13040116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10120 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO:13040116
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:04/15/2013
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
I� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALL]
License Class Lic.# BLDG 21-REMOVE AND REPLACE 16 WINDOWS LIKE
FOR
ContractoreU Date LIKE TO MEET EGRESS IN BEDROOMS
I hereby affirm that I aro 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:32627036.10120 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 DA ROM LAST 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 Issued b Date:
granting of this permit. Additionally,the applicant understands and will comply Y'
with all non-point source regulations er the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Irate 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,Sections 2155105,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date: /
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 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
CONSTRUCTION PERMIT APPLICATION (`(9
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISIONO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)7773228-FAX(408)777-3333•buildingOcuDertino.ora
CUPERTINO
❑NEW CONSTRUCTION �❑ ADDITION ElALTERATION/Ti ElREVISION/DEF/Ej um ORIGINAL Pau"UT#
PROJECT ADDRESS. L/ a C x 52 -P Z-7 03 T , 101
2-"
OWNERVAME �/&-72 / 'n�E MAII L-YL yS vJl•{t(.
STREET 3DP7 V Ci va s�• C CITY. G/ t Gt; l.f� F !-►��ip�/ ' 7�
CONTACT NAME t('✓ rV AlJC.t L `Ed 6-$O �t�Aa,
S T'N F 14..1/ /LL 5•-
STREET'ADDRESS r t I CrrY.STATE.ZIP F
t�17/ N yk U
13 OWNER [3OwNst-aurimi R C3oWNERAGENT 11YCOMRAcToR ❑ccNIRACTORAGEKr ❑ ARCBnECr ❑FNGmnt ❑ DEVELOPER ❑TmANT
CONTRACTORNAMES1 eve UMMMMEV)16 56UCENSETYPE 5 Bus.UCit
COMPANY NAME E-MAB: `7 ( F ��a' 12 e4 k6o
r'
2 n S Q u E V r)'?a 'I r�C�n1
STREET ADDRESS [+ "yy CITY,STATE.zIP U le C! DIVE - (o
b I-
ARcHrrF=/ENoiNEER NAME ► 3 ,iL LICENSENUMBER BUS.uC#
COMPANY NAME 'v I T E-MAIL FAX
STREET ADDRESS CrrY.SATE.ZIP PHONE
DESCRIPTION OF WORK
F;f/�Q>v�..Q, Gc-ewe.. �k U c�✓s'
EXISTING USE PROPOSED USE.. CONSTR.TYPE #S RIES
G_ USE TYPE OCC. SQ.FT. VALUATION(S)
E asTO KWFLOOR DOM TOTAL
AREA AREA AREA NETAREA
BATHROOM RIFE TTt OTHER
REMODELAREA REMODELAREA. REMODEL AREA
PORCHARFA DECKAREA AL ECK/PORCHAREA GARAGE AREA: H DETACH .
ATTACH
#DWELLING UNITS: IS A SECOND UNrT E3yEs SECOND STORY YES
BENCADDED? ❑NO ADDMON? ❑NO
PRE-APPLICATION ❑YES 7 YES.PROVIDE COPY OF LS TSE BLDG AN ❑YES I TOTAL VALUATION:
PLANNING APPL# []NO PLA1WINGAPPROVALLHrTER EICH EROOKL? ❑NO
By my signature below,I certify w each of the following: I am the property owner or ant to act on the owners behalf. I have read this
application and the information I ha vided is correct I have read the Description Of, vork and ify itis accura . I to comply with all applicable local
ordinances and state laws relating ding on. I authorize representatives of Cupertino to enter tha vh-iden /ed
property for inspection purposes.
Signature of Applicaat/AgeatDat
SUPPLEMENTAL INFORMATION REQUIRED CSECr TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-•rim-COUNTER ❑ BVR.DiNG PIAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building. ❑ EXPRESS ❑ PLANTMGPLANREVB:W
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 13srArmARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fmz bm
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sANaaxY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH -
BldgApp 1011.doc revised 06121/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESSd;•1.. 25 PARICWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO:13040116
CONSTRUCTION
OWNER'S NAMI~c;;AVERY GLENBRWK.LP 528 S mATHILDA AVE STE 2 DATE ISSUED:04/15/2013
OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
I ENSED O Q$', DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
l
Lic:#: il0 BLDG 21-REMOVE AND REPLACE 16 WINDOWS LIKE
FOR
Contractor. Date LIKE TO MEET EGRESS IN BEDROOMS
I hereby arm that:I am licensed under.the provisions of Chap 9
affirm
(commencing with Section 7000)-of Divisl"A;of the Business&Professions
Code and that.my license bin full force ard:eHect.
I hereby affirm under penalty of perjury'one.oftbe 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 ofthe 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 Compensatiofi Insurance,as provided for by
Section 3700 of. cL,abor Code;.for the performance of the work for which this APN Number:32627036.10125 Occupancy Type:
pemiit,es tissued.
APPLICANT CERTIFfCATION
I certify that I have lead this application and state thattte°above information is PERMIT E MES IF WORK IS NOT STARTED..
eetcomplyithilcitacorrect I. gowordinances and state laws relating W�SINDAYS OF PERMIT ISSUANCE OR
to building:construction,and hereby aulboriao representatives of this city to enter
upon the above mentioned property for inspecdo4 purposes..(We)agree to save 180 DAYMROM LAST CALLED INSPECTION.
indemnify and keep harmless the City.gf"Gupfrtrio,against liabilities,judgments,
costs,:and'e rises which may accrue against said City in consequence of the Issued by:
g of Date• !�
grantinthis-permit: Additionally,the;applicant understands and will comply
with all noirpo our 'Xe onwpor flhe Cupertino Municipal Code,Section
O ' RE- O
R OFS:
Sigihitture ",:. t I)ate 3 All roofs shall be inspected prior to any roofing material being installed If a roof is
all
. :.., :•-• .:, ;:., .' inspection, to remove
new.
installed without first obtaining an inspe •on,I agreematerials for
inspection.
. Q,..:`!; .'.° ''i :OWNER-SUILDERDECLAItATION
Signature of Applicant: Date:
I hereby affirm than am exempt from.the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L as owner of the property,or my employees with wages as their sole compensation,
Will do;the;work,:and time xtructure.is notintended or offered for sale(SCC-7044,
Business&Professions Code)' HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
constructthe project(Sec;7044;Busingss'&Professions Code). I have read the hazardous materials requirements under Chapter'.95 of time .
California Health&Safety Code,Sections 25505,25533.and 25534. I will
I liercliy'afiirm under penalty of perjury one ofthi following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declaratioui;- Health&Safety Code,Section 25532(a)should I store or handle hazardous
I hive and will maintain aCertificate ofConsent Wself-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 370U 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 uperdoo Municipal Code,Chapter 9.112 and
provided b the Health&Safety Code,Sectio 5, ad 25534.
I have and will main4in Worker's Compensate y
Section 3700-of the:Labor Code,for the perfotmanceof the work for which this Owner or authorized age t! Date'
permit.is;9SUe(I '.';:i3'
I.certify l atm the peaifoSm►iinc4 of the ww1vtor which this permit is issued,I shall
I
not employ:any persop`inl airy mmm.er*, as to be4 me subject to the Worker's CONSTRUCTION LENDING AGENCY
Com nsation:laws of; ifoinia It-aftpr,.makiftB thio certificate of exemption,I
Pe .,
becAme•stlb�j to&1! ..., - ;Cour i '0n provisions°ofthe Labor Code,l must I hereby affirm that there is a construction lending agency for the performance of
' u I•: ': ' _= work's for which this permit is issued(Sec.3097,Ciy C.)
forthwithcomply�vr ;such provisions:ortlus petmitshall be deemed revoked. Lender's Name
APPLICAN'C CER9IF�CA`P ON Lender's Address
I cerxify,timet I have_read rs application acid state:that the above information is
correct I agree:to comply,wtth'all city and county ordinana es and state laws relating
to building constiucgon;:and hereby authonierepresentatives of this city to enter
upon the;abovc:mentioned property-fq !mRheF<io purposes•(We)agree to save
ARCHITECT'S DECLARATION
indemnify ahid;keep:hacin�ess`rbc City of(4tpett no against liabilities,judgments,
cost§,a hd ezperise4 tiYlijci►°inay;acCmmie ag�i.said Cit- consequenceof the I understand my plans shall be used as public records.
grab fing.Pfi dins p. it Additionally;tiva pplicant understands and will comply
with all'nori-point 046e'egglations;pei the'CuQertamo Mtmicipal Code,Section Licensed Professional
Date
(L)
CON RUCTION PERMIT APPLICATION
COM . NITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10 0 TORRE AVENUE CUPERTINO,CA 950143255
( 8)777-3228-FAX(408)777-3333-building(McuDertino.ora
CUPERTINO
❑NEW CONSTRUCTIO ❑ ADDYIION ❑ALTERATION 1 TI ❑ RbVIsION 1 DEFERRED ORIGINAL PERMIT#
PROrEcrADDRESS APNI � o2i
) 'J
ORTlERNAME /�U�7z l'L tr N3wZop/� ! PHONE6S O'9S�—�lJ!/' FMAII.AVI ��..
STREET ADDRESS CITY. =/ t ; n d F �s�Q ��^ e.7l
CONTACT NAME �fC'✓[' F0EtAu�
t & 1 'ctr
STREET ADDRESSr e +4 CITY.STA N W U F
t L(
❑owNER ❑ owNER-sun.Dmt ❑owNERAGENr 0'6mcrm ❑coNTRAcroRAGR4T ❑ ARcsrrEcr ❑ENGINM ❑ DEvELoPat ❑TwANT
CONTRACTORNAME Sleve I
LICMMNUMB 27,16 <767
6 LICENSE TYPE jZ BUS.LIC#
COMPANYNA"'E e,,e _n 'MAIL ev C'V /r la ,.�vn{ P
J l(vt C4
STREET ADDRESS CITY,STALE,Z[P ONE
C. M.
u le 09U, s
ARCHITECT/ENGINEER NAME LICENSE NUMBER sus.LIc 3
COMPANY NAME �v i E-MAIL FAX
STREET ADDRESS CnY.SLATE,ZIP PHONE
DESCRIPTION OF WORK r
LQW0,,Q_.Q, 41210
EXISTINGUSE PROPOSED USE CONSTR.TYPE #STORMS
USE TYPE OCC. SQFf. VALUATION(5)
EXISTG NEWFLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCID:I't OTHER
REMODELAREA REMODELAREA, REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREADETACH
ATTACH
a DWELLING UNITS: IS A SECOND UNIT 13YES SECOND STORY YES
BEINGADDED? ONO ADDMON? ❑NO
PRE-APPLICATION ❑YES IFYES,PROVIDE COPY OF LS THB BLDG AN ❑YES TOTAL VALUATION:_
PLANNDQG APPL I ❑NO PLANNIIIOAPPROVAL.L.E1TEit EICBLER HOM87 C1 NO '
Z6'000
By my signature below,I certify to each of the following: I am the property owner or iuthorVzd ageRto act on the etty owner's behalf. I have read this
application and the informarion I,ha a rovided is correct I have-read the Description of work and v 'fy it
accuta [ to comply with all applicable local
ordinances and state laws relating I ding a S6t tion I authorize representatives of Cupertino to enter th&V-idea' ed^pr�operty for inspection purposes.
Signature ofApplicant(Agent: ---=—� Date:
SUPPLEMENTAL INFORMATION REQUMED CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ovsR.rHF,COUNTER ❑ Bun.DiNG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building. ❑ 1CPREss ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WOM
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ >�nt rr
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application_ ❑ MAJOR ❑ SANrrARx SEWER DISTRICT
❑ ENVIRONMENTAL R-FALTJI .
B1dgApp 3011.doc revised 06/21/11
CITY OF CUPERTINO
EE ESTIMATOR—BUILDING DIVISION
ADDRESS:.Olds parkwood dr bldg 21 DATE: 04/15/2013 REVIEWED BY: Mendez
APNs gp#; *VALUATION: $20,000
*PERMIT TYPE: Building Permit _T_PLAN CHECK TYPE: Akeration I Repair . -.
PRIMARY PENTAMATION 1GENRES
USE: SFD or'Duplex PERMIT TYPE:
wORK Bld '21-remove and replies 16 windows like for like to meet egress in bedrooms
SCOPE
Mech.Plan Check:
' Plrtntb.Plan Check Elec.Plan Check
A-tech.Permit Fee:' Plumb.Permit Fee: Elec.Permit Fee:
Other Alech.Insp: Other Plumb Insp. Other Elec.Insp.
Li
Adech.Insp.Fee:: Plumb.lisp.Fee: Elec.Insp.Fee:
1. NOTE:This estii�iate.does iibt lilrclude fees due to other Deparonents(.e Planning,Public Works,Fire,Sanitary Sewer Dlstriet,.School
Dis eta These•ees art.based bti the r in ornurrion available and are o an estimate Contact the D t or addn l info.
FEE ITEMS`„(F_ee Resolutio�rll-053 E� 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 16 # Window/Sliding Glass Door
Suppl.PC Fee: Q Reg. 'Q'OT 0:0 hrs $0.00 $533.00 IWINREP Replacement
PME Plan Check: $0.00
Permit-Tee: $0.00
.Suppl.Insp.FeeO Reg. O.OT . 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit.Fee: $0.00-
Cvnsttuclion TdT.:
AdminWrattve F ee
Wok Without Permit? `Q Yes Q No
$0.00 Q
:Adva►ced'Elanninee. $0.00 Select a Non-Residential
Building or:Structure
. �� �T;rati�l:7?ocu{n.�ntution Fares: • '” '
tron �lyTotYori Fee: .'! 1BSEISMICR $2.00 Select an Administrative Item
B1dg-SfdsCommissionEee: 1BCBSC $1.00
$3.00 : $533.00 $536:00
Revised: 04/0112013
i
=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: PERMIT
OWNER'SNAME: V PHONE:# •` GCo /
GENERAL CONTRACTOR:. c C ih BUSINESS.LICENSE#
ADDRESS: d. CIT S�/ZIPC.ODE.
*Our municipal code requires all businesses working in the city to have.a City`of Cupelrtinot usiness license.
NO BUILDING. FINAL OR.FINAL OCCUPANCY INSPECTIONS)*wILI::BE.-SCHEDULED UNTIL THE
-GENERAL CONTRACTOR AND ALI^UBCONTAACTORS HAVE.OBTA3NED.A CITY O C PERTIN0
BUSINESS LICENSE.
I am not using any subcontractors:
Signature, Date
Please check applicable subcontractors and complete the following•infnrmationr. .
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 }..
Owner/Contractor Signature f Date