10050043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10666 ROSEWOOD RD APT A-D CONTRACTOR:BKB CONSTRUCTION,LP PERMIT NO: 10050043
OWNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/012010
OWNER'S PHONE: 6508151622 CARROLLTON.TX 75006 PHONE NO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERAfIT INFO: BLDG r ELECT r PLUMB r
License Clas�� Lie,q�4��! r r (- (—
�q'/ MECH RESIDENTIAL COMDIERCLAL
Contractor 6,1./C/ -5 Date�T�
1 hereby affirm that 1 am licensed colder the provisions of Chapter 9 JOB DESCRIPTION: EXTERIOR RE-SIDING TO AN EXISTING APT BLDG,NEW
(commencing with Section 7000)of Dirision 3 of the Business&Professions LNIRA l REI.LIS,WINDOW,DOOR REPLACEMENT"I'IIRU.OUT;SEE
Code and that my,license is in full force and effect. 10050005 FOR PEES&PLAN CK COMMENTS.
I hereby affirm underpenally 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 Calc,for the
performance of the work for which this permit is issued.
1 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 Sq.Ft Floor Area: Voluation:568965
permit is issued.
APPLICANT CERTIFICATION APN Number:31643005.10666.A-D Occupancy Type:
I certify that I have read this application and state that thea e m ormalian is
comet.1 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 of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ � Date:
SignaWry�� �
Date (Z Issued bv_
❑ OAVNER-BUILDER DECLARATION
RF--ROOFS:
1 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 a roof 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 offend for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sm.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of Ore Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
perfomlance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 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,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
.Wditionaily,should 1 use equipment or devices which emit hazardous air
permit is issued, contaminants as defined by the Bay 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&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,afier making this eenificarc of exemption,I
m
becoe subject to Om Worker's Compensation previsions of the Labor Code,I must Os rner o e�th agent
forthwith comply with such provisions or this permit shall be deemed revoked. Dxte
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is I hereby affirm 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.)
m building construction,and hereby authorize repmsentatives 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 accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
all non-point ource regulations per the Cupcnino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signatu DateLicensed Professional
CITY OF CUPERTINO
CITCUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN u Date:
Lj�
Building Add ess: C)d 4fe
U
Mailing Address (if different from building address):
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#:
5 caw (Oln — &S-o- 16 z 2-
Contractor:
Contractor: Phone:
r3K8 o- I Fax: (o5O ^ 37o ^
Contractor License#:
Cupertino Business License#:
Contact: J I M.vt Gr/A�ICT P one: &SC •$o 2 - 6$6$
y Fax: Oso 62 • of of
Residential I Commercial I
Job Description: EYipra. yp S;a(�; y 1 6"w, �/ ^
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Building Permit Info:
Bldg Elect ElPlumb ❑ Mech ElType of Construction (Usage Class): Occupancy Type:
IUIII/V-A ❑ IUIII B, IV-HT, V-B 2( I
Valuation: ' Square 1`66-tage:
qS
Project Size: ExpressEl Standard ❑ 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.buildit-,reen.ort4
Revised 07/14/09