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13090035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10275 PARKWOOD DR CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 13090035 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 CONTRACTOR'S DECLARATION � BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# Cf co ( O MECH RESIDENTIAL COMMERCIAL Contractor \�`ea�-e.� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 10-APT 1 THRU 8-REMOVE AND REPLACE 28 (commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS.JOB COVER 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 t".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:32627036.10275 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 AYS FROM AST CALLED INSPECTION. with all non-poi source regulations per the Cupertino Municipal Co Sectio 9.18. �y (� Issued b Date: Signature Date �q ❑ 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 Heal% &Safety f ode,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 auth zed gent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: I 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 C)g � �� 5 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333- building(cocupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS l - )L75 PQ V W'.J br j APN# / � /`� �j ( ,.�1 �` OWNERNAIvIE /J� er, / �/ y /J FHO ds 0-961-k E-MAIL .^vL��s' ✓ STREET ADDRESS V ( (/ / CITY. TE ZIP 7 0'r Fi ,, Qvli(Q4 / - Z 7( 30 CONTACT NAME I tAa, Lo- 7 CS'UArJCtL, P`tf�fs'$d6� ) `f)� ES 7`L t" uLtJ Cg /LLN- STREET ADDRESS -'-'ICITY.STATE e U F c ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT WKCONTRACroR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMB l /, LICENSE TYPE BUS.LIC# COMPANY NAMEQS ve r� t oh Ca,•I.CCJ�►1 STREET ADDRESS CITY,STATE.ZIP P ONE Spla Q � S -A voi le a - GC71S ARCHITECr/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE ti DESCRIPTION OF WORK _410Qom_ U 7— E)GSTING USE PROPOSED USE- CONSTIL TYPE #S-RIES USE TYPE OCC. SQ_FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: U DETACH []ATTACH #D WELLING UNTTS: IS A SECOND UNTO ❑YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS TRE.BLDG AN ❑YES RECEIVED TOTAL VALUATION:_ PLANNING APPL N []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO Zd�OOU J By my signature below,I certify to each of the following. I am the property owner or authorized agentTothe prr�perty owner's behalf. I have read this application and the information I ha a rovWed is correct I have read the Description of Work and verify i accurate. I agree to comply with all applicable local ordinances and state laws relating ding c tion. I authorize representatives of Cupertino to ente the above-identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED CEMCK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TBE-COUNTER ❑ BUILDING 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 11STANDARD C1PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE buT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06121111 CITY OF CUPERTINO FEEESTIMATOR-BUILDING DIVISION ADDRESS: 10275 Parkwood Drive(bldg#11 DATE: 09/06/2013 REVIEWED BY: 01APN: 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 tZunits including bedrooms which will meet current SCOPE egress rrequirements 0 . X 11 .L1ec,h. Plan(.heck Plurnb.Plan Check flee.Plan(..heck . Perin F:e: laec. Permit ee:LIi>chfc L Ifec�h.Insp. (hirer Plumb Insp. Other lilec_Insp. .Insp,F(,w., Plurub. Insp.Fee: Elec.Insp. Fce: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina information available and are only an estimate. Contact the De t or addn7 in o. FEE ITEMS(Fee Resolution 11-053 E . 711/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: E) Reg. ® OT 0.0 hrs $0.00 $835.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? ® Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fees: Building or Structure I Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 AM $3.00 $835.00SAMM $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:(Uo1- PERMIT#` OWNER'S NAME: S wr. PHONE#F.° i -' GENERAL CONTRACTOR. CCRc y`G BUSINESS LICENSE ADDRESS: CITY/ZlPCODE *Our municipal-code requires all businesses working in the city to have a City.of Cupertino , usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) V�'3LL 1ECIEDULED UNTIL THE GENERAL CONTRACTOR AND AL BCO CTORS HAVE OBTAPNED ACTTY F CU ERTINO BUSINESS LICENSE. I am not using any subcontractors: �` G ignature 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 71. Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Til oco// ner/Contractor Signature fi to