B-2017-1151CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1151
10250 PARKWOOD DR APT 5 CUPERTINO, CA 95014-1523 (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 07/26/2017
OWNER'S PHONE: 650-961-8330
PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO
License Class C-4. C-10;C-36-C-38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION
BLDG 1/UNIT 5, ADD (N) A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION, (N) WASHER AND DRYER HOOKUPS; (I) ELECTRICAL
m. I have and will maintain a certificate of consent to self-insure for Worker's
SERVICE (70 AMP); (I) GAS LINE FOR STOVE, (I) 9 RECEPTACLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
OUTLETS, (N) 1 LIGHT, (N) BATHROOM EXHAUST FAN
and will maintain Worker's Compensation Insurance, as provided for by
Ive.nnit
/�p:c>
Stion 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $20000.00
is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number-
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 27 037
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations per pertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ` Date 7/26/2017
Issued by AbbyAyende
l/
Date: 07/26/2017
OWNER-Bij!�D R DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
m. 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 now materials for
compensation, will do the work and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/26/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
m. 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.
HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505 28533, qgd 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. G.Ow'ner
or authorized agent:
CERTIFICATION
Date: 7/26/2017
APPLICANT
I certify that I have read this application and state that the above information is
CONST_RUCTIO LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless; the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 7/26/2017
professional
M
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • building(a)cupertino.org�
❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION / TI ❑ REVISION / DEFERRED ^ ORIGINAL PERMIT #
PROIECTADDRESs 10250 Parkwood DR, BLDG 1, Unit#5 APN# 32—( _ 2-7 $1-
OWNERNAME Avert'
- Glenbrook LLC PHONE 650-961-8330 E-MAIL avert'@pacbell.net
STREET ADDRESS CITY, STATE, ZIP FAX
130 East Dana Street Mt. View, CA 94041 650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech.com
STREET ADDRESS CITY, STATE, ZIP FAX
425 Aldo ave. ; Santa Clara, CA 95054 408-988-0233
El OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC# 299
Thermal Mechanical C-4.10,20,36,38
cOMPANYNAME Thermal Mech E -M FAx
apical rmoyer@therrnalmech.com 408-988-0233
STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 PHONE
408-988-8744
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME ! E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
' DESCRIPTION OF WORK add new AC, replace furnace in same location, ( N) washer/dry er hook ups, ( N) electrical Panel ( 70 AMP),I
(N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan
N
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEWFLOOR DEMO TOTAL
AREA AREA - AREA NET AREA
BATHROOM KITCHEN OTHER - -
REMODELAREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA. TOTAL DECK/PORCH AREA GARAGE AREA: DETACH -
ATTACH
#DWELLINGUNITS: IS A SECOND UNIT []YES SECONDSTORY []YES - -
BEINGADDED? []NO. ADDITION? []NO
PRE-APPLICATIPLANNINGA PLO# [IYES
PLANNING APPROVAL LE COPY OF ISTHEBLDG ETTER. ICHLER $O E. ❑. NOS RRICEI3 $ TOT L VALUATIQ
By my signature below, I certify to each of the following: I am the property owner or authorized agent to At on thekroperty 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 bun truction. In ize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
_ 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.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_201 Ldoc revised 06121111
SMOKE I CARBON MONOXIDE ALARMS -
OWNER CERTIFICATE OF COMPLIANCE ?Pi.,11_05
,iawn
t COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
Ec+i!.:�
CUPERTINO 10300 TORRE AVENUE • CUPERTINO CA 95014-3255
(408)777-3228• FAX (408) 777-3333 • buildinq a,cupertino.orq
miry'CANNOT BE..FINALED IJM THIS-CERTIFICATE HAS.BEEN
COMP,IETED SIGI\'ED;.AND RETURNED.;TO THE BUILDINGDI ISION
PURPOSE ,
1'h is affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms tor
compliance with 2013 CRC Section R314, 2013 CBC Sections 420 6 and 907.2.11.2 where no interior access tnr
inspections are required.
GENERAL INFORMATION
1lxisting 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
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
L Within each sleeping room A 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 commercial.power 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 nf Address Jo ZR Poc1•E }�� r %- ) Permit No.3—Z00 7—//S-7)
Specify Number of Alarms # Smoke Alarms #Carbon Monoxide Detectors
!have read and agree to comp! with the.e wsand conditions of this statement
Owner(or Owner Agent's)Name,r4440`/0 Signature Date:
Contractor Name:
te y "�e��,ar�,,i ' Signature � Lic. ' 7 Date:
Qnan l•o n,a�(Y•)1.,.,, .7.:., .,,, ..,,.1 nn/17/ A"
r
WATER-CONSERVING PLUMBING FIXTURES
t , - OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino(a cupertino.orq
Owner Name t;t/ l( �``i L. �' CNo.,— c' 7 - )/( 5
��ir� Permit 2-
Address /0 Z-5--0 941/- eD / -77/-
1. Es your real property a registered historical site?
❑ 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?
(OcYes Civil Code Sections 1101.1 through 1101.8 do not apply.
,F The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
❑ 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.
-qt. 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.
A-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 fixtures throughout the building(regardless of whether property undergoes alterations or
improvements). •
❑ My property is a commercial 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 following page. a
Owner or Owner Agent's Signature: �' r£s t7C/Puree-v ) Date: c,
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
3B4072015.doc revised 08/26/15