B-2017-0598CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0598
10250 PARKWOOD DR_APT 12 CUPERTINO, CA (326 27 037) THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP I I DATE ISSUED: 04/19/2017 1
OWNER'S PHONE: 650-961-8330 1 1 PHONE NO: (408) 988-8744 1
LICENSED CONTRACTOR'S DECLARATION
License Class C-4:10, 20, 36, 38 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:
r. 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
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 comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Date 4119/2017
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG #1/UNIT #12; ADD (1) A/C; REPLACE FURNACE, SAME
LOCATION; (I) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
SERVICE (70 AMP); ("I) GAS LINE FOR STOVE; (1) RECEPTACLE
OUTLETS; (N) 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: Abby Ayende
I hereby affirm that I am exempt from the Contractor's License Law for one of the I 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 properly am exclusively contracting with licensed Signature ofApl
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/19/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL
r. I have and will maintain a Certificate of Consent to self -insure for Worker's I -
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.
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 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 411912017
"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, S ons 25505, 25533, and 25534.
001,
Owner or authorized agent:
Date: 4/19/2017
CONSTRUCTION IN G AG-dof 00Y
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
APPLICATIONCONSTRUCTION PERMIT PIT -I!- 0"
COMMUNITY BUILDING
10300 TORRE AVENUE m CUPER T I O, CA 95014-3255
(408) 777-3228 e FAX (408) 777-3333
CLWEP"TttNo
❑ NEW CONSTRUCTION ❑ ADDITION Q ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10250 Parkwood DR, BLDG 1, Unit#12
APN#
1 3 6
OWNER NAME Avery Glenbrook LLC
PHONE
650-961-8330
E-MAIL
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 -MAS rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP
Santa Clara, CA 95054
FAX 408-988-0233
❑ OWNER ❑ OwNER-BUIIAER ❑ OWNERAGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMEThermal Mechanic
I T LICENSENUMBER256057
LICENSE TYPE
BUS. LIC# 299
aI
C-4,10,20,36,38
co"' 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
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
TOTALDECK/PORCH AREA
GARAGE AREA: EIDETACH
I
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? [:]NO
ADDITION? [:INO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # E]NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RIECLIVFD BY:
T V N:
-
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 hive 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 ctio I authorize representatives of Cupertino to enter the above -identified pr perty for inspection purposes.
Date: 40 ;11-7
Signature of Applicant/Agent:
SUPPLEMENTAL WFORMATION REQUIRElir
PLAN CHECK TYPE
op ROUTING SLIP
❑ OVER-THE-COUNTER
BUH DING 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.
❑SS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
ARD
❑ PUBLIC WORKS
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
ElMA.IoR
ElSANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVH2ON"MENTAL HEALTH
B1dgApp 2011.doc revised 06121111