13060209 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10647 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION, PERMIT NO:13060209
INC
OWNER'S NAME: ESSEX PROPERTY TRUST 528 E WEDDELL DR STE 4 DATE ISSUED:06/27/2013
OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALO
License Class 4- Lic.# q6 3 Y APT A-REMODEL BATHROOM(120),KITCHEN(160)ADD
n, �," G NEW LAUNDRY ROOM,UPGRADE ELECTRICAL PANEL
Contractor O (. 5 61;1 Date AND
I hereby affirm that I am licensed under the provisions of Chapter 9 PLUMBING
(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:$26000
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 WITHIN 180 DAYS OF IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned prope for inspection purposes. (We)agree to save 180 DAYS FRO ALLED INSPECTION.
indemnify and keep harmless the ity of Cupertino against liabilities,judgments,
costs,and expenses which may cute against said City in consequence of the Z
granting of this permit. Ad ally,the applicant understands and will comply ate:
with all non-point source g tions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date � � 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
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)
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 equipmcn 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 r Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertin unicipal Code hapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date
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 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 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
b
CONSTRUCTION PERMIT APPLICATION 0
Lau COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �O
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org
❑CNEW CONSTRUCTION ❑1 ADDITION
`a ALTERATION/Ti El REVISION/D/EFERREDV ORIGINAL PEER,MIT#
PROJE T{i AIN PE I # ` f 0,
Y
OWNER NAME �� —� PHONE _ E-MAM
e�^rr r(,t 00 E0. eSSE r cfi
STREET ADM C TATE,ZIP
daui r, /t O FAX
CONTACT NAME P O / E_MEIy
In AD— 15- 1((03
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUII.DER ❑ OWNERAGENT gYCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGMER ❑ DEVELOPER ❑TENANT
LICEN LICENSEI TYPE 3 BUS.LIC# [/
COMP E-MAIL FAX J
n rL&
S ( PHONE _s4ho*oako—c�6 01409
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK (o La-kx r\
1 A r'( a lL'A_
t
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
b USE TYPE OCC. SQ.FT. VALUATION($)
t"
EXLSTG NEW FLOOR DEMO TOTAL ry
AREA AREA AREA NET AREA i7 I Z e o Ci �
BATHROOM MCHEN OTHER 1f- t O V
REMODEL AREA ^,}� REMODEL AREA'� Q REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: LIDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �IO
By my signature below,I certify to each of the lowing I e p perry owner or authorized agent to a on perry owner's behalf. I have read this
application and the information I have provi is rr I realthe Description of Work and verify i accurate. I agree to comply with all applicable local
ordinances and state laws relating to building o I o e repre tatives of Cupertino to enter the above-i ntifie roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL QUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for El OVER-THE COUNTER El BUILDING 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 El MAJOR El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
-Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTORLIST.
JOB ADDRESS: 10 6 } G Kd PERMIT# 130,(-6-Zoe}
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: AB e— A 9, c: BUSINESS,LICENSE#.-
ADDRESS: 2 1M ' (JcAg fje1jV(,, 179 ITY/ZIPCODE:
*Our municipal code requires all businesses working-,in the city to have a City of-lCupertino_business license.
NO BUILDING FINAL OR FINAL OCCUPANCY I S CTION(S) WILL;BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT RS HAVE OBTAINED A:,CITY OF CUPERTINO
BUSINESS LICENSE. `,
I am not using any subcontractors: 27-l�3
ture Date
Please check applicable subcontractors and c ete 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
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