermit 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. iot employ any person in any manner so as to become subject to the Worker's :ompensation laws of California. If, after making this certificate of exemption, I O or ut zed ent: Date:l >ecome subject to the Worker's Compensation provisions of the Labor Code, I must brthwith 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 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 Lender's Address ipon the above mentioned property for inspection purposes. (We) agree to save - ' 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 ;i witing of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. vith all non-point source regulations per the Cupertino Municipal Code, Section 1.18. Licensed Professional ignature Date CITY OF CUPERTINO 3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32627037.10253 DATE ISSUED.......: 10/24/2011 RECEIPT #.........: BS000015126 REFERENCE ID # ...: 11100123 SITE ADDRESS .....: 10253 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