10050035 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10677 ROSEWOOD RD APT A-D CONTRACTOR: BKB CONSTRUCTION,LP PERMIT NO: 10050035
OWNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED:07/01!1010
OWNER'S PHONE: 6508151622 CARROLLTON.TX 75006 1 PHONENO:(972)478-2255
❑ LICENSED CONTRACTOR'S DECLARATION r F- 1—
BUILDINC PEILM FI'INFO: BLDG ELECT PLUMBLicense Class Lic.0—b'--/—�-5� rl r r
NIECII RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm(lint I mm licensed under the provisions of Clmp(er 9 ENT DESCRIPTION: EXTERIOR RE-SIDING TO AN EXISTING APl'BLDG,NEW
(commencing with Section 7000)of Division 3 of the Business&Professions IeMRY 5 FOR EES&PLAN COR REPT-ACEMENI'THRU-OIfI';SEE
Code and that my license is in full force and effect. 10050005 FOR 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 work for which this pcnnit 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 twI t ' Sq.Ft Floor Area: Valuation:S68965
permit is issued.
APPLICANT CERTIFICATION APN Number:31643004.10677.A-D Occupancy Type:
I certify that I have read this application and state that thea ve utfom."..,is
conect.1 agree to comply with all city and county ordinances and stale laws relining
to building construction,and hereby authorize mpasentatives 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 ol'Cupenino against liabilities,judgments, >'ITHIN ISO DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may aceme against said City in consequence of the
Smiting of this permit. Additionally,the applicant understands and will comply I80 DAYS FROM LAST CALLED INSPECTION.
with all non-paint sou a regula ions per the Cupertino Municipal Code,Section
9.18. j
Issued
Signatu 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 a mof 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 imended or offend for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of property,am exclusively contracting with licensed contractors to
construct the pmjmt(Sm.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby 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 ofthe work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
1 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 1 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 Arca Air Quality lilanagement 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 employ any person in any manner so as to become subject to the Worker's Health&S fey Code,Sections 25505,25533,and 25534.
Compensation laws of Cali forma. If,after making this certificate of exemption,I 1'
become subject to the Worker's Compensation previsions of the Labor Code,I must O e ran ge
forthwith comply with such provisions or this permit shall be deemed revoked. I Date:'7— t*—/y
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that Ihave read this application and state that the above information is I hereby affirm that them is a construction lending agency for the performance of work's
correct.1 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 understands and will comply ARCHITECT'S DECLARATION
with all non-point buret regulations per the Cupertino Municipal Code,Section
9.18. �-f I understand my plans shall be used as public records.
Signature Date/ — !/D Licensed Professional
SON CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # FDate.
OO ` i 0G7 -7.
Building Address: UGC- A6k-
106 7� "
Mailing Addre s (if different from building address):
s Z7,- �' .� / - 9y3o�
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 oln - ?is--
Contractor:
ls-Contractor: Phone:
?k? Fax: 650 ZO
Contractor License#:
Cupertino Business License #:
Contact: J I Mwt ��G P one: 650 $o 2 . 6665
YFax: oio�
Residential Commercial ❑
Job Description: r 1L S oI�^� ♦b a�v 2xi a\ 6O kA,'y
Q, ,,, L.,'lY1(�'•^-'� �JIO� rtplac'e...2nT-Arn:�b�Fo
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
IlAll/V-A ❑ II/VI B, IV-HT, V-B Rr - I
Valuation: Square Foo-tage:
Project Size: Express ❑ Standard [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 wivw.buildit�,Yreen.orsz
Revised 07/14/09