B-2016-3060CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3060
10115 PARKWOOD DR APT 4 CUPERTINO, CA 95014-1446 (326 27 036) THERMAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP J DATE ISSUED: 11/07/2016
OWNER'S PHONE: 650-961-8330 1 I PHONE NO: (408) 988-8744 1
► gay 0 "f 1: 0 Ms
Class C-4.10.20.36.38 Lie. #256057
.or 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.
I 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
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
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
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 thePiWrtino Municipal Code, Section 9.18.
hereby affirm that I am exempt from the Contractor's License Law for one of the
two reasons:
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, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
BUILDING PERMIT INFO:
BLDG X ELECT X PLUMB;
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG 15/UNIT 4; ADD (1) A/C; REPLACE FURNACE, SAME
LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) 9 RECEPTACLE
OUTLETS; (I) 1 LIGHT; (N) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: I Valuation: $20000.00
APN Number: Occupancy Type:
326 27 036
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 11/07/2016
RE -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 of Applicant:
Date: 11/8/2016
I hereby affirm under penalty of perjury one of the following three declarations: I ALL ROOF
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.
z 1 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.
3. 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 11/8/2016
1f A11
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 & SafetyCod s 25505, 25533, and 25534.
Owner or authorized agent:
Date: 11/812016
CO
N -1_110 LENDING
I 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
Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
❑ NEW CONSTRUCTION ❑ ADDITION RX ALTERATION / Ti I—I RENNION 1 DF.FFRRED ORTGIMAI. PERMTT #
PROJECT ADDRESS 10115 Parkwood DR, BLDG 15, Unit #4
APN# 74-
OWNER NAME
Avery Glenbrook LLC
PHONE
650-961-8330
E-MAIL
avery@pacbell.net
STREET ADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
FAx
650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115
E-MAIL rmoyer@thermaimech.com
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP
Santa Clara, CA 95054
PAx 408-988-0233
❑ OWNER ❑ OWNERBUILDER ❑ OWNER AGENT r CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT'
CONTRACTORNAMEThermal Mechanical
LICENSENUMBER 256057
ENSE TYPE
TE
BUS. LIC# 299
cOMPANYNAME Thermal Mechanical
E-MmLrmoyer@thermalmech.com
PA" 408-988-0233
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP Santa Clara, CA 95054
PHONE 408-988-8744
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME.
E-MAIL
FAX
STREET ADDRESS
CITY, STATE; ZIP
PHONE
DESCRIPTION OF WORK
Apartment renovation
EMSTINGUSE -
PROPOSED USECONST-=E
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXTSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
- OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCHAREA
DECK_ AREA -
TOTALDECKIPORCIHI
GARAGE AREA: 0 DETACH
❑ ATTACH
#DWELLINGUNITS:
ISASECONDUNIT OYES
SECONDSTORY OYES
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING AFPL# ONO PLANNINGAPPROVALLETTER
IS THE BLDGAN ❑ YES
EICHLERHOME? ONO
RECEIVED BY: �p
{�J�3`
TOT VAIW A -TION:
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application 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
ordinances and state laws relating to b c tructioriv Lauthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEWNTAL INFORMATION 1ZEQUIRED
i
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
El mA:rOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIItONMENTAL HEALTH
B1dgApp 2011.doc revised 06121111
PURPOSE
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DI'
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingacupertino.org
This -affidavit is a self -certification for the installation of all required Smoke and
-compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2
inspections are required,
GENERAL INFORMATION
Existing single-family al td multi -family dwellings shall be provided with Smoke Alarms and Carbon
in',
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 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:
Monoxide Alarms for
no interior access for
AREA
SMOKE ALARM_
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
X
the bedroom(s)
�On even level of a dwelling, unit including basements
X
X
Withrsl'each slee ing room
Carbon Monoxide alarms are not required in dwellings wl-dch do not. contain fuel -burning appliances and that
do not have art attached garage. Carbon monoxide alarms combined with smoke al !arms shall comply with
i
C -13C Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery, operated,
Th existing, dwelling units, alarms are permitted to be solely battery operated where �,epairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by mea. ' lis o� attic, basement or crawl
space. Refer to CRC Section 8314*andCBC Sections. 907.2.11.4 and 420.6.2. An electric al permit is required for
alarms which must be connected to the building ivirft it-, .
As owner of the above -referenced property, Ihereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with f 'he California Building
al-td California Residential Codes. The alarms specified below have been tested and are operational, as Of the
I
date signed below.
Address: /0//
Specify Number of Alarms: _ #
I have read and agLee to
Owner (or Owner Agent's) Name: Signature ......
00 04, ler�,-ZZO I I-- ..........
Name:
sst Signature ...
. ...........................................
P
Carbon M
conditions of this s
No. 9f-st(�e 'In
-Zol C=:!' SM
.......... .......................... Date:
.......Date:
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
777-3228 - FAX (408) 777-3333 - buiIdInq(aj_)cur)ertino.onq
o
r "
, -t-/? . I I (' PPTI-r
L Is your real property a registered historical site?
F1 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and ign bottom of form.
KNo' Go to Question 2.
2. Dod your real property have a licensed plumber certifying that, due to the ago or configuration
,Plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
,21Wes; Civil Code Sections 1101.1 through 1101.8 do not apply. I
A, The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
0 NTo Go to Question 3.
3. Is water service permanently disconnected for your building? r
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest! of the form and
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
property or its
bottom of form.
0 No My real proper ty 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, 1994.
Civil,Code Sections 1101.1 through 1101.9 apply. Check one of the three following statements and sign
bottom of foriaL.
5. Please check ONE of the following:
0 My property is a single family residential real property. See Civil Code Section 1101.4.
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 January 1, 2017, all non-
,
compliant plumbing fixtures shall be -replaced with water -conserving plumbing fixtures {`regardless of whether
property undergoes alterations or improvements).
My property is a multifamily residential real property. See Civil Code Section 1101.5,
On and after January 1, 2014, specified building alterations or improvements shall require non- �onipliant
plumbing fixtures to be replaced with water -conserving 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 alterations or
improvements).
0 My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced-)Nith water -conserving 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 alterations i
?r improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to'date specified above with water -conserving plumbing fixtures iii accordance with Civil Code Sections 1101.1
through 1101.8, 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 page.
- - - t Uate:
Owner or Owner Agent's Signature; t;�s 14 AWezo 2 -
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SP4072015.docremised O8126115 -