B-2017-1681 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1681
21317 GLEN PL APT 6 CUPERTINO,CA 95014-1473(326 27 036) THERMAL
MECHANICAL
SANTA CLARA,CA
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
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 39 UNIT#6-(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(10);REPLACE LIGHT
mss.p rformance of the work for which this permit is issued. (BATHROOM);(N)(2)EXHAUST,FAN(BATHROOM)
r3 I have and will maintain Worker's Compensation Insurance,as provided for by
,A Section 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.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 27 036
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 an. ill comply with all non-point
source regulations per the Cupertino M i, ;erode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sit ature — - , Date 10/12/2017 Issued by:Abby Ayende
.I' 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:
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:10/12/2017
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 forby 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 Code,Sections 25505,25533 and 25534.
Labor Code,'1 must forthwith comply with such provisions or this permit shall
be deemed revoked.
t'. er or authorized agent % —fL
APPLICANT'CERTIFICATION Date:10/12/2017
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 10/12/2017 Professional
/ CONSTRUCTION PERMIT APPLICATION
LW COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION B.
,s1.1.9,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq cupertino.orq
111NEW CONSTRUCTION ElADDITION 0 ALTERATION/TI 111REVISION/DEFERREDORIGINAL PERMIT#_?, 2.c7 —1t 1—lCA5
PROJECT'ADDRESS 21317 Glen Place, BLDG 39, Unit#6 APN# '62
o- 2 1
�7,0 0
OWNER NAME AveryGlenbrook LLC PHONE E-MAIL avery@pacbell.net
650-961-8330 rY@P
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 ❑ OWNER AGENT IX CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Thermal Mechanical LICENSE NUMBER 256057 LICENSE TYPE I BUS.LIC# 299
C410,20,36,38
COMPANY NAME Thermal Mechanical E-MAILrmoyer@thermalmech.com 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
add new AC, replace furnace in same location, (N)washer/dryer hook ups, (N)electrical panel (70 AMP),
(N)gas line-for stove, (N)eletr1CO
al outlets, (N)light, (N)bathroom exhaust-fan L
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG; ; NEW FLOOR DEMO TOTAL
AREA ' AREA AREA NET AREA
BATHROOMS; KITCHEN OTHER
REMODEL AREA; REMODEL AREA REMODEL AREA
I I'
PORCH AREA ' DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: O DETACH
. ' ❑ATTACH
#DWELLING NG UNITS: ISA SECOND UNIT 0 YES SECOND STORY OYES ,
BEING ADDED? ONO ADDITION? ONO
PRE-APPL[CATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN El YES ICTI'•� �� TOTAL VALUATION:
PLANNING APPL# 0 NO PLANNING.APPROVAL LETTER EICHLER HOME? 0 NO '� ' y 2 O( O D f
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
applicaho i 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 construe tho' e representat' -s of upertino to enter the above-iden'Ii d property for inspection purposes.
Signature of Applicant/Agent: �` �i Date: �2.6 ,.."�
SUPPLEMENTAL INFO,R1IATION REQUIRED ��r /i �, ////F ; / //// /TI /V/,h/ / ,//� /
,�/' PLAN GHxmxxPE ROUTING St.IY::
New;SFD or Multifamily dwellings: Apply for demolition permit for t
aY�R rH>rQpt1NTER �,��, Q BIriLDIN�PL�ANREVIEWq� � �,,,.
existing building(s). Demolition permit is required prior to issuance of building H ' 1y�� /��„/ /,//i , ,",���, �,,/ / y/,/,��;
permit,for new building. HCl EXPRESS a PLAN LANREVIEW/
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure i STANDARD .,x/�;/rar r >. /ori C1 PUBLICWC RI(S///.200,,,,,14,1°//4/ /"
form if any Hazardous Materials are being used as part of this project. //� � ��„77�/ /r//y t, ygEtn;"i"z� %/� //��✓i'l Fr
LARGE
I �o � 'in'G/� /�Y�////iia"ff�,'1✓Pm�/��/'�',�'/// y �//iin/9�zaN/���
Copy of Planning Approval Letter or Meeting with Planning prior to ,/ :;;; F/ / c �;- ,
xQ�M�dJOR/���� � �/%�� SAN[TA12Y SPWER DISTt2ICT
submittal'of Building Permit application. _ '/� 1/'/r'S „4:0,,,r
5 1
m tt - /�,<,<.o� `x r�04Et%IRONMENTALHFAVIlt,OA,o,AN
BldgApp_2011.doc revised 06/21/11.
95 3'60
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
I COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildino ct.cuoertino.ora
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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 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 I X__
Within each sleepi 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 conntnercialpower 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 907.2.114 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 1/3/7 1 v) f"/. ��" r Permit No./3-Z0/7'//,l
Specify Number of Alarms #Smoke Alarms Ij #Carbon Monoxide Detectors
I have read and agree to comp/ with the _„•;nd conditions of this statement
Owner(or Owner Agent's)Name
)74:4405- fl ZOO Signature ,. Date/L/Z/?
Contractor Name:. / 2,5641 5 7
Tlr1L'•p'''1— d 1.4 e6,44,? { Signature . . . Lic.# . .. . . Dateiezkh