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B-2017-0511
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0511 10115 PARKWOOD DR APT 5 CUPERTINO,CA 95014-1447(32627 036) THERMAL MECHANICAL SANTA CLARA,CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED:04/03/2017 OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-4.10.20.36.38 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#15/UNIT#5;ADD(N)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;(N)RECEPTACLE Compensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS;(N)LIGHT;(N)BATHROOM EXHAUST FANS. perforwance of the work for which this permit is issued. ave 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. • 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 27 036 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 ._e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature to 4/3/2017 Issued by:Abby Ayende Date:04/03/2017 OWNER-B '1_DER 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 roofmg 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:4/3/2017 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 permit is issued. maintain compliance with the.Cupertino Municipal Code,Chapter 9.12 and the 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 shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous 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,Selo 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall a� be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION 1/ Date:4/3/2017 I certify that I have read this application and state that the above information is CONSTRUCT ON 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,Civ 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, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 4/3/2017 Professional \J ' CONSTRUCTION PERMIT APPLICATION vCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION w,,.r., . 10300 TORRE AVENUE•-CUPERTINO, CA 95014-3255 � � (408)777-3228•FAX(408)777-3333•buildinq(c�cupertino.orq -2,011--O5-i ' ❑NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 10115 Parkwood DR, BLDG 15, Unit#5 APN# 3 2( . 2-�"41)�t, - Icr 5 OWNER NAME Avery Glenbrook LLC PHONE E-MAIL 650-961-8330 avery@pacbell.net STREET ADDRESS 130 East Dana Street CITY,STATE'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 FAX 408-988-0233 Santa.Clara, CA 95054 ❑OWNER ❑ OWNER-BUILDER 0 OWNER AGENT EX CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS.LIC# 299 C-4,10,20,36,38 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/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 0 ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PLA-APPLICATION ❑NOS IF YES,N NG APPROVAL COPY E IS THE BLDG AN 0 YES ''' — TOTAL_VALU��'ION: PLANNING ADPL# 0 NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �I�� :.. 1A��`"r'//',(/OJT ((�� 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 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 buildin• •:,,,:true N.o.. I au.orize representatives of Cupertino to enter the above-ide tified p operty for inspection purposes. . Signature of Applicant/Agent: Date: T a /v SUPPLEMENTAL 1 ORMATION REQ RED IPLANCHECKTIPE ROUTING SLIP::. _New SFD or Multifamily dwellings: Apply for demolition permit for p ER THE COUNTER 0 I3tIILDINGPLANREVIEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. 0 EXPRESS . 0 PLANNING.PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0 PRELICWOREs form if any Hazardous Materials are being used as part of this project. © LARGE : 0 FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to 0 YIA,JOR 0 SANITARY SEWER DISTRICT , submittal of Building Permit application. 0ENviRONMENTA1 HEALTH - BldgApp_2011.doc revised 06/21/11