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11100133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10274 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11100133 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011 IER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 ❑ LICENSED CONTRACTOR'S DECLARATIONr— BU[LDING PERMIT INFO: BLDG' ELECT PLUMB License Class Lic.# C f �c �6 MECH RESIDENTIAL COMMERCIAL Contractor •�.J k_ C�,_'[AjA«Q_Date ff�kqjl�_ 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. Sq.Ft Floor Area: Valuation:$20000 1 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. APN Number:32627036.10274 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 PERMIT EXPIRES IF WORK IS NOT STARTED to 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. 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- source regulations per the Cupertino Municipal Code,Section Issued by: Date: ���z`I 9.18. I Signatur Date / RE-ROOFS: t_ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,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, 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 p Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Own o auth ed gent: Compensation laws of California. If,after making this certificate of exemption,I s Date: 1P62 1/ become subject to the Worker's Compensation provisions of the Labor Code,I mus[ V 7— 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%ork'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 -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 grai.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 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DNISION -Lw- 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO J (408)777-3228- FAX(408)777-3333 •building(&cupert no.org I I DU, 3� NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERIv11 # PROJECT ADDRESS 1 L �C, 7A?N* OWNER NAME /�V&7? / �` N���CJIC t p PHONE�� O-Q�!—� E-MP`B ,A, ,L �S j�1„4.r• ADDRESS �� CITY. ATE. �, F ,0- ti����I 71 STREET CONTACT NAMES (- ✓ FV AfJ c1 L P'[f7 E ALL og STREET ADDRESS (Z y #-1 CITY,STA NZIP e U F r ❑OWNER ❑ OwNER-surLDER ❑ OWNER AGENT WK CONTRACTOR ❑CONTRACTOR AGENT ❑ ARLar, cr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ' LICENSE NUMB 46 56 LICENSE Tn'E fZ BUs.LIC M E-MAIL F �(�a'73�^ COMPANY NAME � s 2 v E U M.'.'"f C) �'►1 Qn L STREET ADDRESS r C �,f CICY.STATE,ZIP P40NE '► vu le L14 C?1(as 401 bb 6 S ARCHITECT/ENGINZER NAME w ) iL LICENSE NUMBER BUS.LIC M COMPANY NAME 1`I YT E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE f _ DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE P STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH ATTACH M DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:_ PLANNING APPL I ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOJ� 00 U J By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr�nperry owner's behalf. I have read this application and the information Ill s. ect 1 have read the Description of Work and verify it is accurate. I agree to complY with all applicable local ordinances and state laws relatingtion. I authorize representatives of Cupertino to enter the above-i Eed perry for inspection purposes. Signature of Applicant/Agent e SUPPLEMEN'T'AL INFORMATION REQUIREDPLAN C1�CK TYPE ROUTING SLD' _New SFD or Multifamily dwellings: Apply for demolition permit for �Qr-COUN M BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPREW ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3STANDARD ❑ PUBLIC WOBKs 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 Ibmittal of Building Permit application. ❑ Errvi>;tONMENTAL HEALTH Bldg,4pp_2011.doc revised 06/21/11 0 CITY OF CUPERTINO 3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32627036 .10274 DATE ISSUED. . . . . . . : 10/24/2011 RECEIPT #. . . . . . . . . BS000015126 REFERENCE ID # 11100133 SITE ADDRESS . . . . . : 10274 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DNISION -Lw- 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO J (408)777-3228- FAX(408)777-3333 •building(&cupert no.org I I DU, 3� NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERIv11 # PROJECT ADDRESS 1 L �C, 7A?N* OWNER NAME /�V&7? / �` N���CJIC t p PHONE�� O-Q�!—� E-MP`B ,A, ,L �S j�1„4.r• ADDRESS �� CITY. ATE. �, F ,0- ti����I 71 STREET CONTACT NAMES (- ✓ FV AfJ c1 L P'[f7 E ALL og STREET ADDRESS (Z y #-1 CITY,STA NZIP e U F r ❑OWNER ❑ OwNER-surLDER ❑ OWNER AGENT WK CONTRACTOR ❑CONTRACTOR AGENT ❑ ARLar, cr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ' LICENSE NUMB 46 56 LICENSE Tn'E fZ BUs.LIC M E-MAIL F �(�a'73�^ COMPANY NAME � s 2 v E U M.'.'"f C) �'►1 Qn L STREET ADDRESS r C �,f CICY.STATE,ZIP P40NE '► vu le L14 C?1(as 401 bb 6 S ARCHITECT/ENGINZER NAME w ) iL LICENSE NUMBER BUS.LIC M COMPANY NAME 1`I YT E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE f _ DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE P STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH ATTACH M DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:_ PLANNING APPL I ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOJ� 00 U J By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr�nperry owner's behalf. I have read this application and the information Ill s. ect 1 have read the Description of Work and verify it is accurate. I agree to complY with all applicable local ordinances and state laws relatingtion. I authorize representatives of Cupertino to enter the above-i Eed perry for inspection purposes. Signature of Applicant/Agent e SUPPLEMEN'T'AL INFORMATION REQUIREDPLAN C1�CK TYPE ROUTING SLD' _New SFD or Multifamily dwellings: Apply for demolition permit for �Qr-COUN M BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPREW ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3STANDARD ❑ PUBLIC WOBKs 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 Ibmittal of Building Permit application. ❑ Errvi>;tONMENTAL HEALTH Bldg,4pp_2011.doc revised 06/21/11 0 CITY OF CUPERTINO 3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32627036 .10274 DATE ISSUED. . . . . . . : 10/24/2011 RECEIPT #. . . . . . . . . BS000015126 REFERENCE ID # 11100133 SITE ADDRESS . . . . . : 10274 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