B-2016-2465CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10244 PARKWOOD DR CUPERTINO, CA 95014-1526 (326 27 037)
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: 650-961-8330
LICENSED CONTRACTOR'S DECLARATION
License Class C10. C20 C38, C36 Lie. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
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.
hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
CONTRACTOR: I PERMIT NO: B-2016-2465
MECHANICAL.
SANTA CLARA, CA
95054
DATE ISSUED: 10/19/2016
NO: (408) 988-8744
PERMIT INFO:
X BLDG —ELECT X PLUMS
— M ECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG 65 - (N)ADDITION (21 S.F.) FOR WATER SERVICE AND NEW
GAS LINE ENCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
/
2:, 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. 21 Valuation; $35000.00
APPLICANT CERTIFICATION
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 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 with all non -point
source regulations per Cupertino Municipal Code, Section 9.18.
Signature' Date 10/19/2016
OWNER -BUTT DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1.. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
i. I, as owner of the property; am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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.
a. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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 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 with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 10/19/2016
APN Number: Occupancy Type:
326 27 037 U (Private Gar / Ag Bldg)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR_
180 DAYS FROM LAST CALLED INSPECTION.
by:
PE -ROOFS:
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.
Signature ofAppiicant:
Date: 10/19/2016
ALL
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533q and 25534.
Owner or authorized agent /
Date: 10/19/2016
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lenders Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
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
Ca)-cupertino.org
NEW CONSTRUCTION ❑ ADDITION [n ALTERATION/ Ti ❑ _ REVISION / DEFERRED ORIGINAL PERMIT #
PROIECTADDRESS 10244 Parkwood drive I
APN# 326-27-037
GwNERNMAvery Glenbrook LLC PHONE E Avery@pacbell.net
netAE 650-961-8330
STREETADDRESS 130 East Dana St CITY, STATE, ZIP. FAX
Mt. View, CA 94041 650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-81 15 E-MAIL.
STREET ADDRESS 4258 Aldo Ave CITY, STATE, ZIP Santa .clara, CA 95054 -__ FAX
408-9819-0233
El OWNER ❑ OWNER-BumDER 11 OWNER AGENT EX CONTRACTOR ❑ CONTRACTOR AGENT ❑: ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBER LICNSE TYPE ENSE, ZO,N38,C36 EUS. LIC# 299.
Thermal Mechanical 256057 LIC
COMPANY NAME.. _ .
Thermal Mechanical E-MAIL rmo er thermalmech.com FAX 408-988-0233
STREET ADDRESS 425 Aldo Ave CITY, STATE, ZIP SantaI r A 9 054 PHONE 408-988-8744
ARCHIT ECT/ENGINEER NAME Thermal Mechanical V LICENSE NUMBER 256057. BUS. LIC# 299
COMPANY NAME ThermalMechanical rmoyer@thermaimech.com
rmo er thermaimech.com FAX 408-988-0233
'
STREET ADDRESS. 425 Aldo Ave CITY, STATE, ZIP Santa Clara,: CA 95054 PHONE 408-988-8744
-DESCRIPTION-OF-WORK_ New domestic hot water system with new water heater and enclosure
Upgrades and repair of existing building services
EXISTING USErxurvSry
BEING ADDED? ONO ADDITION? ❑NO
PRE -APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDG ATI ❑ YES
NO
I-? ;; i �i `TTAL VALUATION:
'
USE
TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
Signature of Applicant/Agent:
TOTAL
NET AREA
SUPPLEMENTAL INFORMATION REQUIREDLAIiCt°cPr
\ A
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance ofbuildmg
AREA
AREA
AREA
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
I s7CA1wiDAtta P�[tBI ICiRis
_
form if any Hazardous Materials are being used as part of this project.
I At2Gl BwbErT
Copy of Planning Approval Letter or Meeting with Planning prior to
'
M�TAJ¢R, � Q Se1Nt"f.4R�SETV�iE�R STRICT
_
submittal of Building Permit application,
BATHROOM
KITCHEN - -
OTHER
REMODEL AREA
I REMODEL AREA
REMODEL AREA
ATTACH
#DWELLING"UNITS: IS A SECOND UNIT ❑rYES SECOND STORY LJ YES
BEING ADDED? ONO ADDITION? ❑NO
PRE -APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDG ATI ❑ YES
NO
I-? ;; i �i `TTAL VALUATION:
'
PLANNING ADPL # FIND PLANNING APPROVAL LETTER EICHLER HOME? ❑
By my signature below, I certify to each of the following: I am the property owner or authorized agent to action the property owner's behalf. I have read this
and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
application
ordinances and state laws relating to building con ction. I authorize representatives of Cupertino to enter the above -identified propel for inspection purposes.
Signature of Applicant/Agent:
Date. 7
SUPPLEMENTAL INFORMATION REQUIREDLAIiCt°cPr
O�rxI otiERI tltLnTvW
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance ofbuildmg
permit for new building.
ExtyR's'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
I s7CA1wiDAtta P�[tBI ICiRis
_
form if any Hazardous Materials are being used as part of this project.
I At2Gl BwbErT
Copy of Planning Approval Letter or Meeting with Planning prior to
'
M�TAJ¢R, � Q Se1Nt"f.4R�SETV�iE�R STRICT
_
submittal of Building Permit application,
BldgApp_201 Ldoe revised 06121111