12110014CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10255 PARKWOOD DR
CONTRACI'OR: STEVE PLEVANCIC
PERMIT NO: 12110014
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: II/022012
OWNER'S PHONE: 6509618330
SUNNYV Al.E. CA 94086
PBONF NO: (408) 806-9145
❑ LICENSED CON'I'RACI'OR'S DECLARATION
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PLUMB
BUILDING PERMIT INFO: BLDG ELECT
License Class_ Lie.# 4-t6 9
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NIECFI RESIDENTIAL COMMERCIAL
Contractor �)a–PrR BUet V\e,C Or fUate
hereby affirm that l ant licensed under the provisions of Chapter 9
JOB DESCRIPTION: BLDG 42 - RBMOVE AND RITLACE 28 WINDOWS
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and [het my license is in full force and effect.
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 Ute work for which this
permit is issued
APN Number: 32627036.10255
Occupancy Type:
API'LICA,N I' CliR"rIPIG\TION
I certify that I have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and slate 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 properly for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupenino against liabilities, judgments,
18U 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 -point source regul ions per the Cupertino Municipal Code, Section
Issued by: '� Date:
9.18.
Signature Dale O (�
RF. -ROOFS:
❑ OWNER-RUILDER DECLARATION
All roofs shall be inspected prior to ane roofing material beitg installed. If a roof is
installed without first obtaining an inspection, I agree to remove all nese 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 properly, 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
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code),
hereby affirm under penalty of perjury one of the fnlloming three
IU"LARDOUS 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 Ilealth & 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 Ileallh S
performance of the work for which this permit is issued.
Safety Code, Section 25532(x) should 1 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 9.1..tand the ,
Ileallh & Safely 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
Owor authored agent: •�
Compensation laws of California. If, after looking this certificate of exemption, I
]late: U / /—
become subject to the Worker's Compensation provisions of the Labor Code, I nmsl
forthwith comply with such provisions or this pemoit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of murk's
APPLICAN 1' CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that 1 have read this application and state that the above information is
Lender's Nume
correct. I agree to comply with all city and county ordinances and state Imus relating
to building construction, and hereby authorize representatives of this city to enter
Lender's Address
upon the above mentioned properly for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
,\RCIII'I'ECI"S DECLARATIONcosts,
granting 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 regulatims per the Cupertino Municipal Code, Sectim
9.18.
Licensed Professional
Signature Date
CONSTRUCTION PERMIT APPLICATION Z I C) v l L'
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
CUPERTINO (4 08) 777-3228 • FAX (408) 777-3333 • buildinD(a),cuoertino.arcl
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D{ASECONDUVR YES
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RECEIVED BY:
1TrfAL VALUATION:
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By my sign, me below, I certify m curb of he following I am he property owner err an hor¢td agent o act DD �e prpperty owners behalf I have read this
application and the infarmati®I vidrd u correct I have read the Description of Work and verify it is accuse . I agree to comply with all applicable local
mdin ces and state Ltws telatiag dors 'on. I authoria representatives of Cupertino to enter the above-idend ed property for inspection proposes.
Signature, of ApplicanVAgent Date:
SUPPLEMENTAL INFORMATION REQUIRED
FLAN CHxCTcrrYe
ROOTING sw
❑ OVER.�OTt rrca
❑ BmIniNG Pt.AN aaVtBW
New SM or Multifammly dwellings: Apply for demolition permit for
edsdng building(s). Detaolition permit is regmted prior m issuance of building
permit for new building.
❑ BEPBFSS
❑ PLANIUNG PLAN REVIEW
Commercial Bldgs: Provide a completed Hazmdeus Materials Disclosure
❑ sTwemwaD
❑ Posucwoma
form if airy Hazardous Materials are being used as part of this project
❑ f.AHGE
❑ FmED]TI'
Copy of Planning Approval Lever or Meeting with Planning prior to
❑ MAroR
❑ sANrl'ARY sEwrn otsttut: r
submittal of Building Permit application.
❑ MVDROMENTAL HEALTH.
dldgApp_1011.doc revised 06121/11
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CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
WFI,DDRESS:
10255 parkwood bid 42
DATE: 11/02/2012
REVIEWED BY: larrys
Mech. Permit Fee:
APN:
BPP:
'VALUATION:
1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: Multi -Family Dwelling
Buildina is
>3 Stories C)Yes Q No
PENTAMATION
PERMITTYPE: 1GENRES
WORK
remove and replace 28 windows
SCOPE
$0.00
NOTE: This estimate clues not include jeer clue to other Departments (i.e. Planning, Public N'orks, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nrelintdnarr information mailable and are on1v an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Tce Resolution 11-053 1?
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: SS PcLjo cc. /
PERMIT #
OWNER'S NAME: u -p •T,5 .PHONE
# os- 1g (,
GENERAL CONTRACTOR: �2 e CJo-Kc, t Pons .
BUSINESS LICENSE #
ADDRESS: S . ff6
CITY/ZIPCODE: 5101h 141/W IC' CA -
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL UBCON" R CTORS HAVE OBTAINED A CITY FCUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: `
Signature date
Please check applicable subcontractors and complete the following information:
vwuer i �uuiraciur 31gnaiure
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
vwuer i �uuiraciur 31gnaiure
Date