14020052 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10659 MAPLEWOOD RD CONTRACTOR:ABE CONSTRUCTION, PERMIT NO: 14020052
INC
OWNER'S NAME: ESSEX THE POINTE LP 528 E WEDDELL DR STE 4 DATE ISSUED:02/11/2014
OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
�/^� UNIT C-REMODEL BATHROOM(120 S.F.),KITCHEN(160
License Class Ci� C 14 L1C.# S.F.),ADD(N)LAUNDRY ROOM,UPGRADE ELECTRICAL
1` PANEL&PLUMBING
Contractor to
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:$24000
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:31643003 10659 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 ALLED 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 Issued by: Date: U ]�
granting of this Iso
Additionally,the applicant understands and will comply
with all oie re tions per the Cupertino Municipal Code,Section
9 18
RE-ROOFS:
Sig ture 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
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 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 th A a Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with t t Cu r nf/�!pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code ec ons 255 2d 2534. f
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age n : Date: 11
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
CONSTRUCTION PERMIT APPLICATION hp��
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 BU
C49PERTlAIO (408) (fc
777-3228•FAX(408)777-3333•bulldinauoertino.ora
❑NEW CONSTRUCTION ❑ ADDITION B&TERATION/-n ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PRO APN#
P MA>L X
STREETI FAX
CONTACT NAME
E-MAIL
STREET ADDRESS. CITY,STATE,W FAX
❑OWNER ❑OWNER-BDIIAFA ❑OWNER AGEW ;rCONTRACYOR ❑CONTRACTOR AMT ❑ ARCBIIE(,T ❑FNGIIxER ❑ DEVELOPIIt ❑TENANT
CONTRACTOR NAME LI E BUS.LTC#
COMPANYN
STREET ADDM:�� P
ARCRITECT/ENGE0EEE NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-ALAIL
FAX
STREET ADDRESS CITY,STATE,ZIP
PHOm
DESCRrPTION OF wOR
ok
warrimcium PROP;WTAL
CONSUL TYPE #SWIM
USE TYPE OCC. SQ.Fr. VALUATION(S)
DaSTG NEW DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM EFFEOTHER
REMODEL AREA PMAHA," RFMODELAREA
PORCHAREA DEC&AREA ARBA GARAGEETACHA='
#DWELLINGUNM: 13.4SECOND.UM OVES SECOND STORY ❑rm
BBINGADDEDr ONO ADDITION? ❑NO
PRE-APFLIC.aTtON ❑YFS ffYES;pROVIDE COPY9F IS TBE BLDG wPi OYES gECEryEpB TOTAL VALUATION:
PLAMMGAPPL# ONO PLANNINCAPPROVAL_LETimR EICHLEEHom- 13NO
By my signature below,I certify to each of the_lbIlo I am the property owner or authorized agent to act oa the property owners . I have read this
application and the information I is have read the Description of Work and verify it is accurate.I agree to comply with all applicable local
ordinances and state laws relatia to ti axnhorize representatives of Chperdno to enter the above i�fled etyfor ins
pechon proposes.
Signature of ApplicantlAgent Date:
SUPPLEMENTAL,INFO. ON REQUIRED PLAN CHECK TYPE ROUTLNG SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ovEte ricovNTER Elsw Dare PLAN REVIEW
building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ MCP ❑
PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed hazardous Materials Disclosure ❑ STANDARD 11 PUBLICWORKS
form if any Hazardous Materials arc being used as part of this project. ❑ LARGE ❑ Pros DEPT
_Copy of Planning Approval:Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ W4JOR ❑ SANITARYSEWERDISTRICT
❑ F24MONMENTALBE4LTH
BldgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10659 Maplewood Rd,#c DATE: 02/10/2014 REVIEWED BY: Mendez
APN: BP#: wALUATION: 1$24,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2REM
USE: >3 Stories Q Yes Q No PERMIT TYPE:
WORK ONITC - REMODEL BATHROOM 120 S.F. KITCHEN 160 S.F. ADD N LAUNDRY ROOMSCOPE GRADE ELECTRICAL PANEL& PLUMBING
f
, rte za.,. ..
Ml'£;£;h.f;Ic.rr Che°k 1'trz€€o'111m?CC,€£>£:k.. Elec.Plan Check 0.0 hrs $0.00
.Xle(_dk IF<'rmit 7'£;£:: F'himb. Perm;.Fee: Elec.Permit Fee: 1EPERMIT
C tl?er A'h?ch'fns'p> ET__t_ Oilier l bot zb Ir€sk), E1__L_ Other Elea Insp. 0.0 hrs $47.00
M'v'. PW: Pluir b'Iris/3.Flee: Elef". lf's.jq. t't'.£::
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. ® OT 0.0 1 hrs $0.00 $0.00 IREMRESKIT
PME Plan Check: $0.00 = amps Electrical
Permit Fee: Hourly Only? 0 Yes (E)No $0.00 $47.00 1BELEC200 Services
Suppl. Insp. Fee-0 Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
(.onsiruelion TUX
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? ® Yes (E) No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential
Travel Documentation Fee: 1TR4VD0C $47.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $2.40 =hrs Inspections
Bldg Stds Commission Fee: 1BCBSC $1.00 $695.00 ISTINSP Inspection,Hourly
,. ...,.. . f,.. Y.. ..E,' $141.40 $742.00 TOTAL FEE:
Y, $883 40
Revised: 01/15/2014