13040142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10716 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION, PERMIT NO:13040142
INC
OWNER'S NAME: ESSEX TIM POINTE LP 528 E WEDDELL DR STE 4 DATE ISSUED:04/18/2013
OWNER'S PHONE: 65Q4943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416
�? . LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
LJ
p .
License Class 16 ,CJ0 r-3ttic.'# a: BLDG 10716 UNIT A-REMODEL BATH,KITCHEN ADD
NEW
&
Contractor_) con,5 otuw-i LAUNDRY ROOM&UPGRADE ELECTRICAL&
I hereby affirm that I am licensed under the.provisions of Chapter 9 PLUMBING
(commencing with'Section 1000)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. Sq.Ft Floor Area: Valuation:$28000
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 APN Number:31643005.10716 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that.the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property.for inspection purposes. (We)agree to save 180 DAYS FRO CALLED INSPECTION.
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 Issued - Date:
with all non- oint source r ulati ns r the Cupertino Municipal Code,Section
9.18,
J RE-ROOFS:
Signature Date [" All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
. inspection.
❑ ' ' :OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the.Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER.
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
constrict the project(Sec:7044,Business&ProfessionsCode). I have read the hazardous materials requirements under.Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby;affirm under penalty of perjury.one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work fY or which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain YVorker's Compensation Insurance,as provided for by the Health&Safety CodeC,1 ons 2 05 3,and 25534.Section 3700 of theLabor Code,for.the performance of the work for which this ection issued. Owner or authorized age Dater
p s:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of.
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 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 buildings,construction,and hereby authorize representatives of this city to enter
upon the.above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and,keep harmless the City of Cupertino against liabilities,judgments,
costs,.and expenses which may:accrue against said City in consequence of the I understand my plans shall be used as public records.
granting:of this,permit.Additionally;:the applicant understands and will comply
with ail'non-point source`regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
V
v`
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ('1
10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 M
(408).777-3228•FAX(408)777-3333•building
Ca)cupertino.ora
NEW CONSTRUCTION ADDITION: TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDAPN# / �,/ 0 O 5
OWNS
STREET C ZIP FAX
CONTACT.N `L(�7v E-MAIL
P
STREET ADDRESS' CITY,STATE,ZIP I FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT gO=LCTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT AM 2XnLICj S L S i,E� BUS.LIC#
COMPANY N QQC&LQtM
\no (J' LACR
FAX
STREET ADD$
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION
EXISTING USE PROPOSED USE CONSTR.TYPE #ST USE - TYPE OCC. SQ.FT. VALUATION
EXISTG NEW FL60R DEMO TOTAL
AREA .AREA _ AREA NET AREA 1 .
BATHROOM KITCHEN OTHER "
REMODEL ARE REMO REMODEL AREA
.PORCH AREA " " DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH -
. ❑ATTACH .
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES
BEINGADDED? ONO ADDITION? ONO
.PRE-APPLICATION ❑YES IF YES,PROVIDE
copy.OF. IS THE BLDG AN TO VALUATION:
,PLANNING APPL#, ONO PLANNINGAPPROVAL LETTER EICHLERHOME? NO
By my signature below,I certify to each:of the following: I am the property owner or authorized agent to act on t e erty.owner's behalf. I have read this
application and the information I ha v provided is correct I read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uild' co tru 'on a o=representatives of Cupertino to enter the abov -identifie �rggerty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL TI N 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.
Bldg4pp_201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
N= ADDRESS: 10716 ROSEWOOD RD#A DATE: 04/18/2013 REVIEWED BY: MELISSA..'
APN:. 31643005:10716 BP#: `'VALUATION: 1$28,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Dulex PENTAMATION 1 R3SFDRE
USE: pPERMIT TYPE:
woRK BLDG 10716 UNIT A- REMODEL BATH KITCHEN ADD NEW LAUNDRY ROOM & UPGRADE
SCOPE ELECTRICAL& PLUMBING
NMI
:-tech.Plan Check Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00
rbtech.Permit Fee:, Plumb.Permit Pee: Elec.Permit Fee: IEPERMIT
Other Afech.Insp. Other Plumb Insp. Lj Other Elea Insp. 0.0 ��s $45.00
1fech.Insp..Fee: Plumb. Insp.Fee: Elec.Insp.Tee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelindna information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS,(Fee Resolution 11-053 Eff.' 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 s.£ Remodel,Bath(<=300 sf)
Suppl.PC Feer Q Reg. ® OT0.0 hrs $0.00 $600.00 IREMRESBAT
PME Plan Check: $0.00 1 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 1REA RESKIT
Suppl. Insp.Fee-0 keg. Q OT 0.0 hrs $0.00 0 s.f. Remodel,Other
PME Unit Fee: $0.00 $400.00 IREAMESOTH
PME Permit Fee: $45.00 0 # Electrical
Cons0-fiction Tax: $67.00 IBREMPIXT Fixtures,Lighting
Administrative:Fee: 1ADAffN $42.00
Work Without Permit? ®Yes ie) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure
i.
Strong Motion Fee: 1BSEISMICR $2.80 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
- $136.80 $1,667.00 $1;803.80
Revised: 04/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C O P E RT 1 N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# [3b 10 l
OWNER'S NAME: PHONE# `S� &3
GENERAL CONTRACTOR: u BUSINESS LICENSE#
ADDRESS: CITY/ZIPCOD
*Our municipal code requires all businesses w rking in the city to have a City of Cupertin6 business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE .SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON RA RS HAVE OBTAINED.:A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
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