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B-2017-1157CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1157 10115 PARKWOQD DR APT 6 CUPERTINO, CA 95014-1447 (326 27 036) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE. 650-961-8330 LICEN$ED CONTRACIOR'S DECLARAITON License Class C-4 C-1 07C -36-C-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: 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. shave 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 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 pe upertino Municipal Code; Section 9.18. -Signature /� -�— Date 7/26/2017 RDE I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: s. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.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. 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. a. 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 U 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 7126/2017 DATE ISSUED• 07/26/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT INFO• X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION BLDG #15/UNIT #6; ADD (N) A/C; REPLACE FURNACE, SAME LOCATION, (1) WASHER AND DRYER HOOK UPS, (N) ELECTRICAL SERVICE (70 AMP); (N) GAS LINE FOR STOVE, (1) RECEPTACLE OUTLETS; (I) LIGHT, (l) BATHROOM EXHAUST FANS, Sq. Ft Floor Area: I Valuation: $20000.00 "N Number- Occupancy Type: 326 27 036 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Abby &mn-de Date: 07!26/2017 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 of Applicant: Date: 7/26/2017 COVERINGS TO BE CLASS "A" 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, SeejtiaW 2550&25533, and 25534. Owner or authorized agent: Date: 7/2612017 TI N LENDING 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 ARC'HITECT'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 (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org �� 1 NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN 10115 Packwood DR, BLDG 15, Unit #6 � 2,.G m?„'1 P -Q -S-�o OWNERNAME Aver Glenbrook LLC PHONE E-MAIL Avery 650-961-8330 Avery@pacbell.net STREET ADDRESS CITY, STATE, ZIP FAX 130 East Dana Street Mt. View, CA 94041 FA650-961-0571 CONTACT NAME Rob Moyer PIIONE 408-593-8115 E-MAIL rmoyer@thermalmech.com STREET ADDRESS CITY, STATE, ZIP FAX 425 Aldo ave.' Santa Clara, CA 95054 408-988-0233 OWNER ❑ OWNER BUILDER ❑ OWNER AGENT IX CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME '- LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC # 299. Thermal Mechanical C-4,10,20,36,38 COMPANY" Thermal Mechanical E`MAILrmoyer@thermalmech.com FAX408-988-0233 STREET ADDRESS 425 Aldo ave. c",STATE, 'P 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 FLOORDEMO TOTAL AREA AREA AREA.. NET AREA BATHROOM KITCHEN OTHER - - REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH # D WELLING UNITS: - IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES vED B �� TOA)VALUATION: PLANNING APPL # ❑ NO PLANNINGAPPROVAL LETTER EICHLER HOME? ❑ NO �r`Jd By my signature below, I certify to each of the following: I am the property owner or authorized agent ta 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 buildingdo I authorize resentatives of Cupertino to enter the above-identifie /,property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION RE UIRE Q rAiv`cHEcru P xci )Ncq� iY . New SFD or Multifamily dwellings: Apply for demolition permit for ac x � Siri itl I kADtRBVTt£W existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESSl l I Ak ING 'ibwpET -W _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure [D sTArtrt>xli ❑ i!tT}FI IC ws form if any Hazardous Materials are being used as part of this project. IrhRGE, � �II�.1i12Iti't` _ Copy of Planning Approval Letter or Meeting with Planning prior to A- submittal of Building Permit application. ANITARY SEVETtSTRIT ;i lu)RON14t11NT1FT7iI PH BldgApp_2011.doc revised 06121111