10050027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10697 ROSEWOOD RD APT A-D CONTRACI'OR:BKB CONSTRUCTION,LP PERMIT NO: 10050027
O\VNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/01/2010
OWNER'S PHONE: 6508151622 CARROI. .TON,TX 75006 PHONE NO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class �� Lic.9 A? (7 l& r rl r
�VIECII RESIDENTIAL COM NIERCIAL
Contractor
'/.C/!'- Datc�Z��(r
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRI PTION: EXTERIOR RE-SIDING TO AN EXISTING APT BLDG,NEW
(comntcncing with Sccrion 7000)of Division 3 o(the Business S Professions ENTRYTRELI•IS.WINDOW,DOOR REPIACEMENTTHRU-OU(;SEE
Code and that nn'license is in full.force and effect. 10050005 POR FEES&PLANCK COMMENTS.
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 walk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfomtance of the wo4infomaiii.
Sq. Ft Floor Area: Valuation:$68965
permit is issued.
!\PPLICANI'CER'I'IFIGVI'IONAPN Number:31643004.10697.A-D Occupancy-rype:
I certify that I have rend this application and state that the abov
comet.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 harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence oftbe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply r
with all non-point source regulation per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Dam ;w Issued by: Date:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If mof is
the following two 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(Sm.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the pmjeet(Sec.7044,Business&ProRssions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cenificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided foray Section 3700 of the labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work forwhich this pemtit is issued. California health&Safety Code.Sections 25505.25533,and 25534. I will 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,forthe perfomtance ofthe work for which this Safety Code,Section 25532(x)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 Boy Area Air Quality Management District I will
I 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's"SA y 'Cork, 'ons 25505,25533,and 25534.
Compensation laws ofCaliforma. If,after making this certificate of exemption,I /
become subject to the Worker's Compensation provisions of the Labor Code,1 must amt•
forthwith comply with such provisions or this permit shall be deemed revoked. Date:T_'L./ /v
APPLICANTCERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby alTinn that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,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 hamdess the City of Cupertino against liahilitics,judgments, Lender's Address
costs,and expenses which may accmc against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point sou a regulations ter the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Datcy Licensed Professional
�- CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
1;20.566� 7
APN" Date:
Building Address: p52t,,300 Ck- A,5;1—
Mailing
GLMailing Address if different from building address):
WY E /EZZO) ZZZ
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#:
E '' oa a 71�✓�o`T ,� � l S' 16 z Z
Contractor: Phone:
?K3 S cin Fax: &50 370
Contractor License #:
'
Cupertino Business License #:
Contact: M,14
J 1 / G Phone: 650 $o 2. - &B&5
YFax: j:�So • oz• ofo'
Residential Commercial
Job Description: cy)gver y�J_$;dan� .�p Ol.y. ,Q+�`lyl✓, "O M1+'I'Ir��'4 b�n..�t�h}C'
New / (. 11G�l1 . pvo� �aee ..¢n1JTiru��Fo
Building Permit Info:
BldgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
II/I11/V-A ❑ I1/III B, IV-HT, V-B 2� - I
Valuation: ' Square Foo-tage:
Project Size: Express ❑ Standard ZLarge ❑ Ma or ❑
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