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B-2017-0380CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0380 10183 PARKWOOD DR APT 1 CUPERTINO, CA 95014-1461 (326 27 037) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 03/21/2017 OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C4, C10, C20. C36, & C38 Lic. #256057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT X 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 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: BLDG 52/UNIT 1; ADD (1) A/C; REPLACE FURNACE, SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION; N WASHER AND DRYER HOOK UPS; 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; (I) RECEPTACLE Compensation, as provided for by Section 3700 of the Labor Code, for the OUTLETS; (I) LIGHT (2); (N) BATHROOM EXHAUST FANS (2). performance of the work for which this permit is issued. I ave 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 Sq. Ft Floor Area: Valuation: $20000.00 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 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. WITHIN 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. ��7/�Signature.,2�_ 180 DAYS FROM LAST CALLED INSPECTION. I ", Date 03/21/2017 Issue Date: 03/21/2017 OWNER -BUTT DER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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) z. 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: 03/21/2017 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. 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 Code, 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. 3. 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, S ' us 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: 03/21/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHI ECT'S 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 03/21/2017 professional CUPERTIINC} CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildingacupertino.org aZj� t� ❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESs 10183 Parkwood DR, BLDG 52, Unit #1 APN# owNERNAME Glenbrook LLC PHONE 650-961-8330 E-MAILAver averY@pacbell.net STREET ADDRESS 130 East Dana Street , CITYSTATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT NAME Rob Moyer PHONE 408-593-8115. E-MAIL. rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 FAx 408-988-0233 ❑ OWNER ❑ OWNER-BUHAER ❑ OWNER AGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC # 299 C-4 10 20 36 38 COMPANYNAME Thermal Mechanical E-'vLAILrmoyer@thermalmech.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 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 PROPOSED USE " CONSTR TYPE'# STORIES ,USE. TYPE OCC. SQ.FT. VALUATION ($) EXISTG - NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM- .-.KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - - []ATTACH #DWELLING UNITS: - - ISA SECOND UNIT ❑YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# E] NO PLANNING APPROVAL LETTER EICHLER HOME? []NO By my signature below, I certify to each of the following:- I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is coireCi. fhave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tt g c struction. I authorize representatives of Cupertino to enter the above-identifed prop for inspection purposes. Signature of Applicant/.Agem: - Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN cI{Ecr TYPE = xoU7PHvc siiP ° ` . n OVER-,pnE-0011NTM ❑Bit D3NcPLAN REVIEW _ 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. CI` EXPRI §S i�: ,PLANNING PLAN. REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDARv ; * .-© .PiJ41 WORiCS ..- form &any Hazardous Materials are being used as part of this project. © LARGE -.. l l - FIRE DEkT_ _ Copy of Planning Approval Letter or Meeting with Planning prior to C� MAJOR �" SANITARY SEWER DISTRICT .. submittal of Building Permit application. [] , ENVIR6NMENTAL HEALTH BldgApp_201 1. doc revised 06121/11