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12020083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10689 MAPLEWOOD RD f528 NTRACTOR:ABE CONSTRUCTION,INC PERMIT NO: 12020083 OW'NER'S NAME: ESSEX THE POINTE LP E WEDDELL DR STE 4 DATE ISSUED:02/21/2012 OWNER'S PHONE: 6504943700 _T, VALE,CA 94089 PHONE NO:(408)734-84(6 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ' ELECT ' PLUMB License Class—e? 0 Lic.# �`�U MECH RESIDENTIAL COMMERCIAL { Contractor Dot la Fate JOB DESCRIPTION:APTQNQ A,B,C&DMULTI-FAMILY BATHROOM I hereby affirm that I am licensed under the provisions of Chapter 9 REIVIODEL(1205QFT),KITCHEN REMODEL(160SQFT)AND ADD (commencing with Section 7(100)of Division 3 of the Business&Professions NEW LAUNDRY ROOM Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 Valuation:$28000 Section 3700 of the Labor Code,t6r the performance of the work for which this Sq.Ft Floor Area: Permit is issued. APPLICANT CERTIFICATION APN Number:31643003.10689 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnity and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply I$p DAYS FROM LAST CALLED INSPECTION. with all non-po* t sour e re ations per the Cupertino Municipal Code,Section 9.18. Date z a\ Date 1 Issued n�;/�- Slgnatu ` ❑ OWNER-BUILDER DECLARATION RE-ROOFS- I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&L Professions Code) 1,as owner of the property,arm exclusively contracting with licensed contractors to construct the project(Sea7044,Business&Professions Code), ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation.,is provided for by Section 3740 of the Labor Cade,for the [have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,its provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air Permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Healon&Safety Code,Sections 25505,25533,and 25534. \ Compensation laws of California. [f,after making this certificate of exemption,I Owner or all iz d become subject to the Worker's Compensation provisions of tine Labor Code,I must Date: " 1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby a I certify that l have read this application Arid state that the above information is affirm that there is a construction lending agency for the performance of work's correct.I agree to comply will,all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,fund hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non-point source regulatiox,s per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 2 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: \ Y - CITY/ZIPCODE: �'1�(1 *Our municipal code requires all businesses working in the city to have a City of Cupertino b ness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ig ature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 9 ITEMS OF 9 COPY # Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 31643003 .10689 DATE ISSUED. . . . . . . 02/21/2012 RECEIPT #. . . . . . . . . BSOoOO16061 REFERENCE ID # . . . 12020083 SITE ADDRESS . . . . . 10689 MAPLEWOOD RD SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . ESSEX THE POINTE LP ADDRESS . . . . . . . . . . 925 E MEADOW LN CITY/STATE/ZIP . . . PALO ALTO, CA 94303 RECEIVED FROM . . . . ALLAN UY CONTRACTOR . . . . . . . . ABRAHAM PONCE LIC # 32833 COMPANY . . . . . . . . . . ABE CONSTRUCTION, INC ADDRESS 528 E WEDDELL DR STE 4 . . . . . . . . . . . CITY/STATE/ZIP . . . : SUNNYVALE/ CA 94089 TELEPHONE . . . . . . . . . AMOUNT PD-TO-DT THIS REC NEW BAL FEE ID UNIT QUANTITY --- ---------- --- ------ ---------- ---------- ------ ------ ---------- ------- 0 . 00 41.00 0.00 1ADMIN HOURS 1 .00 41-00 0 . 00 130 -00 0.00 1BAPPLOTHE NO OF APPLIAN 2 .00 130 .00 0 .00 2 .00 0 .00 VALUATION 28, 000 -00 2 .00 0 . 00 1BCBSC 2 . 80 0 .00 2 .80 JBSEISMICR VALUATION 28, 000 -00 0 .00 1 .00 44 .00 0 . 00 44 .00 ,ATE 588 .00 0 .00 iMPERMITFE FLAT P 120 .00 588 -00 0 .00 0 .00 1REMRESBAT SQ FEET 160 .00 5-88 .00 0 .00 588 .00 0 . 00 1REMRESKIT SQ FEET 6 .00 780 -00 0 .00 780 -00 0 .00 JSTINSP UNITS 1 .00 44 .00 0 .00 44 .00 --------- 1TP-AVDOC FLAT RATE ------ --- ---------- ---------- 2219 - 80 0 .00 2219 -80 0 .00 TOTAL PERMIT : AMOUNT REFERENCE NUMBER METHOD OF PAYMENT -- ____________________ ------------ ----------- CREDIT CARD -- - , 219-80 VISA --- -Z-------- TOTAL RECEIPT 2, 219 - 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- --------- ------------------ -------- ---------------------------- 302 TUB & OR SHOWER 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 307 INSULATION 305 FRAME 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT CITY OF CUPERTINO 1 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10689 mapplewood rd#A,B,C,D. TDATE: 02/21/2012 REVIEWED BY: bob s. APN: BP#: VALUATION: $28,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY Buildina is PENTAMATION USE: Multi-Family Dwelling >3 Stories Q Yes E) No PERMIT TYPE: 1 R2REM WORK multi-family bathroom kitchen add new laund room. SCOPE Mech.Plan Check El hrs $0.00 I�tech.Permit Fee: 1,11PERMIT - LiOther Mech.Insp. OA hrs $44.00 A10TE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the grelinina information available and are onl an estimate. Contact the De t or addn'1 into. FEE ITEMS a;' S .s: „ > _ ' .i= FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. Q OT Q.Q hrs $0.00 $588.00 1REMRESB.4T PME Plan Check: $0.00 160 s.f. Remodel,Kitchen(<=300 sf) Permit Fee: Hourly Only? 0 Yes () No $0.00 $588.001 IREMRESKIT Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs !$:000F$l 0.00 # Mechanical PME Unit Fee: .00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Administrative Fee: I.ADMIN $41.00 0 Work Without Permit? 0 Yes Q No $0.00 fl _.:..._.._ .«'° '...'....6._r::= .:'...).` $0.00 © hours Inspections Travel Documentation Fee: ITRA VDOC $44.00 $780.00 1STINSP Inspection,Hourly 1BSELSMICR $2.80 Select an Administrative Item i lr `'tds_f_..:_r_=rnksion 1 IBc,BSc $2.00 SUBTOTALS: $133.80 1$2,086.001 TOTAL FEE: 1 $2,219.80 Revised: 1/19/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•build ing(acupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# r (�'/�� PROJECT ADDRES `�'PN J C> O RNAME �i ��r EMAII�N'' _ ` 'Y1 STREET ADDRrS CITY, ST TE ZIP FAX C CONTACPHONE �� E-MAIL r ,1 � z icy �4C1 'a STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ^CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO CTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# 'MAIL FAX ANY NAME _ ��•.�lC..�� _; ;.;�,� �. �� �'� -1 � (�C►� >- — `� STREE?ADpRESS `tom CITY,STATE,ZIP \ PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OFW R � `` un EXISTING USE PROPOSED USE CONSTR.7E #STORIES 1 (�, USE TYPE OCC. SQ.FT. VALUATION($) EXISTAREA NET NEW FLOOR DEMO A AREA AREA AREA AREA v BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA '�� REMODEL AREA PORCH AREA DECK AREA TOTAL DEC/ CH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT [:]YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: ) TOTAL VALUATION: PLANNING ADPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO C•;•(}J• i"`'� By my signature below,I certify to each of the following: 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 J0rreCt 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 buil ng co o Aauonze i e d o representatives of Cupertino to enter the above- rty for inspection purposes. ordinances and state laws relating to builtt Signature of ApplicantlAgent: Date: SUPPLEMENTAL INFO TION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for 0 OVER-IM-COUNTERPLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11