13050166 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19900 OLIVEWOOD ST CONTRACTOR:ABE CONSTRUCTION, PERMIT NO:13050166
INC
OWNER'S:NAME;,,ESSEX PROPERTY TRUST
528 E WEDDELL DR STE 4 DATE ISSUED:05/22/2013
OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94089 PHONE NO:(408)734-8416
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL
UNIT D-REMODEL BATHROOM,KITCHEN ADD NEW
License Class _1 LAUNDRY
Contractors�7S�ivc �/7 Date S 2 ROOM,UPGRADE ELECTRICAL PANEL
I hereby affirm that I,am licensed under the provisions of Chapter 9
(commencing with Section 7000),of Division:3 of the Business&Professions
Code and that my license is in full force and effect.
' 1
I hereby affirm under penalty of perjuryone'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 Valuation:$24000
performance of the;work for'which this permit is issued. Sq.Ft Floor Area:
I have and will maintain Workers Compensation Insurance,as provided for by
Section;3700 of the,Labot Code for the performance of the work for which this APN Number:31643004.19900 Occupancy Type:
permit is issued.
i APPLICANT CERTIFICATION
I certify)that 1 have read is application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct)I agree to colmplwith all city and county;ordinances and state laws relating WITHIN,180 DAYS OF PERMIT ISSUANCE.OR
to building'cgnst;ustrgn,and hergbY arthorize representatives of this city to enter
upon g;aboye,mei ih neb property o�imspectio purposes. (We)agree to save 180 DA OM LAST CALLED INSPEC ION
indei►u►tfy and keep parmle's the) itylofiipertino against liabilities,judgments,
costs olid'exo$nseswltich may a gine against said City in consequence of the Issued b Date 3J
granting of this perrnif j ddtion�all}�'Ithelap licant understands and will comply y'
with al qn pgid s prce e 1 lat n er the Cupertino Municipal Code,Section
i!I RE-ROOFS:
Signature li Date 2 13 All roofs shall be inspected prior to any roofing material being installed.If a roof is
i j j I installed without first obtaining an inspection,I agree to remove all new materials for.
inspection.
❑ OWNER-BUILDER DECLARATION Date:
I Signature of Applicant:
I herebyaffirm that'1 am eiem�t from the Contractor's License Law for one of
the following two reasons:j 'I i'!! ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
T as owner of the properly,or my,employees with wages as their sole compensation,
will do the work,aiidstructure isinotlintended or offered for sale(Sec.7044,
lthe
Busil s,&Professions Code) l
t i HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property am exclusively contracting with licensed contractors to
construct the project 4Sec,7Q44 Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
IliCalifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby.9ffirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the'.
declarations I I ;' i' Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a.C,ertificate of Consent to self-insure for Worker's material. Additionally,should I use equipment'.or devices which emit hazardous
Co►npensation�as'�piovid�d for by Selc�io>,3700 of the,Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for wbt�r this!permit is issued. will maintain compliance with the Cu rt nicipal Code,Chapter 912 and
l have and will maintain YVorkerl�s.Compensation Insurance,as provided for by
the Health&Safety Code,Sec' n 25 05, 5 ,and 25534.
Section'3700 of the Labor Code,for the performance of the work for which this Date: Z
Owner or author' d agent:
permit�s issued 1
I certify,that in the performance of the work for which this permit is issued,I shall
not employ any erso in any maimierlsol as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Cgmpensationllays o C liforn?al ;Ifl afterlmakmg this certificate of exemption,I
becoml s}ibfect to,tlil�IIW rker s Gotnpensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith coin1 ,with suh provis�pnslor this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C)
Y 1 I Lender's Name
II,1,11, h l ,
Address
I I,
Lender's
11:' I I. I,I I APPLIlIANT(;ERTIFICATION
I certi that a'etr5PP111
! ls�apir�i4dtfpn iir►d,State thatthe',above information is
IYIu
correc jI'agree Yo'i Withgggggtt�tt cit}I an�1 County ordinances and state laws relating
1 .to bualtttng ggtSu t , .'�ilei Y�a}irtibrize representatives of this city to enter
upon the;aboye'irie){r tied,proppTl [j orimspection;purposes.(We)agree to save ARCHITECT'S DECLARATION
11
mdemu and keep pcarriiless the)City of Qupertitio against liabilities,judgments,
costs an exper�sesl j tip�may apc a)against said City in consequence of the I understand my plans shall be used as public records.
: I Ili : .i
grantui Igf�tii pe t dditionall}� t}iel t}ppltcant understands and will comply
with al non m, s o e lot ons'per}I}e Cupertino Municipal Code,Section Licensed Professional
9 i I I '
�� L I I'.II�II � Ijll ', i III i�llll l 111111, 1 I I I li
Signature) l: ��1111 1 i 11 I. Date:
i
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIND (408)777-3228•FAX(408)777-3333•building(cDcupertino.org ,30
❑NEW CONSTRUCTION ❑ ADDrrioN ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS IgqW OlvevCod
APN# gT0
7
OWNER NAME PH -MAIL� _LP4-Z;^ OO
STREET ADDWS ^A I FAX
CONTACT NAMEB� �n OsAP O TS l7� E-MAIL
STREET ADDRESS CITY,STATE,ZIP
FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACNAME LI SE L SE TYPE BUS.LIC#
C11WAAf
ev,l.J� E�� FAX
STREETADDRESS ,STATE,ZIP PHONE _� `�
1233 M�c�CS 1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF
1 ` (V`�
EXISTINGUSE PROPOSED USE CONSTR-TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA 2tA V--
BATHROOM KITCHEN OTHER
REMODEL AREA ,nQ REMODELAREA ' REMODELAREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: JJ DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED$ VTOTAL VALUATION:
PLANNING APPL# F]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
1 29 MD
By my signature below,I certify to each of the following: I am the property owner or authorized ag nt act on the property owner's behalf. I have read this
application and the informatio ave p is co have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel g t� ding o I authorize representatives of Cupertino to enter the above-id ntified roperty for inspection purposes.
Signature of Applicant/Ag Date: 52211.;)
SUPPLE ION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit forovER I>�couNTER El BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ExPRESs ❑ PLANNING PLAN REvmw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form 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 ❑ AiA.IoR ❑
submittal of Building Permit application. S_ANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19900 OLIVEWOOD ST#D DATE: 05/22/2013 REVIEWED BY:
APN: BP#: -VALUATION: $24,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 REAP2
USE: SFD or Duplex PERMIT TYPE: i
wORK UNIT D- REMODEL BATHROOM KITCHEN ADD NEW LAUNDRY ROOM UPGRADE ELECTRICAL
SCOPE PANEL
fech .!'ta'n,("heck Phrtnb.Alan Check
Elec.Plan Check 0.0 hrs!!0!0!
h1ec,Ir. Peenrit Fee- Plumb.Permit I,c:e: Elec.Permit Feer IEPERMIT
OtherAle InspE3
0.0 Other Plumb Insp. Other Elec.Insp. hrs $45.00
tech.Insp.Fee: Plumb. Grsp.Fee: Elec.Insp.Fee:
,NOTE,This.estimate.does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These ees are:based on the relimina information available and are onl an estimate. Contact the De t or addn'[in o.
FEE ITEMS (Fee Reso'lution,11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 125 amps Electrical
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $45.00 IBELEC200 Services
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes No $0.00
Suppl.Insp.Fee,0 Reg. O-OT 0,0 hrs $0.00
PME Unit Fee:_ $0.00
PNffi Permit Fee: $45.00
Con o-taction Tear:
Administrative Fee: IADMIN $42.00
work'Without,Permit?' ®Yes 0 No $0.00
Advanced Planning Fee' $0.00 hours Inspections
Travel:DocuinentationFee: ITRAVDOC $45.00 $665.00 1STINSP Inspection,Hourly
Strom 1kl6tiori,Fee 1BSEISMICR $2.40 Select an Administrative Item
g
Bld Stds Cote gion Fee: 1BCBSC $1.00
$135.40 $710.00 , $845.40
Revise13
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
JOB ADDRESS: IC101CO Q /Ve(,t/O()c-4 5-�- PERMIT#
OWNER'S NAME: Y1J PHONE#
GENERAL CONTRACTOR- BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:. ti &
*Our municipal code requires all businesses working in the city to have it,City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL.BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO T CTO HAVE OBTAINED A. CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 5
Signature Date
Please check applicable subcontractors and complete the following.information
Y _
SUBCONTRACTOR BUSINESS NAME =BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date