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B-2016-2823CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10114 PARKWOOD DR APT 6 CUPERTINO, CA 95014-1438 (326 27 036) CONTRACTOR: THERMAL PERMIT NO: B-2016-2823 MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 10/14/2016 OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C10 C20 C36 & C38 Lic. #256057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT: X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: BLDG 191UNIT 6; ADD (N)A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (1) ELECTRICAL i. I have and will maintain a certificate of consent to self -insure for Worker's SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (l) 9 RECEPTACLE Compensation, as provided for by Section 3700 of the Labor Code, for the OUTLETS; (I) 1 LIGHT; (N) BATHROOM EXHAUST FAN VV� performance of the work for which this permit is issued. z ' 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 permit is issued. Sq. Ft Floor Area: Valuation: $20000.00 APPLICANT CERTIFICATION I certify that I have read this application and state -that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 326 27 036 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCEOR source regulations per the Cupertino Municipal Code, Section 9.18. 180DAYS FROM LAST C CTION. Signature ��//i! Y Date 10/14/2016 Issued by: MELI Date: 10/14/2016 OWNEWB TIL D R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is L I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 10/14/2016 I hereby affirm under penalty of perjury one of the following three declarations:ALL 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making flus certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sec�iau 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent., 05 APPLICANT CERTIFICATION Date: 10/14/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 10/14/2016 Licensed Professional a ti CUPERTlINO I I NRW ('nNCTRIICTIn71T CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40(8) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org � � � 2-3 I I AnnTTIt1R1 F)(1 Ar'1•L'D Ami 1 1-, Blclggpp_Z01 Ldvc revised 06121111 �—z(. 17 PROJECT ADDRESS 10114 Parkwood, BLDG 19, Unit #6 0-2 E"'N # w97 OWNER NAME Avery Glenbrook LLC PHONE 650-961-8330 EMAIL every@pacbell.net STREET ADDRESS 130 East Dana Street CITY' STATE' ZIP Mt, View, CA 94041 FAx 650-961-0571 CONTACT NAME Roil Moyer PHONE 408-593-8195 E-MAIL rrnoyer@thermaimech.com STREET ADDRESS 425 Aldo ave. CITY, STATS, ZIP - Santa Clara, CA950 FAX 408-988 0233 11 OWNER ❑ OWNER -BUILDER ❑ OWNFRAGF.NT CONTRACTOR ❑ CONTRACTOR AGHNT ❑ ARCHITECT ❑ ENGINEER ❑. DEVELOPER ❑ TENANT CONTRACTOR NAME Thermal Mechanical LICENSENUMBER 256057 LICENSE TYPE BUS.LIC# 299 C-4.1 .20,36,38 COM13ANYNAMZ Thermal Mechanical E-MAILrmoyer@thermalmech.com FAX 408-988-0233 STRELrrADDRESS 425 Aldo ave. cITY, STATE, 71P Santa Clara, CA 95054 YH° 408=988-8744 ARCI ITECTIENGINEERNAME LICENSENUMBER BUS. LIC # COMPANYNAME E-MAIL FAX 'STREETADDRESS CITY, STATE, ZIP PHONE - _ A, 9 -®tet ON O>? WORK %' = � '�"'``� � y C� l t-^ � i es, Pz EXISTING USE PROPOSED USE CONSTM TYPII $ MRIES - USE TYPE OCC. SQ.FT. VALUATION (S} EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM i KITCHEN OTHER - - - - REMODEL AREA REMODELAREA RHMODELAREA PORCHAREA DECK AREA TOTAL DECEIPORCHAREA GArSAGEAREA: EIDETACH - ATTACH H DWELLING UNITS: - IS A SECOND UNIT LJYM SECONDSTORY ❑YES BEING ADDED? QNO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNINGAPPLil E]NO PLANNING APPROVAL LETTER 1STHItBLDG AN ❑ YES EICHLER HOME? []NO .iVE Bly;• t ': TOI'AL'VALUATION: LR/�jj .... ..: By my signature below, I certify to each of the following: I am the property owner or authorized agent tk act on &e property owner's behalf. I Have read this application and the information I have pinvided 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 to buil ' constrrction. I authorize representatives of Cupertino to enter the above-identifil d properly for inspection purposes. Signature of Applicant(Agent: Date: i lxe SUPPLEMENTAL INFORMATION REQ D PLAIlGHEciG1YPE Roti?INcSL7P' p ovER ilE couNT u ©lsuu nlN PiAl+r utl iv 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 © PLANN[AG PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANnAxn ©PIiI3iIc Walitcs form if any Hazardous Materials are, being used as part of this project. ` ❑ `: `.. ❑ LARGE: ; ; TIRE DEPT.. ' Copy of Planning Approval Letter or Meeting with Planning prior to 1] hiATOit i� SANITARYSFWERDISTRICT submittal of Building Permit application. ` •U FIT`VII2(►Ni4IENTAISBEA LTA�:::�'�_..�.�'��-. Blclggpp_Z01 Ldvc revised 06121111 �—z(. 17