13020146 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10668 MAPLEWOOD RD CONTRACTOR:BASE BUILDERS INC PERMIT NO: 13020146
OWNER'S NAME: ESSEX PROPERTY TRUST 1485 BAYSHORE BLVD STE 121 DATE ISSUED:02127/2013
OWNER'S PHONE: 6504943700 - SAN FRANCISCO,CA 94124 PHONE NO:(415)659.8283
❑ LICENSED CONT'RACFOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
11
License Class I , Lic.k �Jf APT A,B,C,D-REMODEL BATH 120 SQ FT,KITCHEN 160
A,( SQ FT NON-STRUCTURAL W/D HOOK UP,UPGRADE
Contractor Q3 g ,tl N 1 dfdfc Dente o2 -Z� _ / ELECTRICAL
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division Sof the Business&Professions
Code and that my license is in full force and effect.
1 hereby,affirm under penalty of perjuryone of the following two declarations:
I.have and will maintain n=tificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the workfor which this permit is issued. Sq.Ft Floor Area: Valuation:$28000
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 APN Number:31643004.10668 Occupancy Type: -
perrnit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct,I agree to comply with all city and county ordinances and state laws relating WITIDN k80 DAYS OF PERMIT ISSUANCE OR
to building concoction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We).agree to save 180 DAY OM LAST CALLED IN; ON
indemnify and keep harmless the City of Cupertino against liabilities,judgments, / - -
costs,and expenses which may accrue against said City in consequence of the Issued by: Date:
granting of chis pe n plicant understands and will comply
with all non-p ' source regulations per ttie inn Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑- OWNER-BUILDER D19CLARATION Dale:
Signature of Applicant: .`
I hereby affirm that I am exempt fro m the Contractor's License Law for one of -
the following two reasons: - ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 for sale(Sec.7044,
Business&Professions Code)
I,as owner of the roe y g HAZARDOUS MATERIALS DISCLOSURE
property,rty,am exclusive! contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations:. Health&Safety Code;Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit'hazardous'
Compensalion,.azpiovided for by Section 3700 of the Labor Code,for the air contaminants as defined b Ir Quality Management District I .
performance of the work for which this permit is issued. will maintain compli with the Cupertino unicipal Code,Chapter 9.12 and .
I have and will maintain Worker's Compensation Insurance,as provided for by
the Health&S Code,Sections 25505,25$33,and 25534.
Section-3700 of the Labor Code,for the performance of the work for which this Owner or au orized agent: Date!
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If atter making this certificate of exemption,l
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I 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 property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION 1a�
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION vv
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1(LO
CUPERTINO (408)777-3228•FAX
((408)777-3333•building6bcuoertino.org JJ
❑NF
W CONSTRUCTION ❑ ADDITION R((ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERMIT#
PROTECT ADDRESS/0// A,,. �c f,t'� / APN1 �1 r n �/�
OWNER NAME KSI( '•L f/�' 'Y�`�� PH NE 3719.0 MAH. lJ
STREET ADDRESS YO/ Ie f,{la/ CITY,STATE,ZIP X6 ! FAX /
CONTACT NAME ae7714 /�/�R.•�I�4,� PHONE /S - Jam' (EMAIL A/P/ Ci7,h({d�l� �L�,p�yf ne-, 4--w
�r//'' /" LL 1 /�4;.5- -8�.g3 hoed
STREET ADDRESS///A� �Q Q/ -p /Jrte CITY.STATE,ZIP.t'� Z/ � FAX
0 OwNFR ❑ owwNERb -BuiLDER ❑J`owwNERY AGEENr p CONTRACTOR ❑CONnU CCTOJRAG /ENC ❑ ARCHITECT 11 ENGINEER 11 DEVEWPER ❑ TENANT
CONTRACTOR NAME Ma da n' LIC25E NUMBsI, LICEN TYPE BUS.LIC#
COMPANYNAME Bare u I ( Yj1 ot-rt j( (y/t, l �rw J . bq JP�j vI I er( i ti c , Ccm '4(r V �4
STREETADDRESS J#?;- 64 Sf/LUY "V'-�Ir(�, {1- l• [s^IG'y)V AI' ./1 LY f66 ( LA PHO E5-6 J� / -S`B3
ARCHRECD (JENGINEERNAME LICENSENUMBER W BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS /� ;CRY,STATE,ZIP /n PHONE
PTI
DESCRIONOFWORK T t /2 r (2A /C/ � O LI
Gni rovM 0t-) H Akefl
�J v� Y�
EXISTING USE PROPOSED USE CONSIRTYPE #STORES
y/ USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTO / NEW FLOOR DEMO ; TOTAL
AREA y AREA AREA NECAREA
BATHROOM1��^.}A/ KITCHEN I OTHER
REMODELAREA EM
Y RODELAREN T0() REMODEL AREA
PORCHAREA I DECKAREA TOTALDEcK/PORCHAREA GARAGE AREA DETACH
ATTACH
#DWELLING UNITS: ISASECONDUNrr DYES SECOND STORY ❑YES
BENGADDEDT ANO ADDITION? DNO
PRE-APPLICATION DYES WYES,PROVDECOPYOF ISTBERUDGAN ❑YES RECEIVED TOTA VALU
PLANNINOAPPLN ❑NO PIANNNOAPPROVALLETTEA EICHLERHOMET DNO 4VCto
By my signature below,I certify to each of the following: 1 am the property owner or authorized agefit t ct on the property owner's behalf I have read this
application and the information I h wded is c3 t I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel t g to building construe• n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
SignatureofApplicant/ ent: Date: a -a7 `/3
SUPPLEMENTAL INFORMATION REQUIRED PL&D&CeECKTYPE ROOTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forOVER•THECOUN78R 11 BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST;
JOBADDRESS: 10668 )PERMIT#''`
OWNER'S NAME: t rIOL PHONE#
GENERAL CONTRACTOR: BUtl4W BUSINESS LICENSE•# PSJG
ADDRESS:/ W / d#1 I-n zi . CITY/ZIPCODE: , n
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB=E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
G/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date