11090136 (2) CITY OF CUPERTINO BUILDING PERMIT -
BUILDING ADDRESS: 10134 PARKWOOD DR CONTRACTOR:AVERY GLENBROOK LP PERMIT NO:11090136
OWNER'S NAME: AVERY GLENBROOK LP 130 E DANA ST DATE ISSUED:09/20/2011
OWNER'S PHONE: 6509618330 MOUNTAIN VIEW,CA 94041-1508 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL0
License Class_ Lica# !1146 (f_ ALL UNITS-MULTI-FAMILY REPLACE 8 WINDOWS
NON-STRUCTURAL BEDROOMS TO MEET EMERGENCY
Contractor. I '4® Date RESCUE
I hereby affirm that I am licensed under the provisions of 4hapter 9 AND ESCAPE.
(commencing with Section 7000)of Division 3 of the Business&Professions 3/11/2013-ADD 20 MORE WINDOW TO(E)PERMIT FOR
Code and that my license is in full force and effect. WINDOW ADDITION(ALL WINDOWS TO MEET EGRESS&
I hereby affirm under penalty of perjury one of the following two declarations: TEMPERED WHERE REQUIRED)
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
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perforance of the work for which this permit is issued. Sq.Ft Floor Area: Valuati-M—$20900
I 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:32627036.10134 Occupancy Type:
permit is issued. .
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA ERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 1�b .
DAY M L CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs;and expenses which may accrue against said City in consequence of the J 1 I3
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-posource.regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Signature Date / 7 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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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,
Business&Professions Code)
1;as.owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
constrict the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a.Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with th Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5505 33,and 25534. /1'T h
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: / Date•0 '(I 1 'l
permit is issued. I
I certify,that in the performance of the work for which this permit is issued,I shall
not employ any person irr any manner so as to become subject to the Worker's
Compensation laws of California.. If,atter making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
.APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10134 PARKWOOD DR DATE: 03/11/2013 REVIEWED BY: MELISSA
log APN: BP#: *VALUATION: 1$20,000
*PE.RMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Building is PENTAMATION 1GENRES
USE: Multi-Family Dwelling >3 Stories 0 Yes (E) No PERMIT TYPE: A
WORK ADD 20 MORE WINDOW`TO E PERMIT FOR WINDOW ADDITION ALL WINDOWS TO MEET
SCOPE EGRESS&TEMPERED WHERE REQUIRED).
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:kfec:h.Plan Check Phimb,Plan Check Elec.Plan Check
L1ech.Pern it Fee: Plumb.Permit Fee. Elec.Permit Fee:
F�ih -7klech.Insp. Other Plumb Insp. Other Elec.Insp,.Insp.Fee: Plumb. htap.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E 711/12) FEE QTY/FEE MISC ITEMS
.
Plan Check Fee: $0.00 20 1 # Window/Sliding Glass Door
Suppl.PC Fee: (j) Reg. ®:OT 0.0 1 hrs $0.00 $666.00 IWINREP Replacement
PMS Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp:Fee:Q Reg: Q OT ro.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction
Tax.
Administrative.Fee:
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee:. $0.00 Select a Non-Residential
Building or Structure.
!7�el Docianentution Fees--
Strong Motion.Fee: IBSEISMICR $2.00 Select an Administrative Item mp
Bldg Stds Commission Fee: IBCBSC $1.001 4q
$3.00 $666.00 r� � .00
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Revise : 01/01/2013