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11040167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10696 ROSEWOOD RD APT409- CONTRACTOR:ESSEX PROPERTY TRUST PERMIT NO: 11040167 OWNER'S NAME: ESSEX PROPERTY TRUST 925 EAST MEADOW DR DATE ISSUED:04/27/2011 OWNER'S PHONE: 6508151403 PALO ALTO,CA 94303 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION C" BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r- RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UNIT B-KITCHEN(60SQFT)&BATH REMODEL,ADD NEW (commencing with Section 7000)of Division 3 of the Business&Professions WASHER&DRYERS PLUMBING,ELECTRICAL UPGRADE. Code and that my license is in full force and effect. REPLACE KITCHEN CABINETS&APPLIANCES,REPLACE 1 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. 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 Sq.Ft Floor Area: Valuation:$18000 permit is issued. APPLICANT CERTIFICATION APN Number:31643005.10696.A-D Occupancy Type: 1 certify that I have read this application and state that the above information is correct.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. Issued Date: C-(`1�t Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: Ichereby affirm that 1 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 I,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(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,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 Thereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 1 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. 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(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air 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 healthty Code,Sectio s 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must r ag t1 Owne forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of N+ork'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 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 and rstandswilcom y ARCHITECT'S DECLARATION with all non t source regulations pe theon 9.18. I understand my plans shall be used as public records. Signature Date ( Licensed Professional_ OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333• buildino(a)cupertino.om Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS (J fin cU M1Mj APN ,6( _ t ?^O o� /P jb Lf t OWNER, (J L.. _I OWNER ADDRESS r 1 DESCRIPTION OF WORK: i 0✓ RXIJJ V-4, 3ptL Toole We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS. Please read and initial each statement below to signify you understand orverify this information.) w"'t. I understand a frequent practice of unlicensed persons is to have the property owner obtain an'Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 1 understand building permits are not required to be signed by property owners unless they are responsible for Thee construction and are not hiring a licensed Contractor to assume this responsibility. M.3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. &�. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer'under state and federal law. rur8. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and federal govemment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. V7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. /� h 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderFOrm 1010.doc revised 04114110 I understand I may obtain more information regarding my obligations as an'employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, the California Division of Industrial Accidents. I also understand I may contact the California ContractorsState License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed =' contractors. _.' 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am�Qthe party legally and financially responsible for proposed construction activity at the site address listed above. 4 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _�_J12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsibl r issuing the permit. Note:A copy of the property owners driver's license, form notarization, or other verificati cceptable to the city may be required to be presented when the permit is issued to verify the property owner's sign Property Owner's Signature: Date: f - - - - - - - __- -------------------------------------------the ------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 � 7 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildinaCMcuoertino.oro ❑NEW CONSTRUCTION Cl ADDCCION ALTER-ATT1ION/TI ❑ REVI(SION�I DEFERRED ORIGINALPERN11T# r/^ P 'I(' VS r�IT_ d"!p V . / APN dam/ 0 001!!5-104/// ��� 1�e 4) OWNER NAME �r �1 � 4 I PHONE/( v O/I�S— `//\� E-M1WB. �j x/.1714 STREET ADDRESS / e�d [FpY A(lF1NZ�P OC-' r"CV / i-3 a3 I FAx CONTACT NAME `a J U PHON HE�r ds/ f— /Vo?/1[(.,`tEIMLAM�j� �te� 2 �",V, srnEETngD�gsl;S ,,/per /J_ .W- crrr.srArE�C,z.1 >W0 L rJ >C..''Y FAX Cl OWYER ❑//0w- -8 mnl-"�WXX(El OWNERAGENT ❑ CONfRACroR ❑COMRACTORAGENT ❑ ARCHRECr . El EIGWEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA LICENSENUG ER LICENSETYPE BUS.UCa OU C /I COMP NMAII. FAX Uj Crov c- n n ct 'CO, 52 STREET ADDRESS w O ( s 1�'(A C .STAt�TE,zIP �� S Ho S 30A c ARC=C IEtGLNEZR NAME LICENSE m ER I Bus.LIC+ COMEA.NY NAME E-MAR FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION WO / r ,rr MCLS �� EXIS[NGtAni PROPOSED ISE CONSrR TYP aSTORlES cP.a'�rx MUST NEW �O TOTAL. AREAL AREA FLOOR DREA :IET AREA JJV3,J BATHROOM RTTCHEr 601 orrHat EODEL AREA EoOEAREA NODELAREI I Pt�f��,Ay':rtrtrtrr" j ,,,tqr P PORCH AREA DEO(AREA TOTAL DECI4POROi AREA GAMGE AREA:❑ DETACH ♦y ��'..ty.� fw`�'�' - � �>. ❑ ATTACH roWEu tants: oAsccoro wvrr ❑rF3 sccorD sroar ❑ras Be ADDED' ❑NO AnamMl ❑NO .+> l 3 £•`J ,eta 1+� eae.YePLCAnoN ❑ res 6YEl.PROVO)E CDPYOF t1.VW.EAS NAME `tReeEr+Eo eY.-`-t �''}= - D it M nI' PLANNND APPLI ❑ FD N.YNNP'O APPROVAL IarIEA R -��.`�y�G21k1 VY r "� .1 '\` � By my signature below,I certify to each of the Ilowmg: I am the property owner or authorized agent to act an the property owner's behalf. I have read this ^ application and the information I It vid is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to it i construction I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes. Signature ofApplicandAgenc Date: S SUPPLER ORMATION REQUIRED ��ePt.AN.CHECK:LYPE„z�f.f��?'.� ROIFCCiGSWPgc-j New SFD or Multifamily dwellings: Apply for demolition permit for --�-MEN-- t`+ >•®;..�F'" 1�=`-�-- THELry UFIN PLA.\REG IEw existing building(s). Demolition permit is required prior to issuance of building ` A permit for new building. N1:1 RE�ss�� \PUNv�Iac PLAXNREG'tEw t'�< _Commercial Bldgs: Provide a completed Hazardous bfaterials Disclosure IjD S A:vn ° +-'e D�PWn tctwFo`rt: � s form if any Hazardous Materials arebeing used as part of this project. °' f'?�'r © uARCE>f � - � �gPIRE!D Copy of Planning Approval Letter or Meeting with Planning prior to © Muv.roR'_ - =.v Qsi: RYsa ' subotitW of Building Permit application. _ .r.43� r. h�JENS'mOh;G1EhTAL;BEAL'tH}4 BldgApp_201 1.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1214 ADDRESS: 10696 rosewood rd.#B DATE: 0 412 5/2 01 1 REVIEWED BY: bob s. APN: BP#: "VALUATION: $18,000 *PFRMIT TYPE: Building Permit PLAN CII ECK TYPE: Alteration/ Repair /� n PRIMARY PENTAMATION SFD or Duplex 1R3 REM IVVV n USE: PERM IT Tl'PE: WORK R-1 apt complex kitchen and bath remodel non structural add W/D hook-up. SCOPE Mech. Plan Check 0.0 firs $0.00 Plumb. Plan Check 0.0 his $0.00 Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Pee: IMPERMIT Plumb. Permit Pee: IPPERMIT Elec. Permit Pee: 1EPERMIT Other Mech. Insp. 0.0 his $42.00 Other Plumb Insp. 0.0 hrs $42.00 Other Elec. Insp. 0.0 hrs $42.00 Mech.Imp. Fee: Plru:rb.In,ip,Fe':- Eley.Insp.Fee: NOTE: These ees are baser/air the prefindnarl,information available and are onh,an ectinmte. Contact the De a or addn7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7i1/101 FEE QTY/FEF MISC ITEMS Plan Check Fee: $0.00 60 s.f. Remodel, Kitchen(<=300 so Suppl. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 $570.00 IREdtRESA1T PME Plan Check: $0.00 0 # Plumbing Permit Fee: $0.00 $16.00 1BPFIATURE Fixture or Trap Suppl. Insp. Fee<D Reg. O OT 0.0 1 hrs $0.00 /{ PME Unit Fee: $0.00 PME Permit Fee: $126.00 1 # Mec nical Cwrstrrtction Tac $63.00 Vent,Appliance(only) Acoustical Fee: O Yes t7 No $0.00 1� # Electrical O Work Without Permit? O Yes E) No $0.00 $42.00 1BREMRECFP Recep/Switcl>/0utlets 0 Planning Fee: $0.00 Select a Non-Residential Q Travel Documentation Fee: ITRAI DOC $42.00 Building or Structure O i Strong Motion Fee: IBSF-1SMICR $1.80 Select an Administrative Item Bldg Sttls Commission Fee: IBCBSC $1.00 SUBTOTALS: $170.80 $691.00 TOTAL FEF: 1 $861.80 Revised: 04/01/2011