B-2017-1669 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1669
10275 PARKWOOD DR APT 3 CUPERTINO,CA 95014-1511(326 27 036) THERMAL
MECHANICAL
SANTA CLARA,CA
n 95054
OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 10/12/2017
OWNER'S PHONE:650-961-8330 PHONE NO:(408)988-8744
LICENSED CONTRACTOR'S DECLARATION 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 X MECH 3C RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 o the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BLDG 10 UNIT 3-(N)AC UNIT;REPLACE FURNACE(SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION);(N)WASHER/DRYER HOOK-UPS; REPLACE
1. I have and will maintain,a certificate of consent to self-insure for Worker's ELECTRICAL PANEL(70 AMP)(SAME LOCATION);(N)GAS LINE
Compensation,as provided for by Section 3700 of the Labor Code,for the FOR STOVE;REPLACE OUTLETS(9);REPLACE LIGHT
of the work for which this permit is issued. (BATHROOM);(N)(1)EXHAUST FAN(BATHROOM)
,rfonnance
ave 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
/,-� 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.]agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state;laws relating to building construction,and hereby authorize 326 27 036
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 regulation's per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
lure Date 10/12/2017 Issued by:Abby Ayende
Date: 10/12/2017
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
followingtwo 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)
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: 10/12/2017
I hereby rm u
affiunder penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. '1 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,C I••ter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the.Health&Safety Cod:,Sections 25505,25533 : d of--.
Labor Code,I must forthwith comply with such provisions or this permit shall ,,,,...m. �
be deemed revoked. ner or authorized age .( `rt/ -
APPLICANT CERTIFICATION Date: 1 0/1 212 0 1 7
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.
Signature Date 10/12/2017 Licensed
Professional
/ CONSTRUCTION PERMIT APPLICATION
IV COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,41.19.,,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 / /
(408)777-3228•FAX(408)777-3333•buildingaa.cupertino.org W( (�(P
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 10275 Parkwood DR, BLDG 10, Unit#3 APN# 324
Z--+_ 0 3 CP
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 ❑ OWNER-BUILDER 0 OWNER AGENT IX CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE BUS.LIC# 299
C-4,10,20,36,38
COMPANY NAME Thermal Mechanical E-MAIL rmoyer@thermalmech.com FAX 408-988-0233
STREET ADDRESS 425 Aldo ave. MY'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/dryer hook ups, (N)electrical panel (70 AMP),
(N)gas line for stove, (N)electrical
outlets, (N)light, (N)bathroom exhaust fan C 1.)
)
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: 0 DETACH
0 ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? 0 N ADDITION? EI NO
� p
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REa� b ,. � -b ; : ^"' ' TOTi�L XA�DO
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO *, i ` _�O LLL/V
1, /
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 cons I authorize represen ive f Cupertino to enter the above-identified prope for inspection purposes.
Signature of Applicant/Agent: � � Date: r ��7
SUPPLEMENTAL RMATION REQUIRED PLAN'CHECK TYPE ' ROUTING SLIP i ,.,,f4.4
New SFD or Multifamily dwellings: Apply for demolition permit for a .
❑ OVER THE-COUNTER ❑ BUILDINGPLa1V REVIEW
existing building(s). Demolition permit is required prior to issuance of building ,
permit for new building. E`EXPRESS Myo�y$�� ''* ❑ PLANNING PLt REVIEW " ""l
1/ii rid€
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD a �° (❑ WS �� e
PUBLIC ORK
❑
form if any Hazardous Materials are being used as part of this project. LARGE,-z4 0°FIREDEPTs'_
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application. '' -
/,) 1� �. w„4 :6..,* -"❑/.ENVIRONMENTALIIEALrI „„!,W`,
BldgApp_2011.doc revised 06/21/11