B-2017-1149CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR.
PERMIT NO: B-2017-1149
10270 PARKWOQD DR APT 4 CUPERTINO, CA 95014-1515 (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 -1 0:C -36-C-38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X RESIDENTIAL _ COMMERCLAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION.
BLDG #6/UNIT #4, 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 HOOK UPS, N ELECTRICAL
i. I have and will maintain a certificate of consent to self -insure for Worker's
SERVICE (70 AMP); (N) GAS LINE FOR STOVE, (1) RECEPTACLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
OUTLETS; (1) LIGHT, (N) BATHROOM EXHAUST FANS.
performance of the work for which this permit is issued.
i I have d 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
Sq. Ft Floor Area:
Valuation: $20000.00
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
APN Number-
Occupancy Type:
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 upertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature 7/26/2017
Issued by AbbyAyende
/
Date: 07/26/2017
OWNER -BUILDER 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:
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 property, am exclusively contracting with licensed
Signature of Applicant:
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
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 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 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 Cupertin Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Spedbuls 2j.05, 25533 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION (,Date:
7/26/2017
I certify that I have read this application and state that the above information is
�ONSTRUC ION 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 7/2612017
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ti
(408) 777-3228 • FAX (408) 777-3333 • buildingp-)_cupertino.orgCUPERTINO
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PROJECTADDMss 10270 Parkwood DR, BLDG 6, Unit#4
APN#
OWNERNAME Aver/ Glenbrook LLC
PHONE
E-MAIL650-961-8330
avert'@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-MAIL
rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo ave. i'..
CITY, STATE, ZIP
Santa Clara, CA 95054
FAX 408-988-0233
OWNER ❑ OWNER-BUMDER 0 OWNER AGENT IX CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑. DEVELOPER ❑ TENANT
CONTRACTORNAME
Thermal Mechanical
hanical
LICENSE NUMBER
256057
LICENSE TYPE
BUS. LIC
299
C-4,10,20,36,38
COMPANY NAME Thermal Mechanical
E-MAILrmoyer@thermalmech.com
FAX 408-988-0233
STREET ADDRESS 425 Aldo ave.
cTTY°STATE, zIP Santa Clara, CA 95054.
PHONE 408-988-8744
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANYNAME - - -
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
EXISTINGUSE -
PROPOSED USE CONSTR.
TYPE
# STORIES
1
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEWFLOOR
DEMO.
TOTAL
-
-
AREA
AREA
AREA
NET AREA
-
BATHROOM KITCHEN -
OTHER
-
-
REMODEL AREA REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA -
TOTAL DECK/PORCH AREA
- GARAGE AREA: DETACH
-
-
ATTACH
-
#DWELLINGUNITS:
IS A.SECOND UNIT ❑YES
SECONDSTORY ❑YES
- -
BEING ADDED? ONO ..
ADDITION? ❑NO
' r
PRE. -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESMCE By.,`; rr ! TO ALUAT N'._
PLANNING APPL # FIND PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO r ;
By my signature below, I certify to each of the following: I am the property owner or authorized agent to, act o 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 build" n cI- n. I authorize re r ntatives of Cupertino to enter the above-identi d prop for inspection purposes.
o
Signature of Applicant/Agent: Date: L
JUFFLEMbN 1 K ,1NFUKMAHUN F—EQUIKN�/
New SFD or Multifamily dwellings: Apply for demolitionpermitfor
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 2011.doc revised 06/21/11
I
i
. . SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
64" COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333 • buildina(a cudertino.orq
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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 ho 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:
1. 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 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.907.2.11.4 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: /02 70 Pa(�G Gtie.90.67 J / 6-0" Permit No.g--2.01 -)1"/
?
Specify Number of Alarms: # Smoke Alarms: I 2 J #Carbon Monoxide Detectors: Lim
1,have read and a.ree to compl with the tem-nd conditions of this statement _
Owner(or Owner Agent's)Name:
Signature Date7A1;1,4.440E D� ? LGo. g
Contractor.Name:. Z 56e S 7
/,
v'eC ee,44t7+Ga( Signature Lica Date: ��7 ��
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