13100087CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10115 PARKWOOD DR
CONTRACTOR: STEVE PLEVANCIC
PERMIT NO: 13100087
CONSTRUCTION
OWNER'S NAME: AVERY GLENBROOK LP
528 S MATHILDA AVE STE 2
DATE ISSUED: 10/11/2013
OWNE PHONE: 6509618330
SUNNYVALE, CA 94086
PHONE NO: (408) 806-9145
11
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
# 15 - REMOVE & REPLACE 28 (E) WINDOWS (WILL
License Class Lic. # 0BLDG
MEET EGRESS & BE TEMPERED WHERE REQUIRED BY
Contractor N' Date
CODE)
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $20000
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32627036.10115
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 -FRO A LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the1"j)
ate:
granting of this permit. Additionally, the applicant understands and will comply
with all non -poi source regulations per.the Cupertino Municipal C de, S tion
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 is notintended 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(x) 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance with th Cupertino Municipal Code, Chapter 9.1 and
the Health & Safety Code, Sectio 505,2 3, nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: l(
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
CONSTRUCTION LENDING AGENCY
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
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildino(&cupertino.org
❑ NFW C`ONSTRU=ON M ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROTECT ADDRESS /a/ _ / �r
APN
OWNER NAME 7 �J v&]a / rLOO�%e1 ` !
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STREET ADDRESS
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CONTACT NAMEJ e -U AfJ G l L
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STREET ADDRESS# CITY, STATE ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT WCONTRACTOR ❑CONTRACTORAGENT ❑ ARCH1TECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEr
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LICENSE NUMB J %� �j
LICENSE TYPE 23
BUS. LIC #
COMPANYNAME
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STREET ADDRESS
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ARCHTTECT/ENGWEER NAME ► )
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
E7GSTING USE
PROPOSEDIUSE -
CONSTR. TYPE
# STORIES _
USE TYPE
OCC.
SQ.FT.
VALUATION (5)
EXLSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
-
BATHROOM
KIrCHEN -
OTTER
_
REMODEL AREA
REMODEL -AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECWPORCB AREA I GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
ISA SECOND UNIT ❑YES
SECOND STORY ❑YES
BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RE TOTAL VALUATION:
PLANNWGAPPL# []NO PLANNINGAPPROVALLErm
EICHLERHOME? []NO
_
By my Signature below, I certify to each of the following: I am the property owner or au ed gent to ac a property owner's behalf. I have read this
application and the information I ha a rovWed is correct. I have read the Description of Work an ven 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
PIAN CHECK TYPE
ROUTOG SLD'
��-,TBZ-COUNTER
❑ BUII,DING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
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
C1 STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
❑ I= DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRON(IVI[ENTAI. HEALTH
B1dg,4pp 2011.doc revised 06/21/11
e 71
���'�� CITY OF CUPERTINO
1O1 VFW Ti.CTTM A TnR — R1T11,DING niVISION
L9ech. Plan Check
Filch, Permit Fee:
Other .1fech. Insp.
ilech. Insp. Fee:
P1Twnb. I'lun Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check
glee. Permit lee:
Other Elec. Insp.
Elec. Insp. Fete:
NOTE: This estimate does not includefees due to otner Departments (Le. rianning, ruauc rrarna, c, qui ""'y uc-., esus .1.1
and ora now an octimato_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13)
ADDRESS: 10115 PARKWOOD DR BLDG 15
1 DATE: 10/11/2013
REVIEWED BY: MELISSA
APN: 326 27 036
BP#:
"VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
hrs
$0.00
PENTAMATION 1GENRES
I PERMIT TYPE:
USE:
Permit Fee:
woRK
REMOVE & REPLACE 28 E
WINDOWS WILL MEET EGRESS & BE TEMPERED WHERE
SCOPE I
REQUIRED BY CODE)
L9ech. Plan Check
Filch, Permit Fee:
Other .1fech. Insp.
ilech. Insp. Fee:
P1Twnb. I'lun Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check
glee. Permit lee:
Other Elec. Insp.
Elec. Insp. Fete:
NOTE: This estimate does not includefees due to otner Departments (Le. rianning, ruauc rrarna, c, qui ""'y uc-., esus .1.1
and ora now an octimato_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
28 #
$835.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: O Reg. O OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. OOT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cons1Pvction :Tax:
rtw11711,
Administrative .Fee:
'€
.,4
L9ech. Plan Check
Filch, Permit Fee:
Other .1fech. Insp.
ilech. Insp. Fee:
P1Twnb. I'lun Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check
glee. Permit lee:
Other Elec. Insp.
Elec. Insp. Fete:
NOTE: This estimate does not includefees due to otner Departments (Le. rianning, ruauc rrarna, c, qui ""'y uc-., esus .1.1
and ora now an octimato_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
28 #
$835.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: O Reg. O OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. OOT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cons1Pvction :Tax:
Administrative .Fee:
O
Work Without Permit? O :Yes O No
$0.00
Advanced Planning Fee:$0.00
Select a Non -Residential
Buildingor Structure
O
i
Travel Documentation Fees:
Strong Motion. Fee: 18SEISMICR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
_ —Zzj
$3.00
$835.00
. a
ti�MAI*`
$838.00
Revised: 10/01/2013