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11070089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS. 1,-Yl t t4 _U.10(0, CONTRACT PERMIT NO: 11070089 OWNER'S NAME: ESSEX THE POINTE LP ~ y d -#ATE ISSUED:07/14/2011 NER'S PHONE: 4089967626L� i!)C ` * "fl ;� . r PHONE NO: ` . . LJ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# \ ' 6_4 MECH F_ RESIDENTIAL� COMMERCIAL � Contractor `� Date < 11 t a fZ t - 'I %s I hereby affirm licensed under the provisions of Chapter 9 JOB DESCRIPTION:4#EDG-'7#&-&ATHROOM(140SQFT)&KITCHEN(400SQFT) (commencing with Section 7000)of Division 3 of the Business&Professions RENOVATION&WASHER&DRYER HOOKUP 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 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 no oint s e regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: 1 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 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 !hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 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. 1 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&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 Owr uthori ed gent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 Cupcitino 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 v,,, 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 1 OF 2 PERMIT RECEIPT OPERATOR: patg COPY $# 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643005 .10716 DATE ISSUED. . . . . . . : 07/19/2011 RECEIPT #. . . . . . . . . BS000014098 REFERENCE ID # . . . : 11070089 SITE ADDRESS . . . . . : 10716 ROSEWOOD 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 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 318 ELECTRICAL ABOVE CEILING 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19920 olivewood Bldg 716 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 Building is PENTAMATION 1 R2REM USE: 3 Stories Yes 1@ No PERMIT TYPE: WORK R-1 remodel kitchen bathroom add W/D hookup. SCOPE Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 NOTE. Theseees are based on the prelitninary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. ';'1.-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Other Suppl.PC Fee: G Reg. 0 OT F-01hrs $0.00 $457.00 IREMRESOTII PME Plan Check: $0.00 = s.f. Remodel,Bath(<=300 sf) Permit Fee: $0.00 $588.00 IREMRESBAT Suppl.Insp. Fee.-O Reg. 0 OT 0.0-1 hrs $0.002= # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 Acoustical Fee: Yes (F) No $0.00 0 Work Without Permit? 0 Yes (D No $0.00 Plannin,, Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure 0 i Strop: Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $97.00 $1,175.00 TOTAL FEE: $1,272.00 Revised: 07/04/2011 11 o -7vv � � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 � �3a 1 ILI, CUPERTINO (408)777-3228• FAX(408)777-3333• buildin cu ertino. t3 �, ��:, rf-3 �2, )to1(o ❑NEW CONSTRUCTION [:1ADDITIoiT LJ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS 1 APN# ^ OWNER NAME #�• 1 JE J�. c� 4IL STREET ADDRESS Q /J /� CITY, STATJnJj�J /� r�1 i l`�f J FAX CONTACT NAME` 16 ..7tt�i• L•"" PHONE �_r�� r./�"OE-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT �❑ CCONTRgACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT 1:1 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I j`.�Ag ��/ IUj�''�CENSE NUM _ LICENSE TYPE BUS.LIC# I IA COMPANY NAME 'V i`J 1� O M M (/ /Vr- /)1fi E-MAIL FAX STREET ADDRESS `///A O,A kv� CITY,STATE,ZIP r�t �� C� CtY�l�t�' PHONE ARCHITECTIENGINEER NAME �(/"' 1 LICENSE NUMBER f�'J BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS / 7 CITY,STATE,ZIP PHONE DESCRIPTION OF WORK L/�/�� I j�J�J/I I" ��✓1, r✓►� U V�`�� /V� � � �'�`�" - EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW OR DEMO TOTAL �/' AREA AREA AREA NET AREA K, BATHROOM KITCHEN '1 OTHER REMODEL ARE REMODEL REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL V Cis UATION, PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO �2_-,� C T6a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prrperty owner's behalf. I have read this application and the information I e . ed 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 relati o lding onstruction. I authorize representatives of Cupertino to enter the a11 bov -ident ed property for inspection purposes. Signature of Applicant/Agent: Date: —14 SUPPLEME AL ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for L:17�R-THE-COUNTER n_ffC LbING 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