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B-2017-1152CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: ° CONTRACTOR: PERMIT NO: B-2017-1152 10164 PARKWOOD DR APT 3 CUPERTINO, CA 95014-1414 (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 License Class CA, C -1 0:C -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 th work for which this permit is issued. !`— °h ve and will intain Worker's Compensation Insurance, as provided for by Section 3700 of e 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_he,,rzupertino Municipal Code, Section 9.18. WM-Pill VA 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) 2. I, as owner of the properly, 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 7/26/2017 ISSUED: 07/26/2017 NO: (408) 988-8744 PERMIT I NFO BLDG X ELECT X PLUMB MECH X RESIDENTIAL COMMERCIAL JOB DESCRIPTION BLDG #291UNIT #3, ADD (I) A/C; REPLACE FURNACE, SAME LOCATION, (N) WASHER AND DRYER HOOK UPS, (I) ELECTRICAL SERVICE (70 AMP); (N) GAS LINE FOR STOVE, (1) RECEPTACLE OUTLETS; (N) LIGHT, (N) BATHROOM EXHAUST FANS. Sq. Ft Floor Area: I 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 A ey nde 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 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 - Date: 7/26/2017 V -11 - CONSTRUE I 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.) Lenders 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 (408) 777-3228 • FAX (408) 777-3333 • building9cupertino.org NEW CONSTRUCTION ❑ ADDITION _ ❑X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10164 Parkwood DR, BLDG 29,.Unit #3 APN9 OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E-MAIL avert'@pacbell.net STREET ADDRESS CITY, STATE; ZIP FAX 650-961-0571 130 East Dana Street Mt. View, CA 94041 CONTACT NAME Rob Mo er PHONE E -MARL Y 408-593-8115 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 NAMELICENSE NUMBER LICENSE TYPE BUS. LIC # Thermal Mechanical 256057 C-4 10 20 36 38 299 COMPANYNAME Thermal Mechanical E-MAIL rmo er thermalmech,com FAX Y @ 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGINEERNAME 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) electrica'—"haust fan - SE CONSTR. TYPE I OCC. SQ.FT. VALUATION ($) EXISTING USE PROPOSED U EXIST AREA NEW FLOOR DEMO TOTS - AREA AREA AREA NfiTI BATHROOM - KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL ARI I. 1 PORCH AREA DECK AREA TOTALDECK/PORCH AREA - GARAGE 1 - '. -� ATTACH #DWELLING UNITS: - IS A SECOND UNIT ❑YES. SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ONO PRE APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RE D93Y; ' ' TO a L VALUATI N: PLANNING APPL# ❑.NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO' "� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the �roperty 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 build' c .on I authorize representatives of Cupertino to enter the above -identified )rrope / for inspection purposes. Signature of Applicant/Agent: Date: / SUPPLEMENTAL INFORMATION REQU - ECK z c7 LANIITYRE New SFD or Multifamily dwellings: Apply for demolition permit for �abv, I2 " " THE-CUUNTEIW ❑ U1Li2ING PIA RE W existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl U+XPOES - CI P k`l `ZING rl t IIHvi v Commercial Bldgs: Provide aLcompleted Hazardous Materials Disclosure i , "T I r,`u E IC was form if any Hazardous Materials are being used as part of this project. ❑. L A1Cx1 ©liE YII'1 Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAaox�avr�g>srcT submittal of Building Permit application. ❑NVIi�(71rMENTAliiEAITT- BldgApp_2011.doc revised 06121111 _ . .i SMOKE / CARBON MONOXIDE ALARMS j �► ' fa 13. OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 4lFE�. 'ItCs 10300 TORRE AVENUE• CUPERTINO CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(c7cupertino.orq .ill .. x�;: '{'�';") �g�.,�� :t: ': '. '�`�..,...,'.':{� .,r ,'(� - - µw., v ,a3q. s > .._, ...> ' '• �,,...a.. j.' __.. - _ - .... .:M_.ca§.` ::t',:.:_4 ; .._.z:.-•, 'fM, s��..�" �1,,2.. ' r � :.:,....<».,, ,.x.. .r..:,.,.� Y �..� ..ice_..-,. > _ "�3 _.�" � t^ s y,• ` "e xR^Z ,.'R_y° 'Y, .,:SwY� _� '"r. _^;'}_'°..dk Y:r'£' t'� >" l SN �� �;,'.��. -.���(w� �6" �a �'R''."".,..§.`", -�, �" �'g�••. .,r�ti ���.> h. es.ix.rts.. ...e�:.....,�...X:u.^. �^n. _moi.x`T r5.,.-.. .,kiY ..24 . '. �'.'�.',xs p,4..'y'^i- map,,, ��'� .. �T '. � `A. ` ... >. .:.......... ...,_. .....,.<. .a ter. ...... ~a.�^ps°�: PURPOSE This affidavit is a self-certification for the installation of all.required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 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 -~� SMOKE ALARM CO ALARM j Outside of each separate sleeping area in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping-room 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 Section.420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercialpower supply, alarm(s) may be solely battery operated. In 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.907.2.114 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/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. /016 - „,„ Permit No.,2a 71± Specify Number of Alarms #Smoke Alarms. 1 Carbon Monoxide Detectors- Li__ I I have read and agree to comp! with the - .R _ nd conditions of this statement Owner(or Owner Agent's)Name- 1:44 ame- - )� .' p zzo Signature ,00.00Date/07 7 /7 Contractor Name; Pie Z 6e - 7 {'1 ' �L fvi e ' A�d,�b Signature :Lica Date / / cmnl-,marl('(l frr,-,,,rinn,^n, rnrl 1)0/7 7/1/, ' WATER-CONSERVING PLUMBING FIXTURES ( 1 q OWNER CERTIFICATE OF COMPLIANCE 411%. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• buildino o(�cupertino.orq owner Name ' !r t' �. 6 3t t' C Permit No. 0/7-// Address 1 - 7-3 1. [s your real property a registered historical site? 0 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. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? �0.:Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. O No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1A No Go to Question 4. 4. Is your real property built and available for 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 and 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.. 5. 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 fixture s throughout the building(regardless of whether property undergoes alterations or improvements). 0 My property is a commercial cial 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 followin• age. Owner or Owner Agent's Signature: ( ' s Ati«o Date: Ap dstmisimittotttissir Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 .