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11080190 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10656 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION,INC PERMIT NO: 11080190 OWNER'S NAME: ESSEX PROPERTY TRUST 528 E WEDDELL DR STE 4 DATE ISSUED:08/25/2011 OWNER'S PHONE: 6508491600 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 3 —1 a'M MECH RESIDENTIAL COMMERCIAL Contractor �C��'l7��-1 C7��ate �d °,�S 4 � � I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT A,B,C&D-MULTI-FAMILY APT.,REMODEL (commencing with Section 7000)of Division 3 of the Business&Professions LAUNDRY SHOOK-EMODEL KITCHEN(160SQFT),ADD NEW Code and that my license is in full force and effect. LAUNDRY HOOK-UP 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 Sq.Ft Floor Area: Valuation:$28000 permit is issued. APPLICANT CERTIFICATION APN Number:31643005.10656 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless 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 of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point soa regulations per the Cupertino Municipal Code,Section u 9.18. � 1 �. ZS la 9 Issued by: Date: 4P Z'--i(" Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one 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.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.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 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 Health&Safety Code,Sections 25505,25533,and 25534. I 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(a)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 I will I 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 Code,Sections 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,I must Owner orh �e nt: forthwith comply with such provisions or this permit shall be deemed revoked. - — Date: b 21 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 cr-'c,and expenses which may accrue against said City in consequence of the 7g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643005. 10656 DATE ISSUED. . . . . . . : 08/25/2011 RECEIPT #. . . . . . . . . : BS000014570 REFERENCE ID # . . . : 11080190 SITE ADDRESS 10656 ROSEWOOD RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST ADDRESS . . . . . . . . . . : 925 EAST MEADOW DR CITY/STATE/ZIP . . . : PALO ALTO, CA 94303 RECEIVED FROM . . . . : ESSEX PROPERTY TRUS CONTRACTOR . . . . . . . : ABRAHAM PONCE LIC # 32833 COMPANY . . . . . . . . . . : ABE CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 528 E WEDDELL DR STE 4 CITY/STATE/ZIP . . . : SUNNYVALE, CA 94089 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BAPPLOTHE NO OF APPLIAN 2 . 00 130. 00 0. 00 130 . 00 0. 00 1BCBSC VALUATION 28, 000 . 00 2 . 00 0. 00 2 . 00 0. 00 1BSEISMICR VALUATION 28, 000 . 00 2. 80 0. 00 2 .80 0. 00 1MPERMITFE FLAT RATE 1 . 00 44 . 00 0. 00 44 .00 0.00 1REMRESBAT SQ FEET 120 . 00 588 . 00 0. 00 588 .00 0. 00 1REMRESKIT SQ FEET 160 . 00 588 . 00 0. 00 588 .00 0. 00 1STINSP UNITS 6 . 00 780 . 00 0. 00 780 .00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 2178 . 80 0 . 00 2178 .80 0. 00 ( I OR C, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 13 (408)777-3228 • FAX(408)'777-3333 • buildinG(cDcuoerlino.org CUPERTINO ❑NEW CONSTRUCTION - ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGIN(A�L�PERMIT# PROIECT ADDRE I l=)�+ ' ,-\ APN O✓ ' (� OWNER NAME , PHONE C r E-MAIL L,::Y\ S DRESS 4 CII]( STATE ZIP FAX CONTACT` \e,, E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 0!J CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET_ ADDRESSSTATE ZIP PHONE ARCHITECT/ENG]NEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE .rSCRIPTION OF WORK, y r EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KrfCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA L7DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED?- ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY- TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER KICHLER HOME? ❑NO By my signature below,I certify to ea h of th f.llowing I am the property owner or authorized agent to act on the prrperiy owner's behalf. I have read this application and the information I ha vi is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ldi construction. I authorize representatives of Cupertino to enter the above-identifi d prop for inspection purposes. Signature of Applicant(Agent: Date_ Z7 a SUPPL ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily d ellings: Apply for demolition permit for D OV� �0�I� 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 ❑ STANDARD ❑ PUBLIC WORKS n if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ DEPT FM _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_1011.doc revised 06/71/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10656 rosewood rd#A,B,C,D TDATE, 08/25/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$28,000 `°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK multi-family apt. remodel bath and kitchen add new laundry hook-up. SCOPE Mech.Plan Check0.0 hrs $0.001 T Mech.Permit Fee: IMPERMIT Other Mect..Insp. 0.0 hrs $44.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 11-053 fff, 71.11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 = s.f. Remodel,Bath(<=300 sf) Permit Fee: Hourly Only? 0 Yes 0 No $0.00 $588.00 IREMRESBAT Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.002= # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential 0 0t St Building or Structure Travel Documentation Fee: 1TPA VDOC $44.00 Bu � Strong Motion Fee: IBSEISMICR $2.80 6.0 hrs Inspections BId>,Stds Commission Fee: 1BCBSC 1 $2.00 $780.00 ISTINSP Inspection,Hourly SUBTOTALS: 1 $92.801$2,086.001 TOTAL FEE: $2,178.80 Revised: 07/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ntostoPERMIT# OWNER'S NAME: Xe- rp 'CYL�S PHONE # 73 L< GENERAL CONTRACTOR: nSCn�� BUSINESS LICENSE # ADDRESS: 5 We-Ck36k '-10( CITY/ZIPCODE: rjAt0gq *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 1 Signature Date Please check applicable subcontractors and complete the following information: V 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