10050037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10706 ROSEWOOD RD APT A-D CONTRACTOR: BKB CONSTRUCTION,LP PERMIT NO: 10050037
OWNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/012010
O\VNER'S PRONE: 6508151622 CARROLLTON,'I:X 75006 PHONE NO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION r_ r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Claslc:;� Lie,pMECII r r
RESIDENTIAL COM\IERCIAL r
Contractor Datc�Z'
'finn Ilml 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: EXTERIOR RE-SIDING TO AN EXISTING APT BI.DG,NE-W
I herchv nl
ENTRY TRELLIS,W INDOW,DOOR REPLACEMENT TI IRU-OUT;SEE
(commencing with Section 7000)of Division 3 of the Business&Professions 10050005 FOR 17EIZS&PLAN CK COMMENTS.
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following 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 permit is issued.
I have and will maintain Worker's Compensation Insurance,m provided for by
Section 3700 of the Labor Code,for the performance of theSq.Ft Floor Area: Valuation:$68965
pemnit is issued.
APPLICANT CF.RT'IFIC.\TIONAPNNumber:3161300S.10706.A-D Occupancy Type:
I cervi fy that 1 have read this application and state that the ata
correct.I agree to comply with all city and county ordinancg
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 harnlessthe City ofCupertinoagainstliabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
cosis,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point souste regulationsper the Cupertino Municipal Code,Section
9.18. `7 �.
!!s�v Issued by. ��Date.
SignatureDale ,[_[/
❑ O\VNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All mofs shall be imspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,1 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(Sm.7044,
Business&Professions Code) 'Signature of Applicant: Dale:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(&x.7044,.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,as provided for by Section 3700 of the Libor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&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 Cade,for the performance of the work for which this Safety Code,Section 25532(x)should I 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 1 will
1 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 Codc S tions 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Ow!�Er or atho z a en Date.
. O
forthwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infomation is I hereby afTmn that them is a construction lending agency foclhe perfonnance 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 Namc
upon lire 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 acerae against said City in consequence of the
granting of this permit.Additionally,lh applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point soure regulations a the Cupertino Municipal Code,Section
9.IS. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING 1Q� 37
PERMIT APPLICATION FORINT
APN # , Date:
Building Address:
0'7 o
Mai(in dr s (if fferent from building address)-' 9a5 Z5-
Are Hazardous Materials being used as part of this project? Yes ❑ No)ZI 9
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from AOA
Owner's Name: Phone#:
2 �5515Y Re),kV44 6n - &S' 16 z Z
Contractor: Phone:
?K'3 o- / Fax: (a5a Zo
Contractor License#:
Cupertino Business License #:
Contact: J IMS Grp IG Phone: 650 $o2 • Qa
Y Fax: ('so . 9M. oio'j
Residential Commercial ❑
Job Description: &)&;., VV-5;o,,; -In a,H 4-xi- ' OX�n•-4-r.rw��
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Building Permit Info:
BldgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
IUIIUV-A ❑ II/III B, IV-HT, V-B K� -'
Valuation: M Square Fd&age:
Project Ze: 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 ww-w.builditgreen.or
Revised 07/14/09