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B-2017-0166
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0166 10224 PARKWOOD DR APT 8 CUPERTINO,CA 95014-1535(326 27 037) THERMAL MECHANICAL SANTA CLARA,CA 95054 OWNER'S NAME: AVERY GLENBROOKLP DATE ISSUED:01/31/2017 OWNER'S PHONE:650-961-8330 PHONE,NO:(408)988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C10.C20.C36.C38 Lic.#256057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT _PLUMB X MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division Sof the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: BLDG 63/UNIT 8;ADD(N)A/C;(N)ET.FCTRICAL SERVICE(70 AMP); I hereby affirm under'penalty of perjury one of the following two declarations: (N) RECEPTACLE OUTLETS;(N) .LIGHT;(N)BATHROOM i. I have and will maintain a certificate of consent to self-insure for Worker's EXHAUST FAN 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. Sq.Ft Floor Area: Valuation:$20000.00 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 27 037 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. �J 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. ISignature^ � _ ._ Date 01/31/2017 Issued by:MELISSA NAMES Date:01/31/2017 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 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,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 Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:01/31/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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. I 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 Codc,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. a. I 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,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:01/31/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws 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,Giv 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, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 01/31/2017 Professional CONSTRUCTION PERMIT APPLICATION V .. COMMUNITY DEVELOPMENT DEPARTMENT••BUILDING DIVISION syr,'rs • 10300 TORRE AVENUE••CUPERTINO,CA 95014-3255 CUPERTINO- (408)777-3228•FAX(408)777-3333•building Th,cupertino.orci 2.013_ ,0 1 6 ❑NEW CONSTRUCTION ❑ ADDITION Q ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINALPERMIT# _ PROJECT ADDRESS 10224 Parkwood DR, BLDG 63, Unit#8 APN# 2.‘ 0/ © 3 OWNER NAME AveryGlenbrook LLC PHONE E•IviAiL avery@pacbell.net 650-961-8330 Y@P STREET ADDRESS 130 East Dana Street CITY,STATE,ZIP Mt.View,CA 94041 FAX 650-961-0571 CONTACT NAMERob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY,STATE,ZIP FAx 408-988-0233 Santa Clara, CA 95054 ❑OWNER 0 OWNER-BUILDER 0 OWNER AOBNT ER CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS.LLC# 299 C-4,10.20,36.38 COMPANYNAMEThermal Mechanical RMATLrmoyer@thermalmech.com BAR 408-988-0233 STREET ADDRESS 425 Aldo ave. car,STATE,ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC C COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK add new AC, replace furnace In same location, (N)electrical panel(70 AMP) - - (N)electrical outlets, (N)light, (N)bathroom exhaust fan EXISTING USE PROPOSED USE CONS'I`R.TYPE #STORIES USE TYPE OCC. SQ.PT. VALUATION($) EXESTG NEW PLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCEIAREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ]DETACH ATTACH #DWELLING UNITS: - ISA SECOND UNIT ❑YES SECOND STORY DYES •_ BRING ADDED? 0 N • ADDITION? ©NO PRE-APPLICATION ❑YES IF YES.PROVIDE.COPY OP IS TIlE BLDG AN ID YES dpeetV_ 'tir,.,:�%,:'_: ,` ` ,:. TOTAL VALUA'T'ION: f A PLANNING AI'PI,# NO PLANNINGAPPROVAL LEITER EICIrUBR NOM? )♦ �'i�..f,---":.' . - ,-:.e 2.0 By my signature below,I certify to each of the following: I am the property owner or Iorizetraagent to i. .- the property 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 accurate. I agree to comply with all applicable local ordinances and state laws relating to building c. tis tion. I audio ze representatives of Cupertino to enter the above-identi ieop�rtyrrection purposes. Signature of Applicant/Agent: / ,---<-.17.,-...., --1.---- Date: f" SUPPLEMENTAL INFORMATION REQUIR D PLAN:CitECKTYL' :`,.' :: -:,:.RourrINCSLIP -. _New SFD or Multifamily dwellings: Apply lot demolition permit for LJ:'OVER-TIIE-CUuivTKR.`. >:' l❑`'BUJL1.DII GPLARREVIEry=' °: existing building(s). Demolition permit is required prior to issuance of building ,., : :.::., -' ''' , '.. ' ,:,: - permit for new'building. I�`iEXPR4S':=: :: : : :, ,: O':PLANrtiNG:EiAN-REyi v., .. : _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0•STANDARD :. ' .:0.PUBLICwoiixs'..1' form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to .fo:;MAJOR -, a SANITARY SEWER.DISTRICT submittal of Building Permit application. -.• . D•ENVIRONMENTALARALTH BldgApp_2911.dac revised©6/21/11