10050013 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10716 ROSEWOOD RD APT A-D CONTRACTOR: BKB CONSTRUCTION,LP PERMIT NO: 10050013
OWNF-R'S NAME: ESSEX PROPERTY TRUST 2812 TRINIT\'SQUARE DR STE 110 DATE ISSUED:07/012010
OWNER'S PHONE: 6508151622 CARROLLTON,TX 75006 PHONENO:(972)47&2255
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PBRM IT INFO: BLDC r ELECT r PLUMB r
License Class_ Lic.4 :�`S� "7fT��I/ NIECII r - RESIDENTIAL r1 COMMERCIAL r
Connector
I hereby affirm that I am licensed under lire provisions of Chapter 9 JOB DESCRIPTION: EXTERIOR RE-SIDING 9'0 AN EXISTING APT BLDG,NEW
(commencing with Section 7000)of Division 3 of the Business&Professions ENTRY TRELLIS,WINDOW,DOOR REPLACEMENT THRU-OUT;SEE
Code and that my license is in full force and effect. 10050005 FOR 17EFS&PLAN CK COMMENTS.
hereb%y affirm under penalty of perjury'one of the Inflicting two declarations:
I have and will maintain a cenificate 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 pennit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfomhance of the work for which this Sq..Ft Floor Area: Valuation:$68965
penmit is issued.
APPLICANT CERTIFICATION ANN Number:31643005.10716.A-D Occupancy Type:
I certify that I have rand this application and state that the ab veinform:tion 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
indemnify and keep hamtless the City of Cupertino against liabilitics,judgments,
costs.and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply Igo DAYS FROM LAST CALLED INSPECTION.
with all non-point soot :rcgulati ns err the Cupertino Municipal Code,Section
9.18.
Issued by: �J Date:
Signature Dale
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of A0 roofs shall be inspected prior to any roofing material being installed.If a mof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,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, -
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjuy one of the folloting three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided forby Section 3700 of the Labor Code,for the I have read[lie hazardous nmterials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilealth&Safety Code,Sections 25505.25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
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 Health&Safety Cndc cetions 25505,25533,and 25534.
Compensation laws of Cali fomia. II;after making this certificate of exemption,I
become subject to the Worker's Compensation provisions ollhe Libor Code,1 mustOw r 0
Dale:-7
forthwith comply with Such provisions or this pennil shill be deemed revoked. �---y--r—t/
APPLICANTCERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this'applicalion and state that the above information is I hereby afTimh that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 ill non-pain 'ou a rent ion r the Cupertino Municipal Codc,Section
9.18. 1 understand try plans shall be used as public records.
Signature Date Licensed Professional
�UU 5 OU /3
CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # .-31 (, y� 0 1071 A �e.
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Building Address: Q-V'L000GL
C511 c"
Mailin Address (if different frlorn building address):
t �� C QAbP t'�W U 0 O� —
Are Hazardous Materials being used as part of this project? Yes LJ No
HOA: (Exterior work only) Yes ❑ No Vr If yes, provide letter from AOA
Owner's Name: Phone#: q
caw 71�v5T 0%S' 16 z Z
Contractor: Phone:
3K? 5 Lr, -v .t Fax: (o50 . 20
Contractor License
Cupertino Business License#:
Contact: J I mm Grf.9�IG P one: 650 -So2 • 06 C-5
y Fax: IS c • 0• o/o
Residential Commercial EJ
7obDescription: �> yp_5;�(��j h a� t✓Ciy� '��m Lrvr�� 4 6�kAd y
/`In.,, O�.�w. rra,,-�sC1 ` c..�l•'�O�J�'-' 1�vor- rt�l6 ee,�.2^"1—'�iivv�+o
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
IUIIUV-A ❑ IlAll B, N-HT, V-B j
Valuation: Square Foo-tage:
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED 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 wivw.buildit2reen.oriZ
Revised 07/14/09