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B-2017-0152I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10154 PARKWOOD DR APT 5 CUPERTINO, CA 95014-1419 (326 27 037) OW'NER'S NAME: AVERT GLENBROOK LP OWNER'S PHONE: 650-961-8330 I a Lei 010.1 Di rCrt 11 Kr► License Class C10. C20, C36. C38 Lic. #t25M Contractor THERMAL MECHANICAL Date 01/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing 'ith Section 7000) of Division 3 of the Business & Professions Code and that my cense 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 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 1 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. Sianature s h t I��1! 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 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. 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 snaking 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. 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 01/3112017 CONTRACTOR: PERMIT NO: B-2017-0152 THERMAL MECHANICAL SANTA CLARA, CA 95054 DATE ISSUED: 01/31/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT IlYFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL ^ COMMERCIAL JOB DESCRIPTION: BLDG 27/UNIT 5; ADD (N) A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) RECEPTACLE OUTLETS; (N) LIGHT; IN) BATHROOM EXHAUST FAN Ft Floor Area: I Valuation: $20000.00 "N Number: Occupancy Type: 326 27 037 PERMIT EXPIRES IF WORD IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSAN Date: 01/31/2017 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 ofApplicanl Date: 01/31/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Sec ' 25505, 25533, and 25534. Owner or authorized agent: _ Date: 01/31/2017 CONSTRUCTION LENDING AdBNCY 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 Lender's 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 95014-3265 CUPERTINO (408) 777-3228 - FAX((408) 777-3333 - building(a)-cuperfino.ora M AiITRiTifIAT MY AVDATTr11T1 F-1 DV17Tq7nM1TN1TMDT)Rn "T"I"INTA7 PPRM1I'fR PROJECT ADDRFSS - - 777 10154 Parkwood DR, BLDG 27, Unit #5 0 WNERNAME Avery Glenbrook LLC PHONE 1 650-961-83307 -MAIL avery@pacbell.net S'rRBPTADT)RBSS 130 East Dana Street CITY, STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT NAME Rob Moyer I PHONE 408-593-8115 1 E-MAIL rmoyer(gthermatmech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 1 FAx 408-988-0233 13 OWNER D owNPIE_BuiLDea Cl OWNHRAGENT D1 CONTRACTOR 11 CONTRACTOR AGENT 11 ARCHITECT El ENGINEER 13 DEVELOPER ❑ TENANT CONTRACTORNAME Thermal Mechanical LICENSE NUMBER 256057 C-4 10 20 36.38 BUS, LIC # 299 COMPANY NAME Thermal Mechanical E-MAIL rmoyer@thermaimech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. Santa Clara, CA 95054 408-988-8744 ARCHITECTIENGINEERNAME LICENSE NUMBER BUS. LIC ft COMPANY NAME E-MAIL VAX STREET ADDRFSS CITY, STATE, ZIP PHONE IDUSCRIPTION OF WORK add new AC, replace furnace in same location, (N) washerldryer hook ups, (N) electrical panel (70 AMP), (N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan EXISTING USE CONS PROPOSED USE CONSTRITYPE PROPOSED 'J' PST USE ryPR occ. SQxT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NHrARFA BATHROOM KtrCIJBN OTHER OT. REMODELARBA RISMODELAREA R13MODISLAREA fUP_,_CHA0y,k -] D ECKAREA TOTAL DECKMORCH AREA AR DETACH 1AGE EA: E3D AC ATTACH # DWELLING UNITS,. ISA SEWCO 1) uNIT LIVES 1 0, R GA ON. EINGADDED? ONO SECONDSTORY Elyfis ADDITION? ONO PRE -APPLICATION []YES IF YES. PROVIDE COPY OF `APPL"' TION ISTHEBLDGAN OYES 'REC T TAL VALI A' [ON: P TTER NNING A PLANNING APPROVAL LE PL' PLANNINGAPPLH [IND BIC 111,F'R nomm ONO By Finysignature below, I certify to each of the following: I all, the property owner or authorized agent to act oil I elty owner's behalf, I have read this application and the information I have provided is correct, I have readthe, Description of Work and verify it is __-Hrote I agree to comply with all applicable local . d the above -identified property or inspection purposes. rdinances and state laws relating to build' 11311 t I authori7prepresclita Ves of Cupettina to enter ordinances 2 Signature of Applicaut(Agent: Date: SUPPLEMENTAL"INFORMATTON RE 1"6 .*. Type. p OvElkzrfik- Cootw New SFD or Multifamily dwellings: Apply for demolition 110rinit for existing building(s). Demolition.perinit is required prior to issuance of building P for new building. PLANNTNf3.PLAJP Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANbARD /'i:. pjiBlIC-)VORKS' form if any Hazardous Materials are being used as part of this project. J,ARGE- Copy of Planning Approval Letter or Meeting with Planning prior to AJ, R 0 C "SAN -.T q submittal of Building Permit application. . . F N VJ RONNIENTAL.HEA LTH-. BldgAlip__2011.doc revised 06121111