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B-2017-1318 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1318 10184 PARKWOOD DR APT 2 CUPERTINO,CA 95014-1406(326 27 037) THERMAL MECHANICAL SANTA CLARA,CA 95054 OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED:08/15/2017 OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744 ..._1 a. lit.: I '. I_ ._t I. r I k BUILDING PERMIT INFO: License Class C-4:10.20.36.38 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 MECH RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: BLDG#53/UNIT#2;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 1. I have and will maintain a certificate of consent to self-insure for Worker's SERVICE(70 AMP);(N)GAS LINE FOR STOVE;(N)RECEPTACLE Compensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS;(N)LIGHT;(N)BATHROOM EXHAUST FANS. deperformance of the work for which this permit is issued. REV#1-CHANGE LOCATION OF FURNACE TO ATTIC SPACE- I have and will maintain Worker's Compensation Insurance,as provided for by ISSUED 10/13/2017 � ection 3700 of the Labor Code,for the performance of the work for which this r permit is issued. Sq.Ft Floor Area: Valuation:$20000.00 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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. do ig __...,..............i....-., ate 10/13/2017 Issued by:ABBY AYENDE Date:08/15/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is i. 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:10/13/2017 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 3. 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 Cod Sections 25505,2553 d 25534. Labor Code,I.must forthwith comply with such provisions or this permit shall be deemed revoked. mer or authorized age • APPLICANT CERTIFICATION Date:10/13/2017 . .,'' I certify that I have read this;application and state that the above information is CONSTRUCTION LENDING 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. I understand my plans shall be used as public records. Licensed Signature Date 10/13/2017 Professional B. t _ l 1` �/ CONSTRUCTION PERMIT APPLICATION az, 1W COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION • wyca,f, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinci cupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ® REVISION/DEFERF?D ORIGINAL PERMIT# -:,ti E , r-i,Di PROJECT ADDRESS 10175 Parkwood DR, BLDG 53, Unit#2 APN# 2"l,'0 OWNER NAME PHONE E-MAIL AveryGlenbrook LLC 650-961-8330 averY@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. CITY,STATE,ZIP FAX 408-988-0233 Santa Clara, CA 95054 ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT IX CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER 256057 LICENSE TYPE BUS.LIC# 299 Thermal Mechanical C-4,10,20,36,38 COMPANY NAME Thermal Mechanical E-MAIL rmoyer@thermalmech.corn FAX 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 .ISIO :' hange location of Furnace to attic space ' 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 REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH ❑ATTACH #DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? 0N ADDITION? 0N PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES CEIVED BY; K TOTAL VALUATION: PLANNING APPL# 0 NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO ;' :04 x By my signature below,I certify to each of the following: I am the property owner or authorized agent to 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 building co. .-. I a .orize represen.Description of Cupertino to enter the above-identified r erty for i spection purposes. Signature of Applicant/Agent: _ . - Date: � �� SUPPLEMENTAL I'' ORMATION REQU I' D ''`r-;.: PLAN CHECK'TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ,Stu 4, ;',-/ -4 ,4`,.,;.',:',4' ,;;-'..1.,,,,,„'",7,'';„4",,„ ,,,,'4 �❑%OVERTHE.,0:0fER ��v', y0iBU, ,PV9,PN '•- '� if�� existing building(s). Demolition permit is required prior to issuance of building f,a a K�ti a moi, , ga permit for new building. ❑ EXPRESS ' ❑ PLANNINGPLANREViEW k7 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑,STANDARD ;64,6„,CS WORKS form if any Hazardous Materials are being used as part of this project. �:r , ;.a .'if `, ,� `i"� `��'% r,' ��� []s LARCE 3 s i j ❑ FIRE DEPT ° �� _Copy of Planning Approval Letter or Meeting with Planning prior to , ASN q:---41.,:v , . submittal of Building Permit application. ❑ nIA�oR ❑ S VITARY$.„ , [STRICT j,:;;'-, ,,,=-.:::-.-1:-,,,-„, ` , i'w,d M❑ :ENVIRONMENTALHEALTH,,,��h,,,,'^'. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1318 10184 PARKWOOD DR APT 2 CUPERTINO, CA 95014-1406 (326 27 037) THERMAL MECHANICAL SANTA CLARA, CA 95054 OWNER'S NAME: AVERY GLENBROOK LP OWNER'S PHONE: 650-961-8330 DI)X9 0 ,. 1 License Class C-4: C-10: C-36: C-38 Lic. #253- 5_7 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: t. 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 S on 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 per the Cupertino Municipal Code, Section 9.18. Signatu to 8115/2017 -QWNER-B DER DECLARATION 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 property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). DATE ISSUED: 08/15/2017 PHONE NO: (408) 988-8744 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BLDG #53/IJNIT#2; ADD (I) A/C; REPLACE FURNACE, SAME LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (1) RECEPTACLE OUTLETS; (N) LIGHT; (I) 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: Jasmine Archbold Date: 08/15/2017 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: 8/15/2017 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. 2. 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. 3. 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 CERTiFICATJON 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 8/15/2017 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, Sect'P-11to25505, 2553 and 25534. r Owner or authorized age Date: 8/15/2017'} CONST N LENDING AGENCY I hereby affirm that there ' 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CCUPERTINO F1 NFW CONSTRITCTRIN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinaCtr7cupertino.ora J- f i r_1 ADnITIC)N IAI AITFRATTON/TT F-1 RFVIST01-J/T]FFFRRF.T7 C)RTCINAT.PRRMTT* PROJEcraDDREss 10184 Parkwood DR, BLDG 53, Unit #2. APN# 3 Z(,o -2- 6 OWNERNAME Ave ryGlenbrook LLC PNONE 650-961-8330 MIL averY@pacbell.net STREETADDRESS 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 STREETADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 FAX 408-988-0233 ❑ OWNER ❑ OWNER -BUILDER ❑OWNER AGENT IX CONTRACTOR ❑ CONTRACTOR AOENT ❑ ARCHITECT ❑ ENOEJEE t ' ❑ DEVELOPER ❑ TENANT CONTRACTORNAMELICENSENUMBER Thermal Mechanical 256057 LICENSE TYPE C-4,10.20,36.38 DUS.Laca 299 COMPANYNAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAX 408-988-0233 STREETADDRESS 425 Aldo ave. CITY, STATE, ZIP Santa Clara, CA 95054 rxoNE 408-988-8744 ARCHITECTIENGINEER NAME LICENSENUMBER BUS. LIC COMPANY -NAME E-MAIL FAX STRWI' ADDRESS CITY, STAT', ZIP PHONE DESCRIPTION OF WORK add new AC, replace furnace in same location, (N) washerldryer 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 NETAREA BATHROOM KrI'CHLIN OTHER RBMODELAREA PEMODELAREA RBMODELARBA PORCH AREA DECKAREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLINGUNITS: IS A SECOND UNIT E]YES SECONDSTORY F] YES BEING ADDED? []NO ADDr'rION7 E]NO PRE -APPLICATION []YES IFYES, PROVIDE COPY OF ISTIICBLDGAN ❑YES RE. ED TOTAL VAI,UATLO PLANNINGAPPL# FIND PLANNING APPirOVALLLrmu. EICHLERHOME? ❑ NO � F� b By Iny signature below, I certify to mch of the following: I am the property owner or author zed a ent to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to build' ductfr. I authorize re a Ives of Cupertino to enter the above -id ed pip erly for inspection purposes. Signature of Applicant/Agent: Dale: vJ SUPPLEMENT L INFORMATION REQUIRED'...: '.:.IiotiTiNG p: OVEk-TH&COVNTER .' . '.: : 0 .81JiLDINGpLnt; itEviEw New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition pennit is required prior to issuance of building :. ; : . . permit for new building.�-:ExPRESs'` ?PiAKriitycriiriiiv�Ew::.:..:;:::': _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11,:STANOARn..-'.:.` : ❑, ;PuiiiLic woiiics.; form if any Hazardous Materials are being used as part of this project. 7`... . •❑ •LARGE'.:.. 1� Fi$1r'PEC'I'r.. _ Copy Of Planning Approval Letter or Meeting With Planning prior t0.Q''n.IAJOR':. • '•. •. ❑• 6Ai1�ITARYSER'EReDI$TRICT ''. submittal of Building Permit application. .;' ❑: )ENV [RONMENTAL-HEALTH•.`":. : BldgApp 2011.doc revised 06/21/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE 7 OCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingno cupertino.orq ERMTT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN 'COMPLETED SIGNED,SIGNED,AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 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 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 riot 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: / / ( /zj L.4,00/ z- ) Permit No.f`" /745769 7 Specify Number of Alarms: #Smoke Alarms: I-711 #Carbon Monoxide Detectors: I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner A•,nt's a e: Signature. .' • Date/1 _ !� Contractor Na e: Signature 411PF Lic.# Date: Smoke and CO form.doc revised 12/15/16