10050021 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:, 10696 ROSEWOOD RD APT A-D CONTRAC`T'OR:BKB CONSTRUCTION,LP PERMIT NO: 10050021
OWNER'S NAME: ESSEX PROPERTI'TRUST 2812 TRINITN'SQUARE DR STE 110 DATE ISSUED:07/01/2010
OWNER'S PRONE: 6508151622 CARROLLTON,TX 75006 PII0NF.N0:(972)478-2255
❑ LICENSED CO\IRACPOR/'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class!qc Lie.N a Y-'sT�
p �] :n\IECFI ❑ RESIDENTIAL r COMMERCIAL r
Contractor Date 7— l0
JOB DESCRIPTION: EXTERIOR RE-SIDING TO AN EXISTING APT BLDG,NEW
1 hereto•affirm that 1 am licensed under the provisions o(Chapter 9 BN'IRy'I'RIi1,1.IS,WINDOW,DOOR REPLACEhIEM'TURU-OUT;SEIi
(commencing with Section 7000)of Division 3 of the Business& Professions 10050005 17OR PEES&PLANCK COMMENTS.
Code and that my license is in full force and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
I have.tad will maintain a coni ficatc of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Libor Code,for the
perfa nonce 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:$68965
permit is issued.
APPLICANT CERTI FICATI ON .\PN Number:31643005.10696.A-D Occupancy Type:
I certify that I have read this application and state that the a c na ton is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize repn•semativcs 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 Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grating of this permit. Additionally,the applicant understands and will comply r
with all non-point sou¢ere regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. ��Llv
issue(]Signatur D:ac / p
hyy Dace:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected priorm 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 propeny,or my employees with wages as their sole compensation, iospection.
will do the work,and the structure is not intended or offend for sale(Sm.7044,
Business S Professions Code) Signature of Applicant: Date:
I,as owner of the propeny,am exclusively contacting with licensed contractors to
construct the pmject(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Cenificate of Consent to self-insure for Worker's IIAZARDOUS DIATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I hays read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this pcnnit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insmunce,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the llealds&
Section 3700 ofthe Labor Code,for the perlonnance of the work for which this Safely Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 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 enmploy any person in any manner so as to become subject to the Worker's Bealth S ' fcq' o s 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I 1
become subject to the Worker's Compensation provisions of the Labor Code,I must O er ii or ze
forthwith comply with such provisions or this pcnnit shall be deemed revoked. Date: o
APPLICANT CERTIFICATION CONSTRUCTION LENND�INGGAAGEENCV
I certify that I have read this application and suite that the above information is I hereby affirm that there is a construction lending agency for the perfsmiance 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 com anuction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned pmperly for inspection purposes.(We)agree to save
indemnify and keep hamtless 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 pcnnit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regal tions per the Cupertino Municipal Code,Section
9.18. I understand my plats shall be used as public records. -
Signature Date //q Licensed Professional
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
/bQ57�0�/
APN# - I Date:
Building Address: . O W o ocL
Mailing Address (if different from building address):
n �?-"6 3
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#:
553i5y R*4 'wv-sT oln - $JS' 16 Z 2-
Contractor:
Contractor: Phone:
?X? Fax: (qSQ ^ 37,0
Contractor License
Cupertino Business License #:
Contact: J Y IM Phone: 6s0 •$o 2. 6g&5 Fax: GJo • M. of
Residential Commercial
Job Description:
Building Permit Info:
BlIzIgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
II/III/V-A ❑ IUIII B, IV-HT, V-B 2� -
Valuation: Square Foo-tage:
Project Size: Express ❑ 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.builditgreen.or
Revised 07/14/09