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11070090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS 10 b 5q CONTRACTOR: PERMIT NO: 11070090 OWNER'S NAME: ESSEX THE POINTE LP a 't--N tS+W C F r' r `DATE ISSUED:07/14/2011 f"3""NEWS PHONE: 4089967626 e_,95ax -rif PHONE NO: LICENSED CONTRACTOR'S DECLARATION ( q BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH f— RESIDENTIAL COMMERCIAL� Contractor � _Date-71 j It `r '� I hereby affir that a licensed under the provisions of Chapter 9 JOB DESCRIPTION: B�THROOM(140SQFT)&KITCHEN (commencing wit ection 7000)of Division 3 of the Business&Professions REMODEL(400SQFT)&ADD WASHER DRYER HOOKUP Code and that my license is in full force and effect. v- 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. 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:$60000 permit is issued. APPLICANT CERTIFICATION APN Number:31643004.19920 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 source regulations per the Cupertino Municipal Code,Section 9.18. �-„ L Issued by Date:'-7 Signature Date j `J 11_ WNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 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 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(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(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 1 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 S 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 Own thorize agent: --1 (4 ' forthwith comply with such provisions or this permit shall be deemed revoked. Date: f 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 and expenses which may accrue against said City in consequence of the ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION wan 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 ITEM 2 OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 . 10659 DATE ISSUED. . . . . . . : 07/19/2011 RECEIPT #. . . . . . . . . : BS000014098 REFERENCE ID # . . . : 11070090 SITE ADDRESS . . . . . : 10659 MAPLEWOOD RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ESSEX THE POINTE LP ADDRESS . . . . . . . . . . : 925 E MEADOW LN CITY/STATE/ZIP . . . : PALO ALTO, CA 94303 RECEIVED FROM . . . . : ALLAN UY CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41. 00 0 . 00 41 .00 0. 00 1BAPPLOTHE NO OF APPLIAN 2 . 00 130. 00 130. 00 0 .00 0. 00 1BCBSC VALUATION 60, 000.00 3 . 00 3 . 00 0 .00 0 . 00 1BSEISMICR VALUATION 60, 000.00 6 . 00 6 . 00 0 .00 0. 00 1MPERMITFE FLAT RATE 1. 00 44 . 00 44 . 00 0 .00 0. 00 1REMRESBAT SQ FEET 140. 00 588 . 00 588 . 00 0 .00 0. 00 1REMRESOTH SQ FEET 400. 00 457. 00 457. 00 0 .00 0 . 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 44 . 00 0 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1313 . 00 1272 . 00 41 .00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 82 . 00 VISA --------------- TOTAL RECEIPT 82 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 317 MECHANICL ABOVE CEILING CITY OF CUPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643004 .19920 DATE ISSUED. . . . . . . : 07/14/2011 RECEIPT #. . . . . . . . . : BS000014047 REFERENCE ID # . . . : 11070090 SITE ADDRESS . . . . . : 19920 OLIVEWOOD ST 6ZZ)G- �SY1 SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : ESSEX THE POINTE LP ADDRESS . . . . . . . . . . : 925 E MEADOW LN CITY/STATE/ZIP . . . : PALO ALTO, CA 94303 RECEIVED FROM . . . . : ESSEX PPROPERTY TRU CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , 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 60, 000 . 00 3 . 00 0. 00 3 . 00 0 . 00 1BSEISMICR VALUATION 60, 000. 00 6. 00 0. 00 6 . 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 44 . 00 0. 00 44 . 00 0 . 00 1REMRESBAT SQ FEET 140 . 00 588 . 00 0. 00 588 . 00 0 . 00 1REMRESOTH SQ FEET 400 . 00 457. 00 0. 00 457.00 0. 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1272 . 00 0 . 00 1272 .00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 2, 544 . 00 VISA --------------- TOTAL RECEIPT 2, 544 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 317 MECHANICL ABOVE CEILING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19920 olivewood BIdgAW wS'� 7 DATE: 07/14/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$60,000 "°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2REM USE: 3 Stories 0 Yes E) No PERMIT TYPE: WORK R-1 remodel kitchen bathroom add W/D hookup. SCOPE Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: I MPERMIT Other Mech.Insp. 0.0 hrs $44.00 - NOTE: Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addh I info, FEE ITEMS (Eee Resolution 11-053 I ff. 7;'1.-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Other Suppl.PC Fee: G Reg. 0 OT 0.0 1 hrs $0.00 $457.00 1REMRESOTH PME Plan Check: $0.00 =1 s.f Remodel,Bath(<=300 sf) Permit Fee: $0.00 $588.00 1REMRESBAT Suppl. Insp.Fee-.0 Reg. 0 OT 0.0 hrs $0.00 = # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Acoustical Fee: 0 Yes (F) No $0.00 Work Without Permit? 0 Yes E) No $0.00 G Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bld€7 Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: 1 $97.001$1,175.001 TOTAL FEE: $1,272.00 Revised: 07/04/2011 107 c"39 9 0 CONSTRUCTION PERMIT APPLICATION t_ � COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISIO 10 V p !,P)_r 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (`)p 0 CUPERTINO (408)777-3228• FAX(408)777-3333•building(d) ino/.or ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERA I �` �� Il ❑ REVISION/DEFE D ORIGINAL PERMIT# PROTECT ADDRESS ��i APN# Lf 0 j ) L 1 �� �, t. OWNER NAME C'II,/ Cr_)-fVQ �e L P �1 (71 f'(� E-MAIL STREET ADDRESS � �j�/E I 1 CIT ,$7A/t,�IP �f f- r� [] (�Uf z 3� FAX CONTACT NAME �j / � i/ PHON t) � �J (&#AIL STREET ADDRESS J, I/ (' CITY,STATE, ZIP W J FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR_ 11 CONTRACTOR AGENT 13 ARCHITECT ❑ENGINEER I-] DEVELOPER 1:1 TENANT CONTRACTOR NAMEy LI SL,,,,5t LiL17 LICENSE T BUS.LIC# COMPANY NAME ttt�� 1 FAX STREET ADDRESS ( Q/`� P f/) CITY,STATE,ZIPI / 1�, PHONE" f�I/may ARCHITECT/ENGINEER NAME (• G V Lr LICENSE NUMBER 1/l BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS y� CITY,STATE,ZIP PHONE a) te DESCRIPTION OF WORK12 J� ✓1 �/� w..�� �/?��� ���• � ���I w�r j ci- o— �i11 e EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES q ;lam v 1 /(Z USE TYPE OCC. SQ.FT. VALUATION(S) NEW FLOOR DEMO `,TOTAL AREA �� K ` AREA AREA AREA NET AREA 0, _ BATHROOM KITCHEN OTHER jp� L ARE REMODEL AREAREMODEREMODEL AREA PORCH AREADECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 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: /�� TOTAJrV?LU`TION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO Gn/fJ, foJ' 6 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the information e ovI d 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 relatin o ilding truction. I authorize representatives of Cupertino to enter the above-dcntif d property for inspection purposes. Signature of Applicant/Agent: Date: 11 SUPPLEMENTW,L ORMATION REQUIRED PLAN CHECK TYP ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for [ _rHE-coUNTERBLT UILDING 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 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_201 1.doc revised 06/21/11