The URL can be used to link to this page

B-2017-1210CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-1210 10260 PARKWOOD DRAPT 11 CUPERTINO, CA (326 27 037) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: ROB MOYER DATE ISSUED: 08/08/2017 OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lie. #258057 Contractor THERMAL MECHANICAL Date 01/31/2018 X BLDG X ELECT }C 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 #3/UNIT#11; ADD (1) A/C; REPLACE FURNACE, SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION; (l) WASHER AND DRYER HOOK UPS; (1) ELECTRICAL t. 1 have and will maintain a certificate of consent to self -insure for Worker's SERVICE (70 AMP); (1) GAS LINE FOR STOVE; (1) RECEPTACLE Compensation, as provided for by Section 3700 of the Labor Code, for the OUTLETS; (N) LIGHT; (I) BATHROOM EXHAUST FANS. performance of the work for which this permit is issued. zI have and will maintain Worker's Compensation Insurance, as provided for by ction 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 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 3 26 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 the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur • ate 08/08/2017 Issued by: Kim Dunbar Date: 08/08/2017 R -B DER 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: 08/08/2017 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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, Sections25533, : d 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: At APPLICANT CERTIFICATION Date: 08/08/2017 I certify that 1 have read this application and state that the above information is CON TICTCONLENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) 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, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed SiSignature Date 08/08/2017 9 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION t 10300 TORRE AVENUE CUPERTINO, CA 95.014-3255 (408) 777-3228 FAX (408) 777-3333 building(cD-cupertino.org CUPERTIINO Fi NEW CONSTRUCTION I-1 I ADDITION ❑X ALTERATION TI ,V ❑ REVISION /DEFERRED Y ORIGINAL PERMIT, # ' .`I PROJECT ADDRESS ;APN#; �u -on 10260 Parkwood DR, BLDG 3, Unit#11 OWNERNAME Avery Glenbrook LLC PHONE. 650-961-8330 E-MAIL - ✓. "' ' avery@pacbell.net STREET ADDRESS 130 East Dana'Street CITY, STATE;ZIPi, Mt.'View, CA 94041 AX -961 CONTACT NAMEPHONE Rob Moyer 408-593-811'5 E-MAIL rmoyer@thermalmech.com STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP - Santa Clara, CA 95054 FAX 408-988-0233 ❑ OWNER ❑ OwNER.BUH.DER ❑ OWNER AGENT U CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER, ❑ TENANT CONTRACTOR NAME Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC# 299 Thermal C-4,10,20,36,38 COMPANY NAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAX 408-988-0233 STREET ADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa` Clara, CA 95054 PHONE 408-988-8744 ARCHITECT/ENGrNEER 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 FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM !KITCHEN OTHER REMODEL AREA i REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIFORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: - ISSECOND UNIT ❑YES SECOND STORY E] YES - BERVGADDED? [:]NO ADDITION? ANO PRE -APPLICATION ❑ YES IF. YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES I IurrC% '. a ' % "�/, T T VALUATION: 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 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 building e repr ent Ives of Cupertino to enter the above -identified property f r inspection purposes. �Ction.tyth �Z , Signature of Applicant/Agent:; _ _- Date: SUPPLEMENT INFORMATION RE UIRED QK �' '°' P� "'vr /i ✓vz PLAN,CHECKTYPKra#/uu ,iiiioi,nIrUt7lINCw,STti? , u,; w SFD r Multifamily y for ion permit for permit aY I IIE "Batt �t> uI iings:required-prior toltis uan of building s).Demol tion exist ne buildin g building(s). Pg ourlli //uii/ Dzx"G // permit for new building. rtC1 EXPxEss�"°s"'i�rrtra�� PSAN�INCPhAjxVlEw�/ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure � /H/IE � _ form if any Hazardous Materials are being used as part of this project. % f <A,�Y � *�. A �,�/H( G%H/Yi✓/ !'�� /6 t � 6ibz^ �"rtc`"" d:DF.�k�/s' ` . ' r ©' LA�GE=� <,r �'/��✓'i��°�/��,� 'biRE`DEFT� �� <, �" _ Copy of Planning Approval Letter or Meeting with Planning prior to [j4iuNjAJOR �r/Hn � �� SCI SANI'C,�.R�$EWER'DISTRiCT �� submittal of Building Permit application. BldgApp_201 Ldoe revised 06/21/11