13030139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10130 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO:13030139
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:03/26/2013
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L
COMMERCIA
C
�y
License Class_ Lica# `7 BLDG 22-REMOVE AND REPLACE 20 WINDOWS-LIKE
Z; FOR
Contractor S� �e�Jc�ha.�e Date LIKE BEDROOMS TO MEET EGRESS
I hereby affirm that I am licensed under the provisions of Chapter 9
(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
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:32627036.10130 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 DAYS OF PERMIT 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 180 DAY F M LAST CALLED INSP TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which'may accrue against said City inconsequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Dat6:
with all non-p 'nt source regu"s per:the Cupertino Municipal Code,Section
9.18.
? RE-ROOFS:
Signature Dai !J 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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct 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 the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 25505_",533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Dated
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
Compensation laws of California. If,after 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 aril 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
CONSTRUCTION PERMIT APPLICATION ��
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION �0
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (�
(408)777-3228- FAX(408)777-3333-building(&cupertino.org 1�
CUPERTINO 1
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS.
D PxoNEAPN
1O a(/ 2-1
1 / ✓v�L ` J D
OWNER NAME 4 Ve7z Y �CGN��i` LN EMAZ. ^
4AVA.1 (10
STREET ADDRESS CITY, ATE ZIP rl a
CONTACT NAME _ n�Au,
S ( J L �'uAIJGI L P c7 -g'o 6 4)' ES 7`C r" La-�l Cg itt H- �v
STREET ADDRESS 6 CITY,STATE, ZIP ))�\� F
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13OWNER 13OWNER-BUILDER ❑ OWNER AGENT 5 CONTRAcToR El CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER 11 DEVELOPER ❑TENANT
CONTRACTOR NAME V ' n( c k^ LICENSE NUMB f r� LICENSE TYPE jZ BUS.LIC#
PVC
COMPANY NAME `- E-MA1L -1 (� F 'T�a'73�" (4 E6oT
2ve .s Igo- "Q le L) ��CCJ�t1it QFY alllLO-::Z
STREET ADDRESS CITY,STATE,ZIP PONE
a1` 4S -Avu le c, G S'
ARCHITECT/EYGINSER NAME 1 ,�L LICENSE NUMBER BUS.LIC#
COMPANY NAME (� Y= E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXLSTING USE PROPOSED USE CONSTIL TYPE #STORIES
USE TYPE OCC. SQ.FI. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA -
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES B TOTAL VALUATION:_
PLANNING APPL# ONO PLANNING APPROVAL LETTER EICHLER BIOME? ❑NO Z C7/,OO U.,
By my signature below,I certify to each of the following: I am the property owner or autho ' d ag t to act on the prq erty owner's behalf. I have read this
application and the information I�Izg
ect. I have read the Description of Work and verify it is accurate I agree to mply with all applicable local
ordinances and stats laws relatingtion. I authorize representatives of Cupertino to enter the ab e-deyt ed p�r1}c dor inspection purposes.
Signature ofApplicant/Agent ` Date: f- [l%
SUPPLEMENTAL INFORMATION REQUIRED aiicmCK Tyft ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER 13BUILMiNG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of build'
permit for new building. ❑ EXPRESS ❑ PLANrMG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE nm'r
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL TEAT TH
BldgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1.01:30 parkwood dr bldg 22 DATE: 03/26/2013 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK I bld 22- remove and replace 20 windows
SCOPE
IIech.Plan Check Plumb. Plan Check Elec.Plan Check
Wech.Permit Fee; Plumb.Permit Fee: Elec. Permit Fee:
FEther :Tech.Insp. Other Plumb Insp. Ll Other Elec.Insp.
llech.Insp.Fee: Plumb. Insp.Fee: Elec,Insp.Fee:
NOTE:This estimate does not in:nclude fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relfmina information available and are onlyan estimate. Contact the Dept-for addn'l info,
FEE ITEMS(Fee Resolution.11-053 Eff 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: . $0.00 = # Window/Sliding Glass Door
Suppl.PC Fee:.. Reg; ®.OT 0.0 1 hrs $0.00 $666.00 IWINREP Replacement
PME Plan Check: . . $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ConstructionTax:
Administrative F.
Work Without Permit? ®Yes E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fees i
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$3.001 $666.00 ® 'y $669.00
Revised: 01/01/2013
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino,CA 95014-3255
C O P E RT 1 N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: p c� PERMIT#
OWNER'S NAME: u: n5 PHONE#A0Y Ol,l ��
GENERAL CONTRACTOR: (-2arwtc�L S BUSINESS LICENSE# C(&,r
ADDRESS: S i CITY/ZIPCODE: C CR
*Our municipal code requires-all businesses working in the city to have a City of Cupertino usiness li ense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND. AL SUBCO TRACTORS HAVE OBTAINED A CITY O CUPERTINO
BUSINESS LICENSE.'
I am not using any subcontractors: CIO
Signature Date
Please check applicable subcontractors and<complete the following information:
SUBCONTRACTOR4 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
D-34C l
04�uer l'contractor_Signature Date