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B-2017-0510CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0510 10170'PARKWOOD DR APT 1 CUPERTINO, CA 95014-1413 (326 27 037) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE: 650-961-8330 LICENSED CONTRACTOR'S DECLARATION ATION License Class 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. ! z. 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. APPLICANT CERTIFICATION 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 ssy rf/�— Date 4/3/2017 DATE ISSUED: 04/03/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG #30/UNIT #1; ADD (1) A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (I) RECEPTACLE OUTLETS; (I) LIGHT; (N) BATHROOM EXHAUST FANS. Sq. Ft Floor Area: I Valuation: $20000.00 "N 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: AbbyA ee+de 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 contractors to construct the project (Sec.7044, Business & Professions Code). 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 4/3/2017 Signature ofAl Date: 4/3/2017 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, 'ons 25505, 25533, and 25534. Owner or authorized agent:"'/�'L- Date: 4/3/2017 T CONSTRUCTION LENDING AGENCY 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingRcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION I�I C) 2 1 1-- C),5 -s D I/U ALTERATION/ Ti ❑ RF.VTSTON ! 1)RFFRRFII (1RTrTNAT PFRT/1TT a PROJECT ADDRESS 10170 Parkwood DR, BLDG 30, Unit #1 IAPN"2 st ( — 2+„ v3q {P T 1 J OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAIL 1 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@thermaimech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 FAX 408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER .D TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 7 LICENSE TYPE BUS. LIC # 299 C-4.10,20,36,38 cOMPANYNAME 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 ' 1 USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLINGUNITS: ISA SECOND UNIT []YES SECONDSTORY ❑YES BEINGADDED? []NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ,REE; $ , TOTAL VALUION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , . U, .21C 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 b ' construction. I thorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION utUIRED PLANCHECKTYPE ROUTINGSVP El ©VER_TRF'COUNTER © BUILDING PLAN 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. 0 EXPRESS a`. PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CI STANDARD C1 PUBLIC.WbRKS fo_rm if any Hazardous Materials are being used as part of this project. TARGE `.. CI FIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR © SANITARY SEWER DISTRICT submittal of Building Permit application. D ENVIRONMENTAL HEALTII . . BldgApp_2011.doc revised 06121111 Owner Name 'tddress IMATER-CONSERVING. PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 '408) 777-3228 - FAX (408) 777-3333 - buildino(a cuoertino oro Permit No i? Z cJi 7 •- v5�1� 6_1 l . `s your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 2. ;. Does' your real property have a licensed plumber certifying that, due to the age or configuration of the property or its nlLunbing, installation of water -conserving plumbing fixtures is not technically feasible? Yes . Civil Code Sections 1101.1 through 1101.8 do not apply. ,,�3 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. ❑ No Go to Question 3. Is water service permanently disconnected for your building? I] Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the forin and sign bottom of forn. -'A No Go to Question 4. 4. is your real property built and available fdr use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built dnd available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom Of form.. Please check ONE of the following: ❑ My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1', 2017', all non- compliant plumbing Fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or .improvements). My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures: On or before January 1, 2019, all non-compliant plumbing fixtures shall be' replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or unprovernents). F] My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plurnbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations. or improvements). [,as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures wbe ill replaced prior to date specified above with water -conserving plumbing fixtures accordance with Civil Code Sections 1101.1 ures i through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following nacre Owner or Owner Agent's Signature: Date: Upon completing and signing this Certificate , . , ,please return it to the Building Division in order to final your building permit. SB4072015.docrevised 08/26/15 . `SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408)777-3333 . n; rlfflmntam 1—+;- 11 -Lis -affidavit —+;. PuRpn I11is-affidavit -is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for 'Compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for u--ispections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carboni Monoxide alarms. When the valuation of additions, alterations; or .repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM. Outside of each separate sleeping area in the immediate vicinity of X the bedrooms) On every level of a dwelling unit including basements X Withinthin erping room X CO ALARM. X 917 Carbon Monoxide alarms .are not required. in dwellings which do.not contain fuel -burning appliances and that do not have an- attached garage. i Carbon. monoxide alarms -combined with smoke, alarms shall comply with . CBC Section 420.6 and: shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling unfts withno commercial power supply, alarm(s) may be solely battery. operated. a -i existing dwelling units, alarms are permitted to.be solely.battery operated where repairs or alterations. do not result. in the removal of wall and ceiling finishes or there is no access by means of attic; basement or crawl space. Refer to CRC Section R314 "and CBC Sections 907.2.11.4 and. 420.6.2. An electrical permit is required for alarms which must.be.connected to the building. wiring. As owner of the above -referenced property,.I hereby certify that the alarm(s) referenced above has/1-lave been installed in'accordance with.the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed bQlow. , Address: (� � CGI 7cn� D1. --1 Specify Number. of Alarms: l have read and agree to Owner (or Owner Agents) Name: T41140 04101 CZZ I Signature...... ;me: 1� e,�. g G�,��Si nature:....: Permit No. :LL2 with the and conditions of this statement ...............................................................'............:........ ..... .... Date ........ Lig.# Z S -7 ::::::.:............�..�`-....I.......... %7 c177r&P and r -n fn»» /lnr Irovicod (10/77/W `�;NIOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300-TORRE AVENUE- CUPERTINO, CA 95014-3255 (+08) 777-3228 - FAX (408)777-:111a . hnitrli....b7..,... LTRPOA. This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations; or .repairs to existing dwelling -units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA Outside of each separate sleeping area in the immediate vice nity of. the bedroom(s) On every level of a dwelling unit including basements Within each sleeping room SMOKE ALARM. CO ALARM . X X X I X Carbon- Monoxide alarms.are not-required.in dwellings which do.not contain fuel -burning appliances and. that do not have an attached garage:. Carbon. monoxide alarms. combined with smoke- alarms shall comply with CBC SeL-tion 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling imits.with. no commercial power supply, alarm(s) may be solely battery. operated. Tii existing dwelling units,alarms are permitted to.be solely -battery operated where repairs or alterations.do not result in the -removal of wall and ceiling finishes or there is no access.by means of attic; basement or crawl space. Refer to CRC SectiorrR314"and CBC Sections 907.2.11.4 and. 420.6.2. An electrical permit is required for alarms which mustbe, connected to the building. wiring. As owner of the above -referenced property,.I hereby certify that the alarm(s) referenced above IZas/have. been installed in'accordance with.the manufacturer's instructions and in compliance with the California Building and California Residential Codes; The alarms specified below have been tested and are operational, as of the date signed-below.- Address:— igned-below: Address:. l ®% 2 0 �cc/��..�fJ/ fit"' 3 © _ Specify Number of Alarms: /'have read and agree to Owner (or Owner Agent's) Name: �74MEf 04 AgZ2o I signature.:.... ee',4&j,,L 1 Signature:... with the .rn,.c and conditions of this Permit No.,? Zc7/7,qsx: .-............................................................................. Date6/Z .... .... ........�....... oateC %0 . ��.... % cmnko rrnd i -n f , ,, a,.,..._.. --j , Owner Name ddress WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (/408) 777-3228 • FAX (408) 777-3333 • buildingCcDcuoertino org I HdL3�t1J LLL Permit No 00 i . is your real property a registered historical site? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. T -K No Go to Question 2. Does' your real property have a licensed plmnber certifying that, due to the age or configuration of the property or its ,plumbing, installation' of water -conserving plumbing fixtures is not technically feasible? (MYes Civil Code Sections 1101.1 through 1101.8 do not apply. ,N� The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. ❑ No Go to Question 3. 3. Is water service permanently disconnected for your building? IJ Yes Civil Code Sections 1101.1 through 110 1. 8 do not apply. Skip the rest of the form and sign bottom of form. " No Go to Question 4. 4. is your real property built and available fo'r use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. X Yes My real property is built dnd available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign nottorn of form.. Please check ONE of the following: ❑ My property is a single fm7aily residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). �> My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a cona»aercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations. or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following na_ae. Owner or Owner Agent's Signature: 73M Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your SB407 2015.doc revised 08/26/15