B-2017-0163CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. CONTRACTOR: PERMIT NO: B-2017-0163
10193 PARKWOOD DR APT 3 CUPERTINO, CA 95014-1551 (326 27 037) THERMAL
i�GTal�tl�'iteLitJiOrl3 ZiZ�I �l r�
OWNER'S PHONE: 650-961-8330
E •� t=_ _•t r :t0
License Class C10 C20 36 38 Lic. #255M
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a ecrtificate 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.
1 I have and will maintain Worker's Compensation Insurance, as provided for by
ection 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 perms Cupertino Municipal Code, Section 9.18.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. L 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 (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
a. 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.
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.
SANTA CLARA, CA
95054
ISSUED: 01/31/2017
PHONE NO: (408) 988-8744
BUILDING PERMIT INFO:
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 01/31/2017
BLDG X ELECT Y PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
BLDG 51/UNIT 3; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION; (N) WASHER AND DRYER HOOK UPS; (ISI) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) RECEPTACLE
OUTLETS; (N) LIGHT; (N) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: I Valuation: $20000.00
"N Number: Occupancy Type:
326 27 037
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: MELISSA NAMES
Date: 01/31/2017
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: 0.1/31/2017
/2017
ALL ROOF COVERINGS TO BE CLASS "A"
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, SeSilaRs 25505, 25533, and 25534.
Owner or authorized agent: _
Date: 01/31/2017
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
10*300 TORRE AVENUE - CUPERTINO. CA 95014-3255 B
CUPERTINO (408) 777-3228 - FAX. (408) 777-3333 - buildinq(@cuperfino.orq,7
F1wF.-,vrom-,TRlT(-TI0N R ADDITION N ALTERATIONVIl F1 REVISION/ DEFERRED ORIGINAL PERMIT
#-
PROJECT ADDRESS
10193 Parkwood DR, BLDG 51, Unit #3
FNV 1;
OWNERNAME Avery Glenbrook LLC
KIDNF 650-961-8330
E-MAIL avery@pacbell.net
STREETADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
1 FAX 650-961-0671
CONTACT NAME! Rob Moyer
PITONS 408-593-81
AIL rmoyer@thermalmech.com
STREETADDRESS 425 Aldo ave.
CITY, STATE, ZIP Santa Clara, CA 95054
FAx 408-988-0233
13 OWNER ❑ OWNER -BUILDER 11 OWNERAGENT 0( CONTRACTOR 11 CONTRACTOR AGENT 13 ARCHITECT 11 ENGINEER El DEVELOPER 1:3 TENANT
CONTRACTOR NAME
Thermal Mechanical
LICENSSNUMBBR 256057
LICENSE TYPE
7CC-4.10,20,36,38
BUS, LIC ff 299
"C'm"AN"'A" Thermal Mechanical
E-MAIL rmoyer@thermalmech-com
FAX 408-988-0233
STREETADDRESS 425 Aldo ave.
CITY, STATE, z" Santa Clara, CA 95054
""' 4.08988-8744
ARCHITECTIENGINHERNAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PITONS
DESCRIPTION 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
IDLISTINGUSE
PROPOSED USE CONSTR.
TYPE
I #STORIES
USE TYPE
OCC.
SQ.FT.
VALUATION ($)
EXWO
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NSTAREA
BATHROOM
KrruHgr4
OTHER
REMODELAREA
REMODELAREA
REMODELAREA
PORCH AREA
K AREA
TOTALDIICKIPORC . "A","L
GARAG9AREA: DETACH
ATTACH
I
# DWELLING UNITS:
ISMSEWNDuNIT []YES
SECONDSTORY nYES
BEINGADDED? []NO
ADDITION? []NO
PRE-APPLICAT10N QYES IF YES, PROVIDE COPY Or,
PLANNING APPROVAL LETTFR,
ISTIIEBLDGANI
FIC11LERTIOME? NO
TOTAL VAUUATI
2 o
r,
PLANNINGAPPL4 LINO
By my signature below, I certify to each of [lie following: I am the property owner or atKorized agent,.111ct on the property owner's behalf. lhave read this
application and the information I have provided is comet. I have read the. Description of Work and verify it is accurate. I agree to comply with all applicable Jocat
I
ordinances and state laws relating to representatives of Cupertino to enter the above-iden 0( roportyfor ii ispection purposes.
Signature ofApplicantlftcnt:114r� Date:
SUPPLEMENTAL INFORMATION I SQUIRED
kdlfr NO SLIP
El -'.6 v-'E'r,,-T'
Now 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 '
NING-TIANJiM W:`-.-'.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
A'
�i 'STAND"
O
in if any Hazardous Materials are being used as part of this project.
Toy—
:LA
Zz
Copy of Planning Approval Letter orMeeting with Planning prior to
;1uAJFOR.
submittal of Building Permit application.
BldgApp__201 1,doc revised 06121111
SMOKE / CARBON M-ONOXIDE ALARMS
OMER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-A99R. Dov lAnc\ X15 ., r
P f WOSE
This -affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
'compliance with 2013 CRC Section R314, 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 existing 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
Outside of each separate sleeping area in the immediate vicinity of
the bedroomfsl
On every level of a dwellin
Within each sleeping room
unit including basements
SMOKE ALARM I CO ALARM
X�I X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bun-dng appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with .
`13C Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: Th dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
TA existing dwelling units, alarms are permitteda to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections. 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, T hereby certify that the alarm(s) referenced above has/have been
installed in accordance ivith the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Address:
Specify Number of Alarms:
I have read and a ree tc
Owner (or Owner Agent's) Name:
4MOf Signature.....
3me:
sl 3 Permit No. / ZOf 7 —�
Carbon
with the _rm.c and conditions of this
:..I........................................................................................ Date � 7
�ff /
............................ I............................
ki ec 4e, I Signature.. ..........
III ......................................
i ....... Date:
- -_ ...............................:L �.,� .... .
CS,,.,T,., ..,.,7 /'n r __._ I_ , ,... _..
CUPERTINO
Owner Name
Address
WATER -CONSERVING, PLUMBING FIXTURES,
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building cDcupertino.org
,meet--LA"'Permit Nn �O1 7 ot�
1. Is your real property a 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 certifying that, due to the age or configuration of the property or its
luinbing, installation of water -conserving plumbing fixtures is not technically feasible?
,Yes Civil Code Sections 110 1. 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.
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 form.
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 properly is built and available for. use or occupancy on or before January 1, 1994.
Civil Code Sections1101.1 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 iinprovements shall require all non-compliant plumbing fixtures
to be replacedwith,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 unprovements).
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- 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).
❑ 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 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 fixtures in accordance with Civil Code Sections 110 1. 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 requirements as indicated in the
table on the following age.
Owner or Owner Agent's Signature; T�M1s a . o Date: p IZ
U.FLY L t.VU1i11G1111g QLlU Jlg'illllg UUN l.,e1LillU .le, please return a io the lsuuamg 1Jivision in oraer to nnai your buiiaing periint.
SB4072015.doc revised 08/26/15 .