10050039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10667 ROSEWOOD RD APT A-D CONTRACTOR: BKB CONSTRUCTION,LP PERMIT NO: 10050039
O\VNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/01/2010
OWNER'S PHONE: 6508151622 CARROLLTON,TX 75006 PIIONE NO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG rl ELECT M PLUMB r
License Class Lie.>;
� _ S// MECH r RESIDENTIAL r COMMERCIAL r
Contractor ��(S ^( �Z1JY Dale
hereby alarm(lint I am licensed under(he provisions of Chapter 9 ENT DESCRIPTION:EXTERIOR RE-SIDING TO AN EXISTING APT BLDG,NEW
(commencing with Section 7000)of Division 3 of the Business& Professions ENTRY TRELLIEES& AN CK R COMMENTS.EMENI'THRU-OUT;SEE
Code and drat my license is in full force and effec(. 10050005 FOR FEL•S&PLAN CK COM11M11EM'S.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificale of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfomtanee 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 perfomtanee of the work for which this Sq.Ft Floor Area: Valuation:568965
pennit is issued:
APPLICANT CERTIF ICA'fIONAPN Number:31643004.10667.A-D Occupancy Type.
I cenify that I have read this application and state that the abov n atio 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 1S NOT STARTED
indemnify and keep himidess 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
grunting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �7
Issued by:/ / Date •e i b
Signature Date
❑ OWNER-BUILDER DECLARATION
RF--ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for ane 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
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.70441
Business&Professions Cade) Signature of Applicant: Dale:
I,as owner of the propeny,am exclusively contracting with licensed contmetors to
construct the project(Sm.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
perfomtanee of the work Ibr which this pennit 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 Code,for the performance of the work for which this Safety Code,Section 25532(x)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
1 cenify that in the performance of the work for which this pennit 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 no the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Cali forma. If,ager making this ceni Ecate of exemption,I
became subject to the Worker's Compensation provisions of the Labor Code,I must 0;e. .,7tor'. $
101
forthwith comply with such provisions or this permit shall be deemed revoked. L Date.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I cenify that.(have read this application and state that the above information is I hereby affirm that them 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 pmpeny 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
'r
' ARCIIITECT'5DECLAR;\TION
with all non-point source regulatts,per the Cupertino Municipal Code,Section
9.13. - I understand my plans shall be used as public records.
Signator Dale Or Licensed Professional
Son CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
�UQSOD,3 �'
D te:
Building Address:
Mailing Address (if different from build ng address):
7 O 7
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No 2f If Yes, provide letter from HOA
Owner's Name: Phone #:
5, oa 71�✓�0? n - 8iS' 16 z z
Contractor: Phone:
?K? Fax: &50 — 32o
Contractor License #:
Cupertino Business License #:
Contact: J f M M Grhfl rt�G P one: 650 -$o 2 • 61665
Y Fax: �yp • �. oioj
Residential Ai
Commercial ❑
Job Description: Ey�g, eT y�_S;d.; y h ?Ctyj v\f&.-Iwa. _4 6, A,-.Zj7
r Nne Pwy��CsC11 ` C l�Olo .� (j7 Uo� �a¢e ..znT�ire� o
Building Permit Info:
BldgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I1/1II/V-A ❑ IVIII B, IV-HT, V-B ✓d -'
Valuation: Square Footage:
Project Size: Ex ress ❑ 4 Standard 0/ 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 www.builditgreen.or
Revised 07/14/09