B-2017-1209CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:'B-2017-1209
10234 PARKWOOD DR CUPERTINO, CA 95014-1528 (326 27 037) THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP I I DATE ISSUED: 08/15/2017
OWNER'S PHONE:
9
License Class PLUMBING 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:
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
, pelformance of the work for which this permit is issued.
Frave and will maintain Workef 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:
APPLICANT CERTIFICATION
1' 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.
r
Signat e h Date
PHONE NO: (408) 988-8744
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH YX RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BUILDING #62 - (I) HOT WATER SYSTEM & ENCLOSURE;
UPGRADES AND REPAIR OF EXISTING BUILDING SERVICES
Sq. Ft Floor Area: 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
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
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)
z. 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:
hereby affirm under penalty of perjury one of the following three declarations:
r. 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 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 sourceregulations per the Cupertino Municipal
Code, Section 9.18.
I
Signatu
Date
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, Sections 25505, 25533, and 25534.
V —
Owner or authorized acieno,e
Date:
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
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
CUPBRTINO (408) 777-3228 • FAX (408) 777-3333 • bulldInngft-cupertino.ora J �1,r1 � J
If NEW CONSTRUCTION i1 ADDITION PgALTERATION/TI I -I REVISION/DEFERRED 'ORRIGINALPERMIT#
PROJECT ADDRESS 10234 Parkwood drive Building 62
APNH 326-27-037
OWNERNAME Avery LLC
PHONE 650-961-8330
E-MAIL Avery@pacbell.net
STREET ADDRESS G
130 ast Dana St
East
CITY, STATE. ZIP
Mt. View, CA 94041 1
FAX
650-961-0571
CONTACT NAME RobMoyer
PHONE 408-593-8115
E-MAIL
STREHrADDRESS 4258 Aldo Ave
CITY, STATE, ZIP FAX
santa Clara CA 95054 18-0933
❑ OWNER 13 OWNER -BUILDER ❑ OWNBRAGENT EK CONTRACTOR ❑COMRACrORA013NT ❑ ARC141TECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
Thermal Mechanical
LICENSENUMBER
256057
LICENS TYPE
LIC c1Eo,c20,C38,C36
BUS.LIC B
299
corAraNYNaME Thermal Mechanical
E -MAI` rmo er thermaimech.com
FAX 408-988-0233
STREET ADDRESS
Ave
CITY, STATE, ZIP
4
P"425jAIdo 408-988-8744
ARCHITEQIIENOINEERNAM 1E'
Thermal Mechanical
LICENSENUMBER 256057
BUS. LICK 299
COMPANYNAME +�'
Thermal Mechanical
E-MAIL rmo er thermalmech.com
Y @
PAX 408-988-0233
BTRENI' ADDRESS �•
425, Aldo Ave
CITY, STATE, ZIP
Santa Clara, CA 95054
PHONE
408-988-8744
Di CRIPTillxorwORK -New domestic hot water system with new water heater and enclosure
1lI.
opdrades and repair of existing building services
i
PJC.ISr1NG USB(PROPOSED USE
' I '
CONSTR TYPE
1 11 STORIES
USE
TYPE
OCC.
SQ.FT. VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
ARBA;,-
li
AREA
NEr AREA
BATHROOM'S 'KITCHEN OTHER
REMODEL AREA :REMO1)ELAREA REMODBL AREA
I
�
PORCH AREA
DECK AREA �•' TOTAL DECKIPORCH AREA
-;;
GARAOB AREA: DETACH
p ATTACH
#DWELLWOIMITS: -:
UNIT ❑YES
SECONDSTORY ❑YL•S
1I ,ISASECOND
BEINCADDItUS ENO
ADDITIONS [NO
,PRE -APPLICATION ❑YESI ,WYES,PROVNhCOPYOF
ISTHEBLDGAN El YES
R
'I'ALV LUAT N:
PLANNING APPL0 ❑NO ,PL"INO APPROVAL LETTER
i I
RICHUR IIOMI'.7 ❑NO
t//)
By my signphne below, I certify to each of the following: I mu the properly owner orauthorized agent.to Rot on the property owner's behalf. I line read this
appliontiop and the mforma'6a I have provided is correct, I have rend the Description of Work and verity it is accurate. I agree to comply with all applicable local
ordinance's and Slate 'laws ieliiting to'buildingLot tion, ulhorize rep seats 'vas of Cupertino to enter the above-identifid r�rop ety for h rection purposes.
Sigllahllt ofApplieant/AgcnC Date:
RE ED
SUPPLEMENTAL INFORMATION UIR
Q
PLANCHECK7YPE '
VOVTINO SLIP •''
New SFD or Multifamily dwellings: Apply for demolition permit for
I
: R'
❑ OVER-TIIE.COUNTER .
'
BUII:DIIVGPLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
,
; .
permit for newbuildiIlg.
I� EXPRESS•.
O •rLAt9N*PLAN REVIE}Y .
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
CJ STANDARD.'-
E1:-PU$kQ.1NV0R.YS . `... •. '
form if any Hazardous Materials are being used as part of this project.
' 0 LARGE .'
' D FiREbEk-
_ Copy of Planning Approval Lotter or Meeting with Planning prior to
❑^DIAJOTt . ' `.
D ..SANITARY SEIVER DIS'fHICT
submittal of Building Permit application.
. ,
' ❑ ENVIRoNriENTXLHEAI.Ylt
B7dgApp_201I.doc revised 06121/11