13040192 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10647 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION, PERMIT NO: 13040192
INC
OWNER'S NAME: ESSEX PROPERTY TRUST 528 E WEDDELL DR STE 4 DATE ISSUED:04/29/2013
OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416
LICENSED CONTRACTOR'S DECLARATI'OlN JOB DESCRIPTION: RESIDENTIAL ElCOMMERCIAL0
License Class e�U �3�Lic.# �/ `� UNIT D-REMODEL BATHROOM,KITCHEN ADD
WASHER/DRYER
Contractor a HOOKUP,UPGRADE ELECTRICAL PANEL
I hereby affirm that I 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.
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:31643004.10647 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 WITHIN80 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 DA OM LAST CALLED IN CTI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue.against said City in consequence of the Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regul ti s per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatu Date. I 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.
❑ 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
construct the project(Sec.7044,Business&.Professions Code). 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 for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Wtlions550533,and 25534.Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize agenDate:—'CTT 1
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 CONSTRUCTION LENDING AGENCY
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 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 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 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 all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date I
CONSTRUCTION PERMIT APPLICATION
Lau COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN0 (408)777-3228•FAX(408)777-3333•building(ftupertino.org 1
❑NEW CONSTRUCTION ❑ ADDITION TERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS12aJ .�} APN# �'r^ CC
OWNER N �iQONE 3 /0 EMAIL /U
STREE R$$$ UG� CITY,STATE ZIP I FAX
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CONTACT N PH NE j E-MAIL
STREET ADDRESS CITY,STATE,ZIP ! `L�(� FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N LICEI CIN TYPE C� BUS.LIC#
COMP �N E-MAIL (�
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STREET D SS STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRTPTTQ O ORK n �l `
G%c.9�v -�c.e.Glcr,�-Qe�-tdC��/iS'dtl\ �J/ l/Sl/•"W'
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
u USE TYPE OCC. SQ.FT. VALUATION(s)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA f ?uQ'�
BATHROOM KITCHEN OTHER I
REMODEL AREA`Z U REMODEL AREA / REMODEL AREA
PORCH AREA I DECKAREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? 13NO ADDITION? E]NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESRETE
TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO .r
G C11�
By my signature below,I certify to each of the following: I am the property owner or authori-ed'ag6d to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I ve read the Description of Work and verify it is accurate. I agree to comply with all ap licable local
ordinances and state laws relating to building co cti I thorize representatives of Cupertino to enter the above-identified pro inspec' n pie
Signature of Applicant/Agent Date:
! f' '
SUPPLEMENTALWfOR44AT111m REQUIRED PLAN 91E&TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE COUV7ER El BUILDING PLAN REV�W
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 ❑ F PE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTALHEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10647 ROSEWOOD RD#D DATE: 04/29/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: $28,000
PERMIT TYPE: Building Permit. PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Buildina is ��PENTAMATION 1 R2REM
USE: Multi-Family Dwelling >3 Stories ® Yes ( No YPE: i
WORK UNIT D- REMODEL BATHROOM KITCHEN ADD WASHER/DRYER HOOKUP UPGRADE
SCOPE ELECTRICAL PANEL
i�tcrn t:'hc:� Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 firs $0.00
titer;h.I'ernait Fee: Plumb.Permit Fee: 1PPERMIT Elec.Permit Fee: 1EPERMIT
C)the: a2ech.!�s7,, Other Plumb Insp. 0.0 firs $45.00 Other Elec.Insp. 0.0 �rs �$45.00�
Me&Insp.Fee: Plumb. Insp.Fee: Elec.Insp Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7f 11/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 60 s.£ Remodel,Bath(<=300 sf)
Supp/.PC Fee: Q Reg. OT 0.0 firs $0 $600.00 IREMRESBAT
PME Plan Check: $0.00 60 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 1REMRESKIT
Suppl. Insp.Fee-0 Reg. Q OT 0.0 hrs $0.00 =2 # Plumbing
PME Unit Fee: $0.00 $46.00IBPWSVCS Water Service
PME Permit Fee: $90.00 U25 j amps Electrical
Construction :Torr: 1 $45.00 IBELEC200 Services
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes 0 No $0.00 0
Advanced Planning Fee- $0.00 Select a Non-Residential
Building or Structure" 0
Travel Documentation Feer ITRAVDOC $45.00 A
Strong Motion Fee: IBSEISMICR $2.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
V $181.80 $1,291.00 i 1 'F $1,472.80
Revised: 04/29/2013