10050017CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10686 ROSEWOOD RD APT A -D I CONT'RACT'OR: BKB CONSTRUCTION, LP I PERMIT NO: 10050017
OWNER'S NAME: ESSEX PROPERT , TRUST
2812 TRINIT'1' SQUARE DR STE 110 I DATE ISSUED: 07/01/2010
I OWNER'S PHONE: 6508151622 ICARROI,I.TON,TX 75006 IPHONE NO: (972)478-2255 I
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. #_
Contractor Date —� n
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of tine Business S Professions
Code and that my license is in full force and effect.
herchy' affirm under penalty' of perjury one of the following two declarations
I have and will maintain a cervi ficate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, I'or the
performance of the work for which this permit is issued.
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 whichn
permit is issued. / I
APPLICANT CERTI FI C.\TION
I certify that 1 have read this application and state that the abov nfonn. tion is
cornet. I agree to comply with all city and county ordinances and state laws relating
to building constriction, 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 Cupenino against liabilities, judgments,
costs, and expenses which may acerae against said City in consequence of the
granting of this permit. Additional) the applicant understands and will comply
with all non -point son�meJ is Cupenino Municipal Code, Section
9.18. / /Y
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❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I ant exempt from the Contractor's License Law for one of
the following two reasons:
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 far sale (Sm.7044,
Business R. Professions Code)
I, as owner of the property, ant exclusively contracting with licensed contractors to
construct the project (Sec.7044. Business & Profusions Code).
hereby affirm under penalty of perjury one of the following three
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
Section 3700 of the labor Code, for die performance of the work for which this
permit is issued.
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 Cali fomia. If, after making this cenificme of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this pemnit shall be deemed revoked.
APPLICANT CEId'I'I FICA TION
1 certify that 1 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 pmpeny for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costa, and expenses which may oceme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulatio enino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
NIECII r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: EXTERIOR RE -SIDING TO AN EXISTING APT BLDG,NEW
I,91'RY'I'RGLLIS,WINDOW,DOOR REPLACEMENT TI[RU-0Uf;SEE
10050005 FOR FEES i PLAN CK COMMENTS.
Sq. Ft Floor Area: I Valuation: 568965
APN Number: 31643005.10686.A -D I Occupancy Type:
PERA1IT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date:
Date:
RF. -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGSTO BE CLASS "A" OR BETTER
IIA'l,ARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ileallh S
Safety. Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay .Arca Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health S Safety Code, Sections 25505, 25533, and 25534.
CONSI'RUCI'ION 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
Lender's
ARCIIIT'ECI"S DECLARATION
I understand my plans shall be used as public records.
1005-001-7
«C�CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN #
216;) V,50 &)5%10 �4�' 41
Date:
) 4/15//o
Building Address:OS�W uOG� f�GtL.
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA:(Exterior work only) Yes ❑ No if Yes, provide letter from HOA
Owner's Name:
Phone #:
5" '' TrVaT
Contractor:
Phone:
?K3 c644n,ti
�
Fax: &50 ^ 37-o - 9394
Contractor. License #: Mj J ( Lfg1� G
Cupertino Business License #: a
Contact: J IMwt ��G
P one: 650 '602 - 6$6$
%
Fax: (,moo • gM. of o7
Residential Commercial ❑
Job Description: Ey�w yp_S;d�; l b a ?.YiYh � �Dn.4,,,a 4 6��A, �
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
llnll/V-A ❑ IVIII B, IV -HT, V -B [✓j
-' I
Valuation:' r Square Foo-tage:
G S
( g1
Project Size: Ex ress ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green BuildingfLEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.or
Revised 07/14/09