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10080038 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10657 ROSEWOOD RD APT C CONTI:ACTOR:W.GARCIA PERMIT NO: 10080038 CONST>,UCTION INC OIVNER'S NAME: ESSEX PROPERTY TRUST,INC 3400 El,CAMINO REAL STE 9 DATE ISSUED:08/04/2010 NER'S PHONE: 6508151403 SANTA CLARA,CA 95051 PHONE NO:(408)553-0210 ❑ LICENSED CONTRACTOR'S DECLARATION / �7 BUILT;ING PERMIT INFO: BLDG� ELECT f— PLUMB� License Class Y-G Lic.# cJ 25 /�� 4oate RESIDENTIAL COMMERCIAL � 1'1/ Contractor ,a,-U* & ate OO ��61(_I I hereby affirm that I am licensed under the provisions of Chapter 9 JOB D ESCRIPTION: LAUNDRY REMODEL NON-STRUCTURAL (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I 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. Sq.Ft F oor Area: Valuation:$8000 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 permit is issued. APN Number:31643004.0 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save W_[THIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1811 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit, ddInonally,the applicant understands and will comply with all non-point sourc regulations per the Cupertino Municipal Code,Section Iry: 9.18. Issued ,� .-- Date: Signature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed vithout first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspectio i. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have re id the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Ci ode,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Addition illy,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contamir,ants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety C0191 Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner rn aut t: Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby a ffirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name ,orrect.I agree to comply with all city and county ordinances and state laws relating :o building construction,and hereby authorize representatives of this city to enter Lender's Address -*r the above mentioned property for inspection purposes.(We)agree to save nnify and keep hannless the City of Cupertino against liabilities,judgments, .,,,rs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ,,ranting of this permit.Additionally,the applicant understands and will comply I understa id my plans shall be used as public records. vith all non-point source regulations per the Cupertino Municipal Code,Section ).18. Licensed Professional signature Date CITY OF CUPE RTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lct: APN 316430C4 .0 DATE ISSUED. . . . . . . : 08/04/2010 RECEIPT #. . . . . . . . . BS000031094 REFERENCE ID # 10080028 SITE ADDRESS . . . . . : 10657 POSEWOOD RD APT C SUBDIVISION . . . . . . . CITY CUPERT::NO IMPACT AREA . . . . . . . OWNER ESSEX :?ROPERTY TRUST, INC ADDRESS 10657 -ZOSEWOOD RD APT C CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM WILFREDO GARCA CONTRACTOR WILFREDO GARCIA LIC # 31681 COMPANY W. GARCIA CONSTRUCTION INC ADDRESS 3400 EL CAMINO REAL STE 9 CITY/STATE/ZIP SANTA CLARA, CA 95051 TELEPHONE (408) 553-0210 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL - ---------- ------------- ---------- ---------- ---------- ----- 00 1BCBSC VALUATION 8, 000 . 00 1 . 00 0 . 00 1. 00 0 • 1BSEISMICR VALUATION 8, 000 . 00 0 .80 0 . 00 0 .80 0 .00 1REMRESOTH SQ FEET 100 . 00 = 80 .00 0 . 00 380 . 00 ------0_00 ----- ----- ---------- --------- TOTAL PERMIT : ; 81.80 0 .00 381 . 80 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------ CREDIT CARD 381 .80 V:_SA --------------- TOTAL RECEIPT 381 . 80 M.Indoor Air Ouality and Fm s es 1 IAaHEalth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IA Mealth pts y--yes 0 31AQi�Iealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/iealth pts y=yes 0 S.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/-lealth pts y-yes 0 _. 4 IAQ/isalth. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resc urce pts Y--yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Resc urce pts y=yes 0 10.Install Whole House Vacuum System 3 IAQIealthis es P Y=Y 0 N.Fiaoring . 1 1 1 1.Select FSC Certified Wood Flooring_ 8 Resou-ce pts y=yes 0 =— ---- —--- 4 Resou-ce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resou-ce pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/H:alth pts y=yes 5.Use Exposed Concrete as Finished Floor 0 4 Resou ce pts y=yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Resow ce pts y=yes 0 1 ! 1 Total Points Avai a le: 140 130 57 Total Points Project Received: ` 0 0 0 Gdata/prDWJreenbuilcRnggd serines/remodelers/gresnpointsfina1272D4protectedxls CITY OF CUPERTINO ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# Date: Ll X14110 Is a 2°d unit being added? Yes ❑ NoIfes, please fill out the ermi a lication for 2°d unit. Building Address: © 6 S 7 wcVc) Mailing Address (if different from building address): Owner's Name: Phone# r3 f'1 Contractor: r I Phone#: lv S' y jy j L1 !%c.` W n ArFax#: e)S" 5 Z�0- I q06 Cupertino gusiness License: State Contractor License#: '3q,,-k 3 C C) Contact: Phone#:65 ID L C)` Ca 1 X 3 Y)\POkr_&u 11 C 0 Fax#: J uk 61%rA`-1 Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Waiter-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Waa ter Budget Building Permit Info: Bldg. 0 Elect. Plumb. Q Mech. Q Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled(not including addition)? Remodel Includes Re-Roof Yes ❑ No © If y,-s list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other/2�t) Type of Construction(Usage Class): Occupancy Type* 1-A, 1-B ElII/III/V-A ❑ II/III B, IV-HT, V-B �- Valuation: o0 f9 Please check this box if the project is a Project Size: Express ❑ Standard ❑ Large ❑ Ma'or❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. Revised 05/18/10 CITY OF CUPERTINO FEE ESTIMATOR- BL ILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: $8,000 ;PERMIT TYPE: Building Permit PLAN CHECK TYPE: 'Alteration/Addition/ Repair PRIMARY SFD or Duplex OVER THE APPLICATION USE: p COUNTER? 0 Yes (F)No TYPE: 1 R3SFDADD/REM i F7 ry Yw � a O O 3 � NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (hee Resolution 09-051 l/f' i:'/.'091 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 s.f. Remodel, Other Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 $380.00 IREMRESOTH PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes Q No $0.00 Work Without Permit? ® Yes (F) No $0.00 E) Planning<=Le: $0.00 Select a Non-Residential E) ; Building or Structure o i Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Sids Commission Fee: IBCBSC $1.00 h TSUBTOTALS: � µ $381. . E .80 Revised: 7/28/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST EOBDDRESS: lO (v S 5 G�k: tB RMITR'S E: sSE 2 ETL S ONE# GGENERAL CONTRACTOR: (�t/.Ezct u' (i SINESS LICENSE# (( 3UC S ADDRESS: � bLI SJR V `� CITY/ZIPCODE:Siin, 11 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCYICONTRACTORS ION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL S BUSINESS LICENSE. I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: %/ SUBCONTRACTOR BUSINESS 1\AME BUSINESS LICENSE # Cabinets & Millwork ment Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering ` Plumbing 4,� P ' Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date