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12080087 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADIIRESS: 199860LIVEWOODST COiIXTRACI'OR:' = PERMITNO: 12080087 %NE'R'SNAME: ESSEXTIIE POINTE LP �iA�j� �w��E2S � Asa_ DATE ISSIIFD:08/082012 OWNER'S PHONE: 6504943700 PHONENO: LICENSED CO\I'RAC-f0R'S DECLARATION 0(�..,, ��,+ BUILDING PERMIT INFO: BLDG ELECT r PLUMB r.- License Class C .U. Lie.N D J /Q). " QQ--�'— - g tL � NECH r RESIDENTIAL r COMMERCIAL r Contactor l ,a :aLS IA/Q- Date herehy affirm that Into licensed under the provisions of Chap(er') JOB DESCRIPTION:AnA-D-MULTI FAMILY KITCHEN(60 SQFr)AND (commencing with Section 7000)Of Division 3 Of the Business& Professions BAT'IJ(60 SQIT)RIiMODEI,NON-STRUCTURAI.,INCLUDF-S NHW Cole:mJ that my license is in full(once and effect. N'ASIiIiWDRYER IIOOK-UP I hereby alirm under penalty of perjury one of the fallowin@ two declarations: I have and%%ill maintain a certificate of consent to self-insure far Worker's Compensation,as provided 1'or by Section 3700 of the Labor Code,for the performance of the work for which(tris 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 die work for which this Sq.Ft Fluor Arca: Valuation:$25000 permit is issued. AI'PLIC.\N"I'CEK'I'IP'IC,\'I'IfIN AI;NNumber:31643003.19986 Occupancy Type: I certify that I have read this application and state tial the above information is correct. I agree to comply with all city and county ordinances:ad state Imes 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 EMPIRES IF WORK IS NOT STARTED indemnity and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accreagainst said City in consequence ollhe WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicator understands and will comply 18U DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 4 Signature Date (Z Issued h �J_Z� DaIe:O —O — ❑ OWNER-RUILIIER DECLARATION Rh;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 roof is the following nm 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: 1,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business&Professions Code). ALI,110017COVIiR1NGS TO RE CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS NIA•1'ISRl,%lS[)ISCI.OStIRI. Compensation,as provided for by 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 for which this permit is issued. California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance wilh the Cupertino Municipal Code,Chapter 9.12 and the flealth& Section 3700 ofthe Labor Code,for the perfommance of the work for which this Safety'Code,Section 25532(8)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 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 Ilealth&Safety Code,Sections 25505,25533,and 25534. Conipensetion laws of California. If,after making this ceniticate of exemption,.I become subject to the Worker's Compensation provisions of the Labor Code,I must \)ss'ner-or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. [)me; \I'1'LIC,\N'I'CPI2'I'I PICA.LION CONSTRUCHON LENDING AGENCY I certify that I 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 complywith all city ad county ordinances aid state laws relating for which this pemnii is issued(Sec.3097,Civ C.) to building construction,mid 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 Cin'in consequence of the granting of this permit.Additionally,the applicant understands and will comply ,\KCI II'I'FCI"S DECLARATION %%ith all non-point source regulatiams per the Cupertino Municipal Code,Section 9.18. 1 understrld my plans shall be used as public records. Signature Date Licensed Profeminnal 1- C-N-1k E'`r-' - ( 2- CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION p� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Ictl p B CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingecupertino.oro �05 ` ❑ NEW CONSTRUCTION ❑ ADDITION CZALTERATIONITI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS f (f)(4 APN 4J/ OWNER NAME6�5f7� PHO �jNFy ��C�� E-MAIL STREET ADDRESS 6-, �_Ur„„- ` ^l— CITY, STATE,ZIP�� ^'" /O•� FA7C CONTACT NAME �/�,L`,�/(�/ // PHONF� STREET ADDRESS ^• ^,r CITY. A(J}UZIP mfr`'•! ' ) FAX /` ❑OWNER ❑ OWNER-BUILDERWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENIANT CONTRACTOR NAMEh�om( /' /W / LICENSE NUMBER,?5-e LICENSE TYPE BUS.fy COMPANY NAME E-MAIL FAX STREET ADg vv / CITY,STATE, eIP ar 9 2f` PHONE zfE ARCHITECTIENGINEER NAN LICENSE NUMBER BUS.LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKeC A, �l v n -` � y/� _� 9 I 1 I OP (� IANC- ( BVI JLec1PYOx�IJNJ 1�/wW� /ecyyn FI)Zlqt� - . new EXISTING USE PROPOSED USE CONSTR.TYPE 1 4STORIES USE IyWE SQ.FT. VALUATION(S) EXISTG ARENEW FLOOR DEMO TOTAL — 13 �!^ L+a AREA AREA AREA TOTAL TAREA r '�/ -Zo BATHROOM I KITCHEN OTHER / REMODEL:RR< �_ ,SPO REMODEL AREA I REMODEL AIIFA PORCH AREA DECK AREA TOTAL DECIOPORCH ARE\ GARAGEAREA: EIDETACH ❑ATTACH Y DWELLING UNIITS: ISASECONDUNIT OYES SECONDSTOR\' AYES BEING ADDED? ONO ADDITION'. ONO PRE-APPLICATION ❑YES MYES,PROMECOPYOP IS THE BLDGAN ❑YES RECEIVED BY: - TOTAL VALUATION: PLA.NNINGAPPLN ONO PLAN ENG APPROVAL LETTER EICHLER UOMF:'. 0 N By my signature below,I certify to each of the n the'rope y owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have pr ed is c n ha read t Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b din maho ` representatives of Cupertino to enter the above-idem�ied property for inspection purposes. Signature of Applicant/Agent-. ' - Date: L SUPPLEMENTAL INFORMATI 1 REQUIRED _ PLtNCHECK-TYPE, ROUTING SLIP 4. New SFD or Multifamily dwellings: Apply for demolition permit for L .pW�R+T VCOUNTER BUniDIL7 NGPLAN REv1Ew existing building(s). Demolition permit is required prior to issuance of building permit for new building. ''❑ EXPRESS ❑ PLAN'N'ING PLAN REVIEW - _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAN'DARD ❑ PUBLIC WORKS Tom if any Hazardous Materials are being used as part of this project. ' ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to - submittal of Building Permit application. ❑ •ALUDR . ❑ SANITARI SEN'ER DISTRICT ❑ FNVIRONMENLAEIIEALTIL_ BldgApp_2011.doc revised 06/2//11