10050042 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10676 ROSEWOOD RD APT A-D CONTRACTOR: BKB CONSTRUCTION,LP PERMIT NO: 10050042
OWNER'SNAME: ESSEX PROPERTYTRUST 2812 TRINITYSQUARE DR STE 110 DATE ISSUED:07/012010
OWNER'S PHONE: 6508151622 CARROLLT'ON,9:X 75006 PII0NEN0:(972)478-2255
❑ LICENSED CO\I'RACTOR`'S DECLARATION BUILDING PER,VI IT INFO: BLDG r ELECT r PLUMB r
License Clare Lie.q /T �'^7/- i1fEC11— r RESIDENTIAL r COMMERCIAL
r
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Contractor !'7 c
hereby affirm float I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: EXTLIiIOR RGSIDING TO AN EXISTING APT BLDG,NEW
(commencing with Section 7000)of Division 3 of the Business& Professions ENTRY TRELLIS,WINDOW,DOOR REPLACEMENT THRU-OUI;SEE
Code and that my license is in full force and effect. 10050005 FOR FRES&PLAN CK COMMENTS.
hereby affirm under penalty of perjuy one of the following(sso 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 pemail 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 which this Sq.Ft Floor Area: Valuation:568965
permit is issued.
APPLICANT CERTIFICATIONAPNNumber.31643005.10676.A-D Occupancy Type:
1 certify that 1 have read this application and state that the abo informati 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 hamaless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting ofthis permit. Additionally,theapplicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulation per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signator- � Dale
❑ O\VNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any cooling 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(Sm.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors 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: IIAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as pmvided for by Section 3700 of the Labor 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 llenith&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance is ith the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 ofthe Labor Code,for the perfomtance 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
pcnnit is issued. contaminants as defined b) the Bay Area Air Quality'Management District I will
1 certify that in the performance of the work for which this pcnnit is issued,1 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 Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must Ow Fr ut -a e. .
forthwith comply with such provisions or this permit shall be deemed revoked. - Date: Ld
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm 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 acerae against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITECT'S DECLARATION
with all non-point s mrce regulations -r die Cupenino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Datc '' d I Licensed Professional
CITY OF CUPERTINO
CITY OFMm
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ate:
Building Address: �p�pdGQ
o c. y _ . 195-0111
7
Mailing Address (if different from bdilding address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No 2f If yes, provide letter from AOA
Owner's Name: Phone#:
Contractor: Phone:
3K3 .L Fax: (o50 ^ 37,o ^
Contractor License#:
Cupertino Business License #:
Contact: JY IMSff.+IG P one: 650 •$o2 . 6$65 Fax: 6sc2 - o,• o'
Residential IesCommercial
JobDescription: &J
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Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
IUIIUV-A ❑ IUIII B, IV-HT, V-B V� -• I
Valuation: ' Square F66—tage:
� 96S
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 www.builditareen.or
Revised 07/14/09