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B-2017-0513I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10268 PARKWOOD DRAPT 7 CUPERTINI0, CA (326 27 037) OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE: 650-961-8330 LICENSED ONT ACTOR'S DECLARATION ARATION License Class C-4. 10. 20, 36.38 Lic. #256057 Contractor THERMAL MECHANICA 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: 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. have and will maintain Worker's Compensation Insurance, as provided for by f 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 cor ply with all non -point source regulations Cupertino Municipal Co e, Section 9.18. Signature r' Date 4/14/2017 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). CONTRACTOR: I PERMIT NO: B-2017-0513 SANTA CLARA, CA 95054 DATE ISSUED: 04/03/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT INFO: BLDG X ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG #4/UNIT #7; ADD N A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (1) RECEPTACLE OUTLETS; (N) LIGHT; (I) BATHROOM EXHAUST FANS. 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: Abby A=de Date: 04/03/2017 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: 4/14/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF 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. s. 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 NT RTIFI ATION ` I certify that I have read this application and state that the above information is correct. 1 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 4/14/2017 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, ns 25505, 25533, and 25534. ®wrier or authorized agent: Date: 4/14/2017 N 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 CUPERTINO F-1 XTPAXT fYINQTRI CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)_cupertino.org� F-1 AnnITIOM n AT.TF.R ATTON / TI n REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10268 Parkwood DR, BLDG 4, Unit #7 APN# -- ��j ?T oWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E MAS avery@pacbell.net STREETADDRESS 130 East Dana Street CITY, STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT NAME Rob Moyer 1 PHO`408-593-8115 "rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 FAX 408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 ENSE TYPE 74,10.2036.38 BUS. LIC # 299 COMPANY NAME Thermal Mechanical E-MAILrmoyer@thermalmech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054. PHONE 408-988-8744 ARCHITECT/ENGINEERNAME 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 EXISTINGUSE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) - EXISTG NEWFLOORDEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER ' REMODELAREA REMODELAREA I REMODELAREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA I GARAGE AREA: DETACH ❑ ATTACH #DWELLINGUNITS: ISA SECOND UNIT LJ YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RFCr1V TOT UAr PLANNING APPL # ❑ 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 a ent-o. act on 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 buil ' ns ction. I nthorize representatives of Cupertino to enter the above-identi d prop7ty for inspection purposes. Signature of Applicant/Agent: Date:� SUPPLEMENTAL INFORMATION QUIRED PLAIY,CHECKT.YPI R©t3TING ILII © OVER-THE-COUNTER © BUtIBA'GPLAN 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. [ EXPRESS Q"'PLANNINGPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©<. STANDARD ©r�sLlc _ form if any Hazardous Materials are being used as part of this project. ©LARGE, FIRE DEPT : _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR. (Q, SA?rITARX, SEW ERnISTRICT submittal of Building Permit application. IQ ENVIRONMENTALHEAITH BldgApp_2011.doc revised 06121111