10050024 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10656 ROSEWOOD RD APT A-D CONTRACTOR:BKB CONSTRUCTION,LP PERJIIT NO: 10050024
OWNER'S NAME: ESSEX PROPERTY TRUST • 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/01/2010
OWNER'S PHONE: 6508151622 CARROLLTON,TX 75006 PHONE NO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: 13LDC rELECT r PLUMB r
License Class Lie.4 6TJC"T (�� rr' r
MECH RESIDEN'rIAL COMMERCIAL
Contractor _ Date
1 hereby affirm thus I out licensed under the procisians of Chapter 9 •JOB DESCRIPTION: EXTERIOR RE-SIDING TO AN EXISTING.APT BLDG,NEW
(commencing w'id,Section 7000)of Division 3 of the Business& Professions ENTRY TRFLLIS,WINDOW,DOOR REPLACEMENT TI IRU-OUT;SEE
Code and that my license is in full force and effect. 10050005 FOR FEES&PLAN CK COMMENTS.
1 hereby affirm under penalty of perjury one of the follmving tsso 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 pmvided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:S68965
permit is issued.
\PPI,ICANT CEIi'1'I FIC,\TION ,\PN Number:31643005.10656.A-D Occupancy Type:
1 certify that I have read this application and slate that the above in one:lion 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep hannlcss the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this pemrit. Additionally,the applicant understands and will comply r
with all nor-points ores regular, er the Cu n0 Municipal Code,Section I80 DAYS FROM LAST CALLED INSPECTION.
Issued ra��- -� Date: �4
Signature Date ��
❑
OWNER-BUILDER DECLARATION
RF-ROOFS:
hereby affirm that I am exempt from the Contractor's License Las%for one of All roofs shall be inspected prior to any mofing material being installed.If a mof is
the following mo reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sae.7044,
Business&Professions Code) Signature of Applicant: Date:
1,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
hcrebp affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Cade,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I sci11 maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
1 certify that in the performance of the work for which this permit is issued.I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,S etions 25505,25533,and 25534.
Compensation laws of Califomia. If,after making this certificate of exemption,
become subject to the Worker's Compensation provisions of the Labor Code,1 m1ust 0, fr or ror' - a At:
forthwith comply with such provisions or this permit shall be deemed revoked.
APPI,[CANT CERTIFICATION CONSTRUCTION[,ENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agencyfor the performance of work's
correct. I agree to comply with all city and county ordinances and slate laws relating for which this permit is issued(Sex.3097,Civ C.)
to building constmetion,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may acerae against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point sou •regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date—ZZ� Licensed Professional
-mCITY OF CUPERTINO
C ,-
CITY OF
CUPEkTiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # 0 (_) 5111065(o , ate: 4/L'b/ o
Building Address: CrjfJ Co) 6C
6�_� C.� • 950 /y
Mailing Address (if different fro building address?-. �y✓d3
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Phone#:
paw Try-&-r
Contractor: Phone:
t?KB Fax: (GtSD ^ ZO
Contractor License #:
Cupertino Business License #:
Contact: J i M M 6�G P one: &50 ga 2 . 6$65
Y Fax: j�y p • p.M. of o*
Residential Commercial
'� II_ . ,
Job Description: EYigF o, rg-s;d�^1 b
Building Permit Info:
BldgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
II/111/V-A ❑ 11/III B, IV-1-IT, V-B d -' I
Valuation: " /S Square Foo-tage:
Project Size: Ex ress ❑ Standard L_d Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.or
Revised 07/14/09