11100135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10280 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 11100135
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED: 10/24/2011
S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
011" LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB�
License Class '6 Lic.# (?If(0 MECH — RESIDENTIAL r COMMERCIAL
Contractor� -�e l Q J' t�G'c't-� DateM��U/
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ALL UNITS-REPLACE 10 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
APN Number:32627036.10280 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
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
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 L,
with all non-point source regulati per the Cupertino Municipal Code,Section IssuedDate:
9.18.
Signature Date 1 bo
RE-ROOFS:
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:
I,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)
1,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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
1 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 =gent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
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 work'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
ir'-mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
g,.-aing 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 DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 /
(408) 777-3228- FAX(408)777-3333- building(&cupertino.ora
GUPERTINO ' 1v
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS /0 C� 1 , , ., AM (� 2.-7 03 La - z�
OWNER NAME4 Vega Y �/�i N� J/C p PHONE��_O_Q�f..� E-MAII./`fll�ryL'fS t cr
stTtEEr 3 Oss crrY.
S� I t.�.�
CONTACT NAMES [�✓(. C U ArJ C 1 L PHONE o fs- 6 y I E (✓ t' V /LG ft- /
STREET ADDRESS 1 i( CITY.STA N e U F
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT w CONTRACTOR ❑CONTRACTOR AGENT ❑ ARc=cT ❑ENGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME n C C{ � LICENSE NUNM t f, 5/ LICENSE TYPE } BUS.LIC M
COMPANY NAME E-MAILs 2 tr 0 U
STREET ADDRESS 6 CIfY,STATE,ZIP ONE
A I►'7 -4 vu le C. c� lO –s
ARCYIITECT/FSIGII OEERNAME w ) LICENSE NUMBER BUS.LIC 0
E-MAIL FAX
COMPANY NAME 1
STREET ADDRESS CITY,STATE.ZIP PHONE
DESCRD?T'ION OF WORK e
EXISTING USE PROPOSED USE CONST&TYPE USE TYPE OCC. SQFT. VALUATION(5)
EXLSTG NEW FLOOR DEMO TOTAL C „^
AREA AREA AREA NET.AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECYJPORCH AREA GARAGE AREA: DETACH
ATTACH
M DWELLING UMTS: IS A SECOND UNIT YES SECOND STORY YES
BMG ADDED? QNO ADDITION? �NO
PRE-APPLICATION [JYES IF YES.PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:_
PLANNING APPL/ ❑NO PLANNING APPROVAL LEITER EICBLER HOME? ❑NO z 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 prpperty owner's behalf. I have read this
application and the information I haa 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 tifi�d property for inspection purposes.
Signature of Applicant(Agent Date: }
zz Jr,
SUPPLEMENTAL INFORMATION REQUIRED PLAN CBZCKTYPS ROU IMG SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for C o.iBa cOUMMR [fiB mn'%PLAN Rz VEM
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3STANDARD ❑ Pumucw0wo
_
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ "a DEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANER ITARY SEWDISTRICT
ibmittal of Building Permit application.
❑ eNvmoNmENTAt HEALTH
' B1dPAPP_101 Ldoc revised 06/21/11
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # 1
S6c: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627036 .10280
DATE ISSUED. . . . . . . : 10/24/2011
RECEIPT #. . . . . . • • • : BS000015126
REFERENCE ID # . . . : 11100135
SITE ADDRESS . . . . . : 10280 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 10 .00 522 .00 0 . 00 522 .00 0 . 00
---------- ---------- ---------- -------
TOTAL PERMIT 525 .00 0 . 00 525 .00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--------------- --------------------
CHECK 7, 075 . 00 #136214
---------------
TOTAL RECEIPT 7, 075 .00
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 /
(408) 777-3228- FAX(408)777-3333- building(&cupertino.ora
GUPERTINO ' 1v
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS /0 C� 1 , , ., AM (� 2.-7 03 La - z�
OWNER NAME4 Vega Y �/�i N� J/C p PHONE��_O_Q�f..� E-MAII./`fll�ryL'fS t cr
stTtEEr 3 Oss crrY.
S� I t.�.�
CONTACT NAMES [�✓(. C U ArJ C 1 L PHONE o fs- 6 y I E (✓ t' V /LG ft- /
STREET ADDRESS 1 i( CITY.STA N e U F
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT w CONTRACTOR ❑CONTRACTOR AGENT ❑ ARc=cT ❑ENGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME n C C{ � LICENSE NUNM t f, 5/ LICENSE TYPE } BUS.LIC M
COMPANY NAME E-MAILs 2 tr 0 U
STREET ADDRESS 6 CIfY,STATE,ZIP ONE
A I►'7 -4 vu le C. c� lO –s
ARCYIITECT/FSIGII OEERNAME w ) LICENSE NUMBER BUS.LIC 0
E-MAIL FAX
COMPANY NAME 1
STREET ADDRESS CITY,STATE.ZIP PHONE
DESCRD?T'ION OF WORK e
EXISTING USE PROPOSED USE CONST&TYPE USE TYPE OCC. SQFT. VALUATION(5)
EXLSTG NEW FLOOR DEMO TOTAL C „^
AREA AREA AREA NET.AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECYJPORCH AREA GARAGE AREA: DETACH
ATTACH
M DWELLING UMTS: IS A SECOND UNIT YES SECOND STORY YES
BMG ADDED? QNO ADDITION? �NO
PRE-APPLICATION [JYES IF YES.PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:_
PLANNING APPL/ ❑NO PLANNING APPROVAL LEITER EICBLER HOME? ❑NO z 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 prpperty owner's behalf. I have read this
application and the information I haa 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 tifi�d property for inspection purposes.
Signature of Applicant(Agent Date: }
zz Jr,
SUPPLEMENTAL INFORMATION REQUIRED PLAN CBZCKTYPS ROU IMG SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for C o.iBa cOUMMR [fiB mn'%PLAN Rz VEM
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3STANDARD ❑ Pumucw0wo
_
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ "a DEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANER ITARY SEWDISTRICT
ibmittal of Building Permit application.
❑ eNvmoNmENTAt HEALTH
' B1dPAPP_101 Ldoc revised 06/21/11
CITY OF CUPERTINO
3 ITEMS OF 33 PERMIT RECEIPT OPERATOR: patg
COPY # 1
S6c: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32627036 .10280
DATE ISSUED. . . . . . . : 10/24/2011
RECEIPT #. . . . . . • • • : BS000015126
REFERENCE ID # . . . : 11100135
SITE ADDRESS . . . . . : 10280 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 10 .00 522 .00 0 . 00 522 .00 0 . 00
---------- ---------- ---------- -------
TOTAL PERMIT 525 .00 0 . 00 525 .00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--------------- --------------------
CHECK 7, 075 . 00 #136214
---------------
TOTAL RECEIPT 7, 075 .00