B-2016-3063CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3063
10110 PARKWOOD DRAPT 6 CUPERTINO, CA 95014-1441 (326 27 036)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 11/07/2016
OWNER'S PHONE: 650-593-8115
PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-4,10,20,36.38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/3112018
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:
BLDG 18/UNIT 6; ADD (N) A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL
1. I have and will maintain a certificate of consent to self -insure for Worker's
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) 9 RECEPTACLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
OUTLETS; (N) 1 LIGHT; (I) BATHROOM EXHAUST FAN
performance of the work for which this permit is issued.
i 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
Sq. Ft Floor Area:
Valuation: $20000.00
permit is issued,
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
APN Number:
Occupancy Type:
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 IFWORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per.the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION:
Signature D to 11/7/2016
Issued by: Abby yende
Date: 11/07/2016
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
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, l 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 (Sec.7044, Business & Professions Code).
Date: 11/7/2016
I hereby affirm under penalty of perjury one ofthe following three declarations:
ALL ROOF COVERINGS TO BE.CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 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. 1 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this 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, Se n 5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. G
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 11/7/2016
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
CONSTRUCTIONLE
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.
Licensed
Signature Date 11/7/2016
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE m CUPERTINO, CA 05014-3255 q
(408) 777-3223 ® FAX (408), 777-3333 g L
NEW CONSTRUCTION ❑ ADDITION N ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
10110 Parkwood DR, BLDG 18, Unit #6
APN #
21-03U
OWNER NAME Ave Glenbrook LLC
Avery
PHONE
650-961-8330
E-MAn, avery@pacbell.net
ry@p
STREEETADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View,. CA 94041
FAX
650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115 T77
rmoyer@thermalmech.com
STREET`ADDRESS 425 Aldo ave.
CITY, STATE; ZIP
Santa Clara,. CA 95054
FAX 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT I$ :CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
Thermal Mechanical
LICENSE NUMBER 256057
LICENSE TYPE.
BUS. LIC # 299
C-4 10 20 36 38
coMPANYNAME ThermalMechanical
E—` rmoyer@thermalmech.com
FAX 408-988-0233
STREET ADDRESS -.
425 Aldo ave.
CITY, STATE, zI'
Santa Clara, CA 95054
PHONE
408-988-8744
ARCHITECT/E'NGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Apartment renovation.
EXISTINGUSE --
PROPOSID USE CONSTR
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EMSTG
NEW FLOOR
DEMO
TOTAL
..AREA
AREA
AREA
NETAREA
BATHROOM _. _
KITCHEN -
OTHER -
-.
REMODELAREA
REMODELAREA
REMODEL AREA
FORCH AREA
DECK AREA.
TOTALDEGKIPORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
I
#DWELLINGUNITS:
ISA SECOND UNIT ❑YES
SECOND STORY OYES
BEINGADDED? ONO
ADDITION? ONO'
L
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
REC VED BY:
T TAL VALUATION:
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER
EICHLERHOME? 0 N
By my signature below, I certify to each of the following: I am the property owner or authorized agent to hct on the property owner's behalf I have read this
application and the information I have provide 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 b co cto . authorize representatives of Cupertino to enter the above-identif d prope for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENrAL INFORMATIO QUlRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING 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
❑ STANDARD
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ sANrrARY SEWER DISTRICT
submittal of Building Permit application.
El ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11
PURPOSE
SMOKE ICARBON
MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 -FAX (408) 777-3333 - buildlingO
cupertIno.ogg
`n -tis affidavit :is a self -certification for the installation of all required Smoke and Cafbort Monoxide Alarms for
compliance with 2013 CRC Section 8.314, 2013 CBC Sections 420.6 and 907.2.11.2 Where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existiA- dwelling units exceeds
$1000,00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
I
SMOKE ATARTM
CO ALARM
Outside of each separate sleeping area in the irnmediate vicinity of
X
X
the bedroom(s)
On every level of a dwelling unit including basements
X
x
Within each slee in- room
X
Carbon Monoxide alarms are not required in dwellings which do not contain f uel-b�rrdng appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
1
C'BC Section 420.6 and shall be approved by the Office of the State Fire Marshal. i
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery. operated.
In existing dwelling units, alarms are permitted to be solely battery operated where iepairs or alterations do
not result in the removal of wall and ceilinc, finishes or there is no access by means of attic, basement or cravrl
,
space. Refer to CRC Section 8314 and CBC Sections. 907.2.11.4 and 420.6.2. An electriical pen -nit is required for
alarms i,\rl-dch must be connected to the building lvirftl.cl.
As owrLer of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance i,%dththe California Building
and California Residential Codes. The alarms specified below have been tested and a1,reoperational, as of the
date signed below.
AZ Permit No6?-z_
Address: I .
Specify Number of Alarms:
# Sm
I have read and agree to
-Owner (or Ovmer Agent's) Name: Signature....
,74M�; 91, leZZO .- ......... -...
Aor Name;
Signature.....
P'A- ee,400,,,�,
Detectors:
fy with the jp=s..,9nd conditions of this statement
i
...... ........... Date:
.................. �Z
Lic#7—
......... 5 .. ....... Datel-/130
CUPERTINO
Owner Name
Address /0
i
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE I
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
777-3228 - FAX (408) 777-3333 - buildingCa)-cupertino.org -i - 0 6
Permit No. -2- )
1. Is your real property a registered historical sitJeWb
.0,.Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and, sign bottom of form.
No Go to Question 2.
2., Does* your real property have a licensed plumber certifying that, due to the ago or configuration o� the property or its
'PI'Lunbmg, installation of water -conserving plumbing fixtures is not technically feasible?
,t5=,Yes Civil Code Sections 1101.1 through 1101.8 do not apply,
The licensed plumber's certification has been provided to the Building Division. I
Skip the rest of the form and sign bottom of form.
0 No Go to Question 3.
3. Is water service permanently disconnected for your building?
F1 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form andisign bottom of form.
No Go to Question 4.
4. Is your real property built and available fb'r use or occupancy on or before January 1, 1994?
0 No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and (sign bottom of form.
Yes My real property is built and available for use or occupancy on or before January 1, 190.4.
Civil.Code Sections 1161.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following: i
❑ My property is a single-family residential real property, See Civil Code Section 1101.4. 1
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before Janum-y 1, 2017, all non-
compliant plumbing fixtures shall be -replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
Myproperty is a multifamily residential real propeity. See Civil Code Section 1101.5.
I
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures. 1 1
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -I
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
0 Mypropetty is a cominercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing f i
., fixtures to be replaced with plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterationsJIor improvements).
1, as the owner or owner's agent of this property, certify under penalty of perjury that non-complian)t plumbing fixtures will be
replaced prior to' date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through I 10 1. 8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirei�ents as indicated in the
table on the following i)a�e. i f
Owner or Owner Agent's Signature.: 7-3- P (7K_ 1011&1_0 ) Pate: '7--/ 3 / /
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. '
2015.doc revised 08126115 -