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13060106 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10260 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO:13060106 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:06/13/2013 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL❑ License Class_ Lic.# BLDG#3-REMOVE AND REPLACE 36 WINDOWS LIKE f FOR Contractor L eVC"tcx J--Date 0 LIKE 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:32627037.10260 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 WITHIIN 0 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 DAYZ3M 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 isnot 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 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 t e Cupertino M nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seed s 505 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen : Date permit is issued. 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 �t9 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDINGDIVISION 6� 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 �lbw CUPERTINO (408)777-3228- FAX(408)777-3333-building(a.cupertino.org 1 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS J ! 1_C� P 01,kUJV Cd n APN# 1 -7 n2-7 OWNER NAME /`�C7z Y at l\J l.Y W Y ! �( pPHONE` D-Q�(_� E-MAIL�vL�L S STREET ADDRESS CrIY. 4TE ZIP 7 n fq 3O �,�P, s vr✓ � , < l I / CONTACT NAME P��(' ✓` 7 CC'U A�C, C7 NE�-fv o 0, , 4)� E S/C A LLU CQ /LLQ ` 6ti STREET ADDRESS ZIP )VV • ,1-I CIrY, N 11 e {y U F ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT LKCONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUME LICENSE TYPE BUS.LIC# VC(YJ CA 16 COMPANY NAME E-MAIL F eJe n v S ev le Ir1a, �.Cc�rit STREET ADDRESS .�/� CITY,STATE ZIP ONE CI S -A vu le - !o ARCHITECTIENGINEERNAME .iL LICENSENUMBER BUS.LIC# COMPANY NAME Y E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE /J DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE 9 STORIES USE TYPE OCC. SQ.Fr. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NErAREA - BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DEMPORCH AREA I GARAGE AREA LJ DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT DYES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC=B TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - Z '- 'c�r o00 By my signature below,I certify to each of the following: I am the property owner or authorized a9f6t to act on the pamper owner's behalf. I have read this application and the information I haXe provided is correct I have read the Description of Work andoilcrify 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-identified property for inspection purposes. Signature of Applicant/Agent Date: (�.�✓ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TIE-COUNTSR ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building 1E1 permit for new building. ❑ EXIIRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE nEPT _Copy of Planning Approval Letter or Meeting with Planning prior to C3 MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgAppjOl Ldoc revised 06/21/11 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 DIST JOB ADDRESS:/Ov 3 PERMIT# OWNER'S NAME: AV_ Q Y41 CTI ...K PHONE ifRt &g Lt- GENERAL GENERAL CONTRACTOR: ' c w14ct,t Cc�S nC, BUSINESS LICENSE# ADDRESS: ` CITY/ZIPCODE: si *Our municipal code requires all businesses working in the city to have a City of Cuperti o business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTI"ON(S) WILL`BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED-,*CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature ate Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME B 7SINESS 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 `1 �3 Owne ontractor Signature Date