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11040171-EXPIREDCITY OF CUPERTINO BUILDING BUILDING ADDRESS: 10639 MAPLEWOOD RD APT 4*6 OWNER'S NAME: ESSEX PROPERTY TRUST OWNER'S PHONE: 6508151403 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date 1 hereby affirm that 1 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. 1 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. 1 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 permit. 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: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). CONTRACTOR: ESSEX PROPERTY TRUST PERMIT NO: 11040171 925 EAST MEADOW DR DATE ISSUED: 04/27/2011 PALO ALTO, CA 94303 I PHONE NO: BUILDING PERMIT INFO: BLDG f— ELECT [— PLUMB MECH I— RESIDENTIAL I— COMMERCIAL JOB DESCRIPTION: UNIT B - KITCHEN(60SQFT) & BATH REMODEL,ADD NEW WASHER & DRYERS PLUNBING,ELECTRICAL UPGRADE. REPLACE KITCHEN CABINETS & APPLIANCES, REPLACE Sq. Ft Floor Area: I Valuation: $18000 APN Number: 31643003.10639.A -D I Occupancy Type: 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. 1 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. 1 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 ermit. Additionally, the applicant understands a }vi��e with all no t source regulations per the Cupe mod , 9.18. Signature Date .[7� I1 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: 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 1 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 the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & ety Code, Sectio n 25505, 25533, and 25534. Owner gei>W Date: CONSTRUCTION LENDING AGENCY 1 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 ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10639 MAPLEWOOD RD APT dHB CONTRACTOR: ESSEX PROPERTY TRUST PERMIT NO: 11040171 OWNER'S NAME: ESSEX PROPERTY TRUST 925 EAST MEADOW DR DATE ISSUED: 04/27/2011 PALO ALTO, CA 94303 I PHONE NO: OWNER'S PHONE: 6508151403 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. Contractor Date I hereby affirm that I aro 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 permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date in 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) 1, 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: 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 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 Al/ 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 ermit. Additionally, the applicant understands i with all no t source regulations per the Cupe ' od 9.18. Signature lfrtI"_f1, Date t� BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL f— JOB DESCRIPTION: UNIT B - KITCHEN(60SQFT) & BATH REMODEL,ADD NEW WASHER & DRYERS PLUMBING,ELECTRICAL UPGRADE. REPLACE KITCHEN CABINETS & APPLIANCES, REPLACE Sq. Ft Floor Area: I Valuation: $18000 �PN Number: 31643003.10639.A -D I occupaoc� TN pc: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. /^ Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material berg 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. 1 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 the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & ety Codc,)Scctioni 25505, 25533, and 25534. Owner ge10 V^ �' Date• CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(acupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 21 ALTERATION / TI ❑ REVISION / DEF fER�RED ORIGINAL PERMIT # PROTECT ADDRESS � — - : APN # � (� / L �) /�}�^ / /1 1„��/ X v `fes `� v lJ Cl Sv {{// OWNERNAM�jlr`� PHONE(j (� lOi /' l//a3 E-MAILQ�y STREET AD ,( , I�J(% CITY, STATE, `ZpIPTaa/00 ) 0- &9 3 ;FFAAX�/._2l"'1 T - �" - CONTACT NAME l 1- PHONt&�D 1 S,C 1 �a E-MAIL "J / � l Y STREgAIDp�RF,�} •-�f.rX/`VIr►'-V^r CI3_�1,I,EL? njD FAX ❑ OWNER (❑/ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRAcTOR 11 C(OJNTRACrORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NALICENSE NUMBS LICENSE TYPE BUS. LIC # C COMPAKYNAME ., E-MAIL FAX T DESCRIPTION OF WORK �� Q @�v f1 ?/t/1C�' T/451%'i `1 t" aIf o9ClC�/f'Yt�iJli EXISTINGUSE PROPOSED USE CONSTR TYPH #STORIES3'�rVRMIL EXISTGNEW AREA FLOOR AREA DEMO AREA STREET ADDRESS, i j 11 .0V Cr S SATE IP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK �� Q @�v f1 ?/t/1C�' T/451%'i `1 t" aIf o9ClC�/f'Yt�iJli EXISTINGUSE PROPOSED USE CONSTR TYPH #STORIES3'�rVRMIL EXISTGNEW AREA FLOOR AREA DEMO AREA TOTAL NET AREA cI` BATHROOM 3 KITCHENOTHER$,. k ;. REMODEL AREA REMODEL AREA REMODEL AREA .?? .." �' -- :.: , ,. - s ,- .. Vii,%. ..,,. PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: C1 DETACH ❑ ATTACH q DWELLING UNIT'S: IS A SECOClD UNIT E] YES SECOND STORY ❑YES 5 �c`i"` y • b 41 s�HEIIYO ADDED?NO ADDITION? NO .,., ! s "! PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANN 1NAME: RECEIVED BY ,�. 3 - TOT VAtT. TION" PLANNING APPL X ❑ NO PLANNING APPROVAL LETTER y By my signature below, I certify to each of following: I am the property owner or authorized agent to act on the property owner's behal . I have read this application and the information I have p v' 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 relating to it constructi n. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: S SUPPLEMENTM_-INFORMATION REQUIRED 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. —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. B1dgApp 2011.doc revised 03/16/11 / J c/ Ji -7 / CITY OF CUPERTINO w -MIN FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10639 mapplewood #B Mech. Plan Check p.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. Fo.0 hrs $42.00 DATE: 04/25/2011 REVIEWED BY: bobs. IPA APN: BP#: I '"VALUATION: 1$18,000 °° PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: G Reg. 0 OT 0.0 PENTAMATION 1 R3SF EM PERMIT TYPE: WORK R-1 apt complex kitchen and bath remodel non structural add W/D hook-up. SCOPE 0 # $16.00 Plumbing IBPFIXTURE Fixture or Trap NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (fee Resolution 09-05I Eff' .',1 1; %0) Mech. Plan Check p.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. Fo.0 hrs $42.00 Plumb. Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. L.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (fee Resolution 09-05I Eff' .',1 1; %0) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 60 s.£ $570.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: G Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 0 # $16.00 Plumbing IBPFIXTURE Fixture or Trap Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 Trs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $126.00 1 # $63.00 Mecha ' Vent, Appliance (only) Acoustical Fee: 0 Yes E) No $0.00 # $42.00 Electrical IBREMRECEP Recep/Switch/Outlets Work Without Permit? 0 Yes E) No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A Travel Documentation Fee: ITPA VDOC $42.00 Stronri Motion Fee: IBSEISMICR $1.80 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS: $170.80 $691.00 TOTAL FEE: $861.80 Revised: 04/01/2011 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: 6 !^'t aoc/ % PERMIT # U C% OWNER'S NAME: Q r PHONE # 3—Z/ GENERAL CONTRACTOR: fTdrAe.BUSfNESS LICENSE # ADDRESS: CITY/ZIPCODE: *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: Signature Please check applicable subcontractors and complete the following information: Date Signature T// / Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electricals/�� 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 Signature T// / Date CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build inq(o)cupertino.orq 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� / � APN f {/ � Oo 17JBP# ((J D OWNERA4Atll( _,AISI( OWNER ADDRESS DESCRIPTION OF WORK: la n o✓ t%'D cl-A *-J -/*O(L 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.) U-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 "-2. 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. lA' 3 I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I 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. L. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. A15. 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 co/jn�siiddered an "employer' under state and federal law. . - 6. 1 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. V7. 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 performed under contract with a licensed general building Contractor. A8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 �4. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue 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.cslb.ca.gov for more information about licensed contractors. k10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the parry 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. �12. 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 responsibl r issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verificatiofi Acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si n Property Owner's Signature: U6, C/ ( P_-jelr ?!RL7Y -filAST Date: ' 1 ------------------------------------------------------------------------------------------------------------------------------------------- -- (NOTE: The following Authorization Form is required to be completed by the property 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: OwneYBuilderForm 2010.doc revised 04/14/10