B-2017-0167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0167
10250 PARKWOOD DR APT 2 CUPERTINO, CA 95014-1522 (326 27 037) THERMAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 01/31/2017
OWNER'S PHONE: 650-961-8330 1 1 PHONE NO: (408) 988-8744 1
LICENSED CONTRACTOR'S DECLARATION
License Class C10, C20, C36, C38 Lic. #256057
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 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.
have and will maintain Worker's Compensation Insurance, as provided for by
tion 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 thor
9upertino Municipal Code, Section 9.18.
Signature r Date 01/31/2017
s
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 (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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.
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 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 01/31/2017
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG 1/UNIT 2; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION; (I) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (I) RECEPTACLE
OUTLETS; (N) LIGHT; (I) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: I Valuation: $20000.00
APN 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: MELISSANAMES
Date: 01/11/2017
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: 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 ' 505, 25533, and 25534.
Owner or authorized agent..
Date: 01/31/2017
I hereby affirm that there is a construction le ing 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 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ingQ-cupertino.ora
CUPERTINO 9 r _a
❑ NEW CONSTRUCTION ❑ ADDITION D ALTERATION 1 TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10250 Parkwood DR, BLDG 1, Unit #2 -
APNd Z ( 2 -;? _ d 3 �"
OWNERNAME Aver Glenbrook LLC
Y
PHONE
650-961-8330
A -MAIL aver acbelll..net
Y@p
STREETADDRBSS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
Fax
650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115 B -MAIL rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo ave.
CITY,sTATB, ZIP
Santa Clara, CA 95054
FAX 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTORAGHNT ❑ ARCHETECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC'I'ORNAMEThermal Mechanical
LICENSL'NUMBBK 256057
LICENSETYPE
C-4 10 20 36.38
BUS. LTC 6 299
COMPANY NAME Thermal Mechanical
E-MAIL rmoyer@thermalmech.com
FAX 408-988-0233
STREETADDRESS 425 Aldo ave.
cITY,s'TA"E,z'F Santa Clara, CA 95054
PHONE 408-988-8744
ARCHETECTIENGINEER NAME
LICENSE NUMBER
BUS, LIC #
COMPANY NAMB
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK add new AC, replace furnace in same location, (N) washer/dryer hook ups, (N) electrical panel (70 AMP),
(N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan
EXISTING USE
PROPOSEDUSF. CONS'TILlYPH
I #STORIES
USE TYPE
OCC.
SQ.F'1'.
VALUA'1'fON ($)
EXISTONEW
FLOOR
DEMO
'TOTAL
AREA
ARIIA
AREA
NET AREA
BATHROOM
KITCIIEN
OTHER
REMODEL AREA
REMODELAREA
REMODELAREA
PORCIIAREA
DRCKAREA I
TOTAL DECKIPORCH AREA
GARAGE AREA: DDETACR
❑ ATTACH
# DWELLING UNITS:
ISASECONDUNIT []YES
SECOND STORY []YES
-
REINGADDED? EJN0
ADDITION? []NO
PRH -APPLICATION []YES H+YES, PROVIDE COPY OF
IS THE EL➢GAN [] YES
TOTAL VALUATION:
PLANNING APPL N []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, i certify to each of the following: I atn the propertyowner or authonEzed agent to re 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. 1 agree to comply withal] applicable local
ordinances and state laws relating to buildin o rstr ction. I au horn a representatives of Cupoitino to enter the above -identified pr perry for inspection purposes.
Signature of Applicant/Agent: - -->a - Date:
SUPPLEMENTAL INFORMATION REQTIRED
`.:pAn ctlscK_iri
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:
_Materials Disclosure
Commercial Bldgs: Provide a completed Hazardous M at
`�; sT�irmAFiu'PUBLICWORK-.=-
formifanyHazardousMaterialsarebeingusedaspartofthisproject.
G
_
Copy of Planning Approval Letter or Meeting with Planning.prior to
11: '
sub—mittal of Building Permit application,
..SANITARYSFWERDrSTR1CT-.:�-..
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11 •ENVIROif1inNTALHEALTII.•' '
BldgApp_201 Ldoe revised 06121111