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11080033CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10648 MAPLEWOOD RD I CONTRACTOR: ESSEX THE POINTE LP PERMIT NO: 11080033 OWNER'S NAME: ESSEX THE POINTE LP 1925 E MEADOW LN I DATE ISSUED: 08/03/2011 VNER'S PHONE: 6508151403 Li License Class Contractor LICENSED CONTRACTOR'S DECLARATION Lic. # Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two 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 permit 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this pen-nit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit 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 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, -ts, and expenses which may ace a against said City in consequence of the sting of this p it Additionally, the applicant understands and will comply ith all non -point ce egulations er the Cupertino Municipal ode, Section 9.18. � 3( Signature Date C PALO ALTO, CA 94303 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r- MECH r RESIDENTIAL COMMERCIAL f— JOB DESCRIPTION: UNITS A -D; MULTI - FAMILY KITCHEN & BATH REMODEL,NEW WASHER DRYER HOOKUP,UPGRADE ELECTRICAL & PLUMBING Sq. Ft Floor Area: Valuation: $28000 APN Number: 31643004.10648 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by/ - Date: �- l RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by th Bay Area Air Quality Management District I will maintain compy c with the upertino Municipal Code, Chapter 9.12 and the Health & Safe e, Section 25505, 25533, and 2 34. Owner or aut ri g 3 Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional .Iii tiDVvL' L.L'1L_LAZ CUPERTINO OWNER - BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - buildino(a)cupertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS Q �l /n %� (G O� `% ^ APB _ l� g _ D� tJ BP # OWNER NAME '� OWNS DESCRIPTION OF WORK: 6k/(,f We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) � 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. _&� I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. A53. I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that 1-may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. _t /4 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. J&__5/_I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. —V". I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. _K7. I understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pe ormed under contract with a licensed general building Contractor. C - ell the property for which this permit is issued, I may be held liable for C. 1 understand as an Owner Builder if I s p p y p Y any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Oii,i7e1 "Builde7-For171 2010.doc revised 04114110 V- Reve9nue I understand I may obtain more information regarding my obligations as an "employer" from the Internal Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. K0. I am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. �11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. __U12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification c e table to the city may be required to be presented when the p rmit is issued to verify the property owner's signat Property Owner's Signature: Date: AL-, ��� v y 7�e ------- ----------------------------------------------------------- -- - - - -- - - - - -- -- - - --------- - - - - -- (NOTE: The following Authorization Form is required to be completed by he rope y owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Ow,77oBuilde7F07-777 2010.doc revised 04114110 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - buildingQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # OWNER NAME PHONE E -MAIL STREET ADDRESS M CITY c - '' nCD�1 - FAX ( ea C f' /� CONTACT NAME y� PH NE r570 E -MAa au y QLS s c �corcr�4, 1Lt03 STREET ADDRESS CITY, STATE, ZIP FAX 13 OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CDNTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR A *" ha ,M 1Po(\ LICENSE NUMBE 3 if ICENSE TYPE --c,CC, BUS. LIC # COMPANY AME n E -MAIL FAX 6'10 'I©Y•©R � �/ o � _ - ns>l�UC �'o -M r—cov 1 STREE�ADDRESS S ZIP Vale- C y C�C� � PHONE M 9� sli 5,2 Ulpd A ti .L ARCHITECT /ENGINEER NAME ARCH M LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SCRIPTION OF WORK 2,,(o -1 d 13ci A , h ! ) J rvel 1 `gyp 1i C76&1 Q'e A6 ,- O EXISTING SE PROPOSED USE CONST PE # STORIES f !ti 'Z USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA W REMODEL AREA / REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH I ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ONO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY. TOTAL VALUATION: By my signature below, I certify to each of the Mowing: I am the property owner or authorized agent to act on the pr_nperty owner's behalf. I have read this application and the information I hav2�F- have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: 0 Z i /// STJ`PPLEMEWNCIWORMATION REQUMED PLAN CHECK TYPE ROUTING SLIP ovER_r>� coulvTEx �.� L.7 BUII DING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW — Commercial B1dgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ 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 CI4COF CUPERTINO lawn U>� U C'TTM A rr"ID — RITTI ,DIING D1V1g10N WtI ADDRESS: 10648 d st. #A -D DATE: 08/03/2011 REVIEWED BY: bobs. -- MISC ITEMS APN: I BP#i _� ('� (, 1 j ol, f g - VALUATION: $28,000 '` ° PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: Multi - Family Dwelling Buildina is >3 Stories 0 Yes E) No PENTAMATION 1 R2REM PERMIT TYPE: WORK multi-family kitchen and bath remodel nwe W/D hook-up. SCOPE $0.00 Mech. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 1 0.0 1 hrs 1 $44.001 - _e•_v _ i ..i.. ,...i:.., i. ! n..Inrf Nso Donf finr nddn'i info. wu[ c: i nese fees use uu3eu v. a•.c • C..••..•...• FEE ITEMS (fee Resolution 11 -05 Lj '- 1. - "11) FEE - ___;4 QTY /FEE -- MISC ITEMS Plan Check Fee: $0.00 160 s.£ Remodel, Kitchen (< =300 sf) $588.00 IREMRESKIT Suppl. PC Fee: E) Reg. O.OT 0.0 hrs $0.00 PME Plan Check: $0.00 120 s.f. Remodel, Bath (< =300 sf) $588.00 1REMRESBAT Permit Fee: Hourly Only? E) Yes 0 No $0.00 Suppl. Insp. Fee42) Reg. 0 OT 0.0 1 hrs $0.00 # Mechanical $130.00 IBAPPLOT Other Appliance /Equip PME Unit Fee: $0.00 PME Permit Fee: $44.00 F71 Acoustical Fee: 0 Yes (E) No $0.00 E) Work Without Permit? 0 Yes (F) No $0.00 Planning Fee: $0.00 2 hours Inspections $260.00 ISTINSP Inspection, Hourly E) Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $2.80 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: j $92.801$1,566.00 TOTAL FEE: $1,658.80 Kevisea: ut/u4t/-u CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: (� g ���� "` 7' PERMIT # OWNER'S NAME: € Prb �, �� �, PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS:j�ZiS C cue Y Pr- nn - 'f CITY /ZIPCODE: �,I G( 0 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY I GENERAL CONTRACTOR AND ALL T SUBCOIR� BUSINESS LICENSE. / I // I am not using any subcontractors: ECTION(S) WILL BE SCHEDULED UNTIL THE IRS HAVE OBTAINED A CITY OF CUPERTINO Signature Please check applicable subcontractors vi-nil-complete the following information: q /?' / / // Date Owner / Contractor Signature Date 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 Roc Tile . // I I Owner / Contractor Signature Date SMOKE / CARBON MONOXIDE ALARMS 3' OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION / CtJP RT NO 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 / I S�v0 3 3 (408) 777 -3228 • FAX (408) 777 -3333 • buildingecupertino.ora l Ire . 7 �, Address PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM. Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X `r- Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6,and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with theWms and conditions of this statement Owner (or Owner ;Agent's) Naame: r / 119l,'7160 Si nature............ .............................................. ............................... Date:. .... Contractor Name: Signature.................................... ............................... Lic.* ....... ............................... Date:................... Smoke and CO form.doc revised 03118114