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13090036 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10265 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 13090036 CONSTRUCTION OWNER'S NAME: AVERY GLENBROOK LP 528 S MATHILDA AVE STE 2 DATE ISSUED:09/06/2013 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145 ❑ LICENSED CONTRACTO 'S DECLARATION � '� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class `b Lic.# MECH r— RESIDENTIAL f— COMMERCIAL� Contracto v ct Date D I hereby affirm that I am licensed under the provisions of Chapter 9 /// JOB DESCRIPTION:BLDG 11-APT 1 THRU 8-REMOVE&REPLACE 28 (commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS.JOB COVERS 8 UNITS INCLUDING BEDROOMS Code and that my license is in full force and effect. WHICH WILL MEET CURRENT EGRESS REQUIREMENTS 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. 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 Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32627036.10265 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 D YS FROM ST CALLED INSPECTION. with all non- int source re ulations per the Cupertino Mu:4qn 9.18. � Signatur Date Issued by: �� Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow o aut 5rize agent: r, forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228-FAX(408)777-3333• building aQcupertino.org CUPERTINO ❑NEV CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS //� {� ' AFN# 1 j\ J V7� +� / w j lJ (JJ OWNER NAME �J��It- PHONE E-MAILE-MAI ,Avt�'eS STREET ADDRESSvim,/ x17 l c v F � 'w t°'�a' - X71 CONTACT NAME P ONE �) E- s1 C ✓�— 7 �va.�c�C_ v�-£sa6- ' Spic LaJ MN- STREET ADDRESS �aCITY'ATSZIP e U F C3OWNER ❑ OWNER-BUJLDER [3OWNER AGENT LIYCONTRACTOR ❑CONTRACTOR AGENT 13APcHrrECT El ENGINEER 11 DEVELOPER ❑TENANT LICENSE NUMB C1 LICENSE TYPE BUS.LIC# CONTRACTOR NAMES1 V ( ��nc,`C j r� / COMPANY NAME C' E-MAIL �f LCC F Y�a^73V 44 Q:re n U S eV 6L) mar I .�C�M STREP ADDRESS .�/�� CT1Y,STATE,ZIP PONE S y P S -A Vu le C) - (o ARCB=CT/ENGINEER NAME A LICENSE NUMBER BUS.LIC# COMPANY NAME (� E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP �j PHONE DESCRIPTION OF WORK e 3 C ..�C Q /` l LIJ()w_5 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ FT. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL.DECK/PORCH AREA I GARAGE AREA H DETACH ATTACH #DWELLING UNrrS: IS A SECOND UNIT []YES SECOND STORY OYES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REWB TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? E3 NO Zc�r 000 By my signature below,I certify to each of the following: I am the property owner or authorized igtql act on the prrrperty owner's behalf. I have read this application and the information I ha a rov.ded is correct. I have read the Description of Work and verify 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 ofApplicant/Agent ! Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TIE-COUNTER ❑ BUUX1,tG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORM form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=nr rr _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONN=AL HEALTH BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10265 Paekwood Drive(bldg#11 DATE: 09/06/2013 REVIEWED BY: APN: BP#: ''VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1GENRES USE: 3 Stories ® Yes ® No PERMIT TYPE: WORK remove and replace 28 windows. 'ob covers units includingbedrooms which will meet current SCOPE egress rrequirements 0 �, m, k501 , Xficc:/i. Flan t'hcck Plumb.Plan Cheek Elec.111an Check L1ec41. Permit Fee: Plumb.Permit Fere: Elec. Permit Fee: Other Heck Insp. Other Plumb Insp. Other Elec.Insp. .1:1ech. Insp. Fee: Plumb.Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.c Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the preflmina information available and are only an estimate Contact the De t or addn'l info, FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 28 # Window/Sliding Glass Door Suppl.PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $835.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adininistrati ve.Fee: Work Without Permit? ® Yes (j) No $0.00 (E) Advanced Planning Fee_ $0.00 Select a Non-Residential 0 Travel Documentation Fees: Building or Structure i Strong;Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 On' $3.00 $835.00 $838.00 Revised: 07/01/2013 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'S NAME: PHONE# �C GENERAL CONTRACTO BUSINESS LICENSE# ADDRESS: 0,c,P ,Z CITY/ZIPCODE: "_ �/rt rC> SSS *Our municipal code requires all businesses working in the city to have,a City of-Gupertinc business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) W— LL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL SUBCONTRACTORS HAVE OBTAINED A CITY O CUP RTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 caner/Contractor Signature Dat :i: