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B-2017-0524CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0524 10240 PARKWOOD DR CUPERTINO, CA 95014-1527 (326 27 037) THERMAL OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE: 650-961-8330 T T4'1 1V42 Tl rnNmn♦d' nra rani .r.m —T License Class PLUMBING 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 SANTA CLARA, CA 95054 ISSUED: 05/01/2017 NO: (408) 988-8744 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG 64 - (N) WATER HEATER AND CONSTRUCT (1) ENCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the (�{ 'performance of the work for which this permit is issued. T `'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. 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 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 7 Cupertino My icipal Code, Section 9.18. Signature 7 t/ 1 5/1/2017 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 properly, 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). 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. 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 I Date 5/1/2017 "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 Aygnde Date: 05/01/2017 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: 5/1/2017 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(x) 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 C2#orgre ations 25505, 25533, and 25534. Owner or authorized agent: g� _01 Date:/51/2017 CONSTRUCTION LENDING. A GEK_CY 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Ci7UPERTItk[fl N 1 (4088)I )1777-3228 • FAX((408) 777-3333 • buildingAcupertino.org I FW C'0NTCTR I TC-PTnTT I A..Trinr.T rM AT— I—I PROJECT ADDRESS APN # 10240 Parkwood drive Building b_+ 326-27-037 >>_ OWNERNAMEAve Glenbrook LLC Avery PIIGNE 650-961-8330 E-MAIL Avery@pacbell.net STREET ADDRESS 130 East Dana St CITY, STATE, ZIP Mt. View, CA 94041 FAX 650-961-0571 CONTACT NAME ROt) Moyer PHONE E-MAIL 408-593-8115 STREET ADDRESS 4258 Aldo Ave CITY, STATE, ZIP santa Clara CA 95054 1 FAX 408-988-0933 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 C4EC10,C20,C38,C36 BUS. LIC# 299 COMPANY NAME Thermal Mechanical E-MAIL rmo er thermaimech.com FAX 408-9888-0233 STREETADDRESS 425 Aldo Ave CITY, STATE, ZIP PHONE 408-988-8744 Santa 4 ARCHITECT/ENGINEERNAME Thermal Mechanical LICENSE NUMBER 256057 BUS. LIC# 299 COMPANY NAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAX 408-988-0233 STRFETADDREss 425 Aldo Ave CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744 DESCRIPTION OF WORK New domestic hot water system with new water heater and enclosure Upgrades and repair of existing building services 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 REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN 0 YES EICHLER HOME? [3NOt EIVED BY; - t T L VAJ-UATION: (" J _ t By my signature below, I certify to each of the following: I am the property owner or authorized agenttto.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 con ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: - Date: 5 5,e SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTINGSLIP ©,OVER THF C0UNTER ©BUILDINGPLAN 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 _ © PLANNING Pi A V REvwi w _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I] sTANDARD, © PUBLIC W'ORICS form if any Hazardous Materials are being used as part of this project. F1_ LARGE ©.FIR&DT�.P'I' _ Copy of Planning Approval Letter or Meeting with Planning prior to IO MAJOR ❑ SANI'PARY 5��'ER DISTRICT submittal of Building Permit application. Q ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06121/11