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14010016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10696 ROSEWOOD RD CONTRACTOR:ABE CONSTRUCTION, PERMIT NO:14010016 INC OWNER'S NAME: ESSEX THE POINTE LP 528 E WEDDELL DR STE 4 DATE ISSUED:01/03/2014 OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL �, � �� nn/^ n n UNIT A-REMODEL BATHROOM(120 S.F.),KITCHEN(160 License Class — Lic.# q&, lsw S.F.),ADD(N)LAUNDRY ROOM,UPGRADE ELECTRICAL Contractor i Date r PANEL&PLUMBING I hereby affirm that I am licensed u Me' provisions of hapter 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 ection 3700 of the Labor Code,for the performance of the work for which this APN Number:31643005 10696 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 DA T-C`.4LLED 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. Additt u ionall ,the applicant understands and will comply Issued by: Dat with all non-poince regul 'on er th Cupertino Municipal Code,Section 918. Jn I RE-ROOFS: Signature Date W r 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 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 *, o agement District I performance of the work for which this permit is issued. will maintain compliance with the ,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S etio s 5Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent: Date t 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 Califomia. 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 918. Signature Date AP PLICATION GQMMUN TY L3EVELOPMENT DEPAFtTMEN i•BUILDING DMSION 10300 TORREA1%ENUE.CUPERTINO,CA 950143255 ................... L t'E TdN¢ 777 3229$.FAX(408) 7773333­building0cuoertino.ong I CONSTRUCTION 1�,ADDTTI(3N azRATIax r TI ❑ Islorl t DEFERRED axlcnaAL PERMT# PRO � �� 3 t� - � 3 - 60 �7a6 STREETADDAQ = �s CONTACT RAh E-MML STREET ADDRESS CTrY STArE ZIp FAX ❑f�w1�TEP. ❑ OwNBt-$U2DER Ci'Ot$NfS2 AGENr :"�C0737Re�.CT08" ❑C.Oh°t7tACTOR.AGEN7' ❑ A&Cr1REC7 ❑ENGSNEER ❑ DEVELOPER ❑7EKAh7 CENSETYPE BUS.LTC A CO a E-IdAM, F Ze STRF_Sl D P�tjn��,2 qtk ARCHITELTlENGINEfiR NANTE LSCENSE NTJMBER BUS.LTC# COWANYI�AME' TrMATI FAX STREET ADDRESS STI .77,ZIP Ps'30NE bESCR hT�F�J RK k ac ESOSTWGUSE "PROPOSbD, SEr ,r'r� ',C,ONSIIL TYPE' #5351 5. .. USE TYPE OCC. SQ.FT. VALUATTON(S) EXISTG NESYFTAOR DEtvIO -' TOTAL AREA AREA •ARE,S ATETAREA a„ BATHROOM KSfL'ffi1Q'. OTfE;R R£MOII AREA �/3,�)+` REMODfiL.AREA REMODELAREA �.+ ., ` PORCH AREA DECKAREt4. r01`ALDECK/PQRCHAREA: GARAGE AkEA: DETACH ❑ATTACH #DGIELUhG UNrfSi 15A5ECQNA DT,47T" .}�.Y$S ;S$CONA STORY .YES SEGYG AIITiED?' PRE-APPLICATION.❑YES Tr YES,PROVIDECOP.Y OF :L4 THEHLDCs`AN ❑YES y� toTAL VALUAnohT: PLAMINGAPPL# [1140 PLnNNiPicy.APpRQVAL,IETTER "1 EICSr.ER,;HO.NSE? ONO, By my signature below,I certify to eaeh'af the fotlowuig: I am the prop6ity:owner or authorized aggnt m the property owner's behalf: I have read this application and the information rov�ded Is`CO— I have" 'd the Description of Work and v ix is accurate agree to comply with all applicable local ordinances and state laws reiatin #o dmg hon I "" cprrsentatives of Cupertino to enter the above-identmed property inspection purposes. Sig=m=of ApplicantlAgent: Date: �k f SUPPL A)r FORMATION RBQUMETI PLAN CHECK TYPE ROUMG SLIP _Nero SFD of lvlultifamllyd we]liApply forclemol3tibr permit for ❑ ocx Tcozrt L7; Buu DTu rLnr1 aEVT3 w existing building(s). Demelition permit t requu�l prior tG`issuance of building_ permit for new tluilding. ❑ EXPRESS' ❑' PLANNING PLAN R=W Commercial Bldgs: Provide a completed HazatdoTss,Ivlatertals Disclosure' ❑ STANDARD ❑'PITBLTc woRxs form if any Hazardous Materials are beuTg used as part of this pro}eet ❑ GE ❑'F Derr Copy of Planning Approval Lettez or Meeting wltb`Plat++iing pzioz to ❑ tLAJOR ❑'sANIrARYSERERDIsrRICT submittal of Building Permit application ❑'.ENVIRONMENTAL$E9LTH ''. Bldg,4pp_?©11.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10696 ROSEWOOD RD#A DATE: 01/03/2014 REVIEWED BY: MELISSA APN: 31643005.10696 BP#: *VALUATION: 1$24,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Building is • PENTAMATION 1 REAP2 USE: ® 3 Stories ® Yes No PERMIT TYPE: WORK REMODEL BATHROOM 120 S.F.), KITCHEN 160 S.F. , ADD N LAUNDRY ROOM UPGRADE SCOPE ELECTRICAL PANEL& PLUMBING ,,✓, -vk:c:h.Pl afr(,heck Numb.Plan(iac:c1 Elec.Plan Check 0.0 hrs $0.00 F77-mit I`ee: Pharnar•.Per€aria 1<.: Elec.Permit Fee: 1EPERMIT t.ialrer01h"?r.P!€rra>hap, Other Elec.Insp. 0.0 hrs $47.00 NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prefimina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 amps Electrical Suppl.PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 $47.00 IBELEC200 Services PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes No $0.00 Suppl. Insp.Fee-.0 Reg. 0 OT 00 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (;onstrliction 71ciX Administrative Fee: IADMIN $44.00 0 Work Without Permit? ® Yes (j) No $0.00 Advanced Plannim Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: 1TR4VD0C $47.00 Building or Structure 0 Strom Motion Fee: IBSEISMICR $2.40 5 761 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $695.00 ISTINSP Inspection,Hourly N "a �S $141.40 $742.00 i TOTAL FEE: $8 . :.. ..-.. ..., ria. a�,�,� ���a�. � 83.40 Revised: 10/01/2013