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B-2017-0509CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0509 10245 PARKWOOD DR APT 3 CUPERTINO, CA 95014-1506 (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 Q-4.10.20,36.38 Lic. #256057 Contractor IH ERMAL ME HAN [CAL 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. /zI ve and will maintain Worker's Compensafion 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 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. 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) z. 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. 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. 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 4/4/2017 DATE ISSUED: 04/04/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG #441UNIT #3; ADD (N) A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (1) RECEPTACLE OUTLETS; (I) LIGHT; (I) BATHROOM EXHAUST FANS. Sq. Ft Floor Area: l 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 Avende 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 ofApplicant: Date: 4/4/2017 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 Se ' 25505, 25533, and 25534. Owen or authorized agent: Date: 4/4/2017 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 CUPERTIN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION � I�I 0 1,01S� al t -0 [XALTERATION/TT 1 I RFVTCT0TT/T1FFFRRFn OP I:TLTAT 1) PT14Tr44 PROJECT ADDRESS 10245 Parkwood DR, BLDG 44, Unit #3 APN# ett OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAIL avery@pacbell.net STREETADDRESS 130 East Dana Street, CITY' STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 "TACT 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 -BUILDER ❑ OWNERAGENT IK CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMETilermal Mechanical LICENSE NUMBER 256057 T7Cc- NSE TYPE BUS. LIC# 299 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 fart EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I 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 4 #DWELLINGUNITS: IS A SECOND UNIT []YES SECONDSTORY E] YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES -E $�'' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO AA By my signature below, I certify to each of the following: I am the prop:)rizea 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 building c truction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED IFCKTYPE PLANCH = RE3IiTINGSLIP . F, OVER -THE COUNTER C 3 B66INGPLAN 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. F1 EXPRESS I] PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ' C1 V.VaLIC WORKS Form if any Hazardous Materials -are being used as part of this project. - I1 LARGE - _- O EWDEPT- _ Copy of Planning Approval Letter or Meeting with Planning prior to ©. MAJOR "I� `SANITARY SEWER DISTRICT, submittal of Building Permit application. 0 ENVIRONMENTAL HEALTH'. BldgApp_2011.doc revised 06/21/11