B-2016-3227CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3227
10243 PARKWOOD DR APT 2 CUPERTINO, CA (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 12/09/2016
OWNER'S PHONE: 650-961-8330
PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERA
LIT INFO:
License Class C-4. 10.20.36.38 Lic. #255D57
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:
BLDG 45/UNIT 2;
ADD (I) A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION; (N) MASHER
AND DRYER HOOKUPS; (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 L
IGHT; (I) BATHROOM EXHAUST FAN
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:
Valuation: $20000.00
APPLICANT CERTIFICATION
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 27 037
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 1
0 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM
LAST CALLED INSPECTION.
Signature ', Date 12/9/2016
Issued by: Abby A
en_de
Date: 12/09/2016
OWNER -BUILDER 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 ins
pected prior to any roofing material being installed. If a roof is
a. 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 Applican
:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/9/2016
I hereby affirm under penalty of perjury one of the 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.
H
ARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha
ardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Healti
& Safety Code, Sections 2"5505, 25533, and 25534. I will
permit is issued.
maintain complianc
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 Gode,
Section 25532(x) 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 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, 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized
agent:
f`
APPLICANT CERTIFICATION
Date: 12/9/2016
I certify that I have read this application and state that the above information is
O S O N
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that t
`ere 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 pla
is shall be used as public records.
Licensed
Signature Date 12/9/2016
Professional
I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinqAcupertino.oEl r 6 3
NEW CONSTRUCTION [:1ADDITION 0 ALTERATION/ TI ❑ REVISION / DETERRED ORIGINAL PERMIT #Z
PROJECT ADDRESS 10243 Parkwood DR, BLDG 45, Unit #2 APN# . 0 ?, .
OWNERNAME Avery Glenbrook LLC
PHONE E-MAIL
650-961-8330 avery@pacbell.net
STREET ADDRESS CITY, STATE, ZIP FAX 650-961-0571
130 :East Dana Street Mt. View.,. CA 4041
.,.CONTACT NAME Rob Moyer y PxoNE 408-593-8115 E-MAIL rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP FAX 408-988-0233
Santa Clara, A 95054
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT IX CONTRACTOR D CONTRACTOR AGENT IJ A PCHrrECT D ENGINEER ❑ DEVELOPER D TENANT
CONTRACTOR NAME LICENSE NUMBER 256057 LIC NSE TYPE BUS. LIC # 299
Thermal Mechanical _C-4.10.20 36.38
COMPANY' Thermal Mechanical E-MAILrmoyer@thermalmec i.com FAX 408-988-0233
STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,. STATE, ZIP PHONE
add new AC, replace furnace in same location, (N) was
(N) gas line for stove, (N) electrical outlets, (N) light, (N)
hook ups, (N) electrical panel (70 AMP),
1 exhaust fan
SUPPLEMENTAL INFORMATION REQUIRED
_ 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.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
Submittal of Building Permit application.
BidgApp_2011.doc revised 06121/11
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
-- -
AREA
AREA
AREA.
NETAREA
BATHROOM - - KITCHEN
OTHER-
'REMODELAREA REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
- -
GARAGE AREA: DETACH
-
QATTACH
I
#DWELLINGUNITS:
IS.ASECOND UNIT []YES
SECONDSTORY ❑YES
-
-
BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
IiEO,E;$, '-_
TOTAL VAL��UT1ATIO�N'
PLANNING ADPL# ❑NO PLANNING APPROVAL. LETTER
EICHLERHOME? E] NO
):
O VD
By my signature below, I certify to each of the following: I am the property owner orauthorized ag o ac
perry owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description Of Work and verify it is
ccurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi�n oI struction. I authorize representatives of Cupertino to enter the
above-iden ' ed property for inspection purposes.
Signature of Applicant/Agent: — Date:
SUPPLEMENTAL INFORMATION REQUIRED
_ 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.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
Submittal of Building Permit application.
BidgApp_2011.doc revised 06121/11
SMOKE ] CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
lag COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION,
CUf?ER"iTNO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3128 • FAX (408) 777-3333 • buIIdln cuper Ino.oro
PURPUSE
This affidavit is a self -certification for the iizstalla-tion of allrequired Smoke and Carbon Monoxide Alarms for
,compliance with 2:013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where ho 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 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 followizlg locations:
Carbon Monoxide alarms are not required in dwellings wl-dcl do,not contain fuel-bun-dng appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alai -Ins; shall comply with .
CBC Section 420.6 and shall be approved by jthe Office of the State Fire Marshal.
Poorer 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 repairs or alterations do
riot result u1 the removal of wall and ceiling finishes or there is no access by means of attic, basement or cra«7I
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. Al electrical permit is required for
alarms which must be connected to the building wirhag.
As owner 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 with the California Buildin-
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. - a
Address:
Permit l\To.� 2 946 -92 -2 -
Specify Number of Alarms: # Smoke: Alanlis, # Carbon Monoxide Detectors:
l have read and earee to comoiv with the terms -and conditions of this statement
Owner (or Owner Agent's) Name:
AREA _ SMOKE ALARM CO ALARM
Outside of each separate sleeping
area in the immediate vicinity of X X.
the bedroom(s) {
On every level of a dwelling unit including basements X----rTV X
Within each sleepin room
X
Carbon Monoxide alarms are not required in dwellings wl-dcl do,not contain fuel-bun-dng appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alai -Ins; shall comply with .
CBC Section 420.6 and shall be approved by jthe Office of the State Fire Marshal.
Poorer 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 repairs or alterations do
riot result u1 the removal of wall and ceiling finishes or there is no access by means of attic, basement or cra«7I
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. Al electrical permit is required for
alarms which must be connected to the building wirhag.
As owner 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 with the California Buildin-
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. - a
Address:
Permit l\To.� 2 946 -92 -2 -
Specify Number of Alarms: # Smoke: Alanlis, # Carbon Monoxide Detectors:
l have read and earee to comoiv with the terms -and conditions of this statement
Owner (or Owner Agent's) Name:
"
Signature'''... ........... Daate `0//
Contractor Name:.
lie Pii ee�.
.........y
Signature Lica Date-
ATER-CONSERVING PLUMBING FIXTURES -
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUfgElTtt�t3 10300 TORRE AVENUE • CUPERTINO, OA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcuupertino.org
Owner Name hu 1%,/ 11 r r& ", Z I C Permit No. %x_20% 522-2
Address 102- V�
i•
1. Is your real propertya registered historical site?
❑ 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 cei`tifying that, due to the age or configuration of the property or its
lurmbing, installation of water -conserving plumbing fixtures is not technically feasible?
,Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No Go to Question 3. T
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.,-1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of foam..
19, No Go to Question 4.
4.. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ 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, 1994.
Civil Code Sections 11013 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
❑ 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
oncompliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
My property is a inult family residential real property. See Civil Code Section 1°101.5;
On and after January 1, 2014, specified building. alterations or improvements shall require non- compliant
plurnbing 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). -
Myproperty is a co7nniercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building. alterations or iimprovements shall require non- compliant
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).
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 Mures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and inanufacturer's
installation requirements, and that the -,rater-conseiving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature:_ Date:
Upon completing anct signing tnis uelulicaTe, p1Cd5C retullt 1L w utc yuieuiaib t 1v-1-1
SE4072015.doc revised 08/26/15