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13070110
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10647 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION,INC PERMIT NO:13070110 OWNER'S NAME: ESSEX PRO T 528 E WEDDELL DR STE 4 DATE ISSUED:07/17/2013 OWNER'S PHONE: 6504943700 irvi SUNNYVALE,CA 94089 PHONE NO:(408)734-8416 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r PLUMB License Class 16,C/a(C3� Lic.# 3 p� MECH[_ RESIDENTIAL[_ COMMERCIAL� Contractor Cvn� fio�n veDate O I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UNIT B-280 SQFT,REMODEL BATHROOM,KITCHEN,ADD (commencing with Section 7000)of Division 3 of the Business&Professi ns NEW LAUNDRY ROOM,UPGRADE ELECTRIC&PLUMBING 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 Sq.Ft Floor Area: Valuation:$24000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:31643004.10647 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAY R LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regul ns per the Cupertino Municipal Code,Section 9.18. Issue by� Date: ��& Si na ure Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,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 I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&N.ui4 ctions 25505,25533,and 25534. 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 ner ot: I become subject to the Worker's Compensation provisions..of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date iCONSTRUCTIONPES IT APPLICATION C€31VlMUN1TY DW,ELOPMENT DEPARTMENT<BUILDING DIVISION ' �O 1030Q TORRE:AUENUE®,CUPERTINO,CA 95414-3255 �1 b L 'EF:Tl; t (404),777,3228" FAX{4Q$)777-3333 a buildina(a�cupertino orcx 130 t ❑NEW CONSTRUCTION ;❑,ADI3rnok AT.TERliTTON1-TI ❑ REVISION f'DEFERRED ORIGINAL PERMIT PRorE APx o AbdE G tv7 FAX Ct CONTACT LAQ STREET ADDRESS CTY,STATE,ZIP FAX ❑ ❑ Ow23ER-BU!1DIIt p ¢'wNFBAGENT 'ANfRACiOR : ❑CONTRACTORAGPATr I_I ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TEAT.4NT CO R N IdCFN TWe E BUS.LIC 0 CONT'YN 'v E-MAIL VIC S DESS ,STATE,ZeP FI ARCH[TECT)ENGINEER NAME IICEPTS£NiFMBER BUS.LIC# COMPANYNAME E 1vtAn. FAX STREETADDRESS qM STATE ZIP PHONE DFS EXISt'I NGUS£ PROPOSEDIUSE ! COt�*STR.TY #STO USE TYPE OCC. SQ.FT. VALUATION(S) EXISSG NEW FLOOR -DEMO TOTAL AREA f.REA AREA ?a£T P.REA "' BATHROOM KrfCFATf .OTHER REMODII;.ARE REMOD72 "REMODEL AREA „L PORCHARRA D AREA J: TOTAL ,, ,y AREA', GARAGE AREA: DETACH p ATTACK:.'. a DWELLING UNTM Is A,..:COvn m91T pvEs sEcoND sroxv pis G ADAEI)? 0140 '.._4DDITION? ❑NO PRE APPLICATION ❑YES IF YES,PROV)DEC'OPY.Ofi IS THEWZGANYES, T ALV T U ON: ❑ RE BY PLANNiNGAPPL Y.-QNO PL4NNING APPROVALS 'T�R., 'EIGHI,Eg HOME? -❑N6 By my signaturebelow,T certify to each of tha foilowiug T am the pzoperty oviner or autho" ed a¢ t to act on the property owner's behalf. I have read this application and the usforma6on I have,pro ' is have read the Description of Work an verify it is accurate. I agree to comply with all applicable local ordinances and state laws rela" g to blitz ' p authorize representatives of Cupertino to enter the ab ov identifz ' pro erty for inspection purposes. Signa4ue of ApplicantlAgen' Date: 1, SUPPLEIvIEIv AL IMF REQUI1tED PIAN esa cx Tyra ROMINNG SLIT' New',SFD or Multifamily dwellings Apply fi 'deinolitiaiT'permit for existing building(s). Demolition permit is requiied`prior to issuance of building o -T�poi R' ❑ BUILDING PLAON MlIEW permit for new building. ❑'EXPRESS ❑ PLANNING PLA,NREVIEW _Commercial Bldgs: Provide a.01 npleted liazardous Materials Disclosure ❑'STAMARD ❑ PUBLIC WORKS form if any Hazardous Materials are§*g used as part of this project ❑ LARGE © FIRE DEPT Copy of Planning Approval Letter id Meting vii la Planning prior to submittal of Building Permit application ❑ AwoR ❑ S_4,�JIT'ARY SEWERDISTRICT ❑ ENVIRONM�NTALM4LTH BldgApp_201 Ldoc revised 061211.11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10647 Rosewood Rd#B DATE: 07/17/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$24,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Building is PENTAMATION l �2 USE: V7 1 >3 Stories 0 Yes 0 No PERMIT TYPE: WORK UNI -280 SQFT REMODEL BATHROOM KITCHEN ADD NEW LAUNDRY ROOM UPGRADE SCOPE ELECTRIC & PLUMBING 3 g r'Ia)".L'1ae("A 7'l mib. 111 ari 0eek Elec.Plan Check 0.0 hrs $0.00 1r:Ia..l'<rir<it�car:: t'i,.,rri�, M,r�r:ria 1'r<: Elec.Permit Fee: IEPERMIT 1}Itc'P: ?e r'=.In.r_;. )a;rcrT'I.�rrl=lrti3, OtherElec.Insp. 0.0 hrs $47.00 1�.hech, hi.y. Fee,, .�Br tdt.%l�7•,�f?.,5�, I`FF',' R3.:,�;'t'. #�i f,S'i 1, �'<;�." NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer Distric4 School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 11-053 E . 7/U12,� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 125 amps Electrical Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $47.00 1BELEC2007 Services PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp.Fee: Reg. 00TT0.0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 •. , Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 0 hours Inspections 0 Travel Documentation Fee: 1TRAVDOC $47.00 $695.00 ISTINSP Inspection,Hourly 0 i Strom Motion Fee: IBSEISMICR $2.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 F77TOTLFEE_s : $141.4 $742.00 40 Revised: 07/01/2013