14060013 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19900 OLIVEWOOD ST CONTRACTOR:ABE CONSTRUCTION,INC PERMIT NO: 14060013
OWNER'S NAME: ESSEX THE POINTE LP 1233 MIDAS WAY DATE ISSUED:06/03/2014
OWNER'S PHONE: 6504943700 SUNNYVALE,CA 94085 PHONE NO:(408)734-8416
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO• BLDG r ELECT I— PLUMB f—
license Class CZd G kic.# 3 q `7
9 r j"
// � MECH RESIDENTIAL COMMERCIAL
Contractor �}� Gdi'�7Y PIG OIl 1JKHate
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT B-REMODEL BATHRROM(120 SQ FT);KITCHEN(160
(commencing with Section 7000)of Division 3 of the Business&Professions SQ FT);ADD NEW LAUNDRY ROOM,UPGRADE ELECTRICAL
Code and that my license is in full force and effect. PANEL AND PLUMBING
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.
I e and will maintain Worker's Compensation Insurance,as provided for by
S n 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$24000
ermrt is issued.
APPLICANT CERTIFICATION APN Number:31643004 19900 Occupancy Type:
I certify that 1 have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws 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 EXPI IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Y
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 D1�YS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAS LED`INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18
Issued by: Date:
Signature � sf� Date t!/
y�
❑ OWNER-BUILDER DECLARATION --- -�'
RE-ROOFS:
I 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 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.
wil I do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I 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(a)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 Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner oCaa4h
wized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION 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 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 source regulations per the Cupertino Municipal Code,Section
9 18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
a
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Ggi0id'Ul,ITY DEFIELOPAMENT DEPARTMENT=BU LDING DIVISION'
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❑nwNER I7 mVNr e tr1 DER ❑ owTa Ac�lur CaNrrnaroa ;❑CONTrLACSORAGENT ❑ ARCMTSCT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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STREET ADDRESS LST'Y,SSA1E,ZtP ,PRONE '.
ARCHITECT/ENGATEERISAME LICENSE NUMBER• :BLS.LTC#..
COMPANYNAME E; y
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DESCRIPTTON OF WORK
16
EXISTING VSE PROq CONSTIL TYPE #STORIES
"Y LJSE'' TWE '.00C. SQFT_ VALUATIONImEXIS
NEW FLOOR •UEivFO TOTAL
AREA t .'t1 AREA f ARitA NE3`AREA •l7 .f p'La {,T �•
BATtiP.O{obs 1•� xir`CHEN. OTFIER 1T"
REMODEL AREA' R:Ehob L:B; k-WODIMAREA
PORCEAREA DFJMA.REA T'OTALDECMJ ORMAR,EA` GARAGEAREA: DETACH
BATTACH
#DWMLTNO UNITS: 7S A STtCOIv�IIPiiT [,IYES� SECOND STORY YES
TiEP.1G ADDED. e IND ADAIITO�'? ONO
PRE-APPLtC4.T10N (]YES Lx YsS,PR0VM9_COPYOF ,ISTBEBLDGAN ❑?"rS gECE1VID BX: - TO VAS,UAITO?4:
PL4*R31*IG ADPL#. [,]NO PL4NNII�IG APPROYALLb713R ' raMERHOM? ❑No
By my signature below,I certifyto aach of tha foIIowing Iain the property own".or authorized agent to act on the property owner's be £ I Have read this
application and the information I have provided is.coiieot,T bave read the Description of Work and verify it is acctiu-atr. I a�rec to comply with ail'appFcablc local
ordinances and state laws relating-to ation I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: Date:
SUPPLEMZ1\TTAI INFORIi?ATION3 E•QUiRED• PLANC�oEcxTYPE RovrrnGSLIP
New SFD or Multifamily dwellrags..Apply for demolition permit fOi p DYER-Tim eouvrER ❑ slm Dine rr nN Iw7w
existing building(s). Denolitionpermitis regniredprior,to issuance ofbuilding
permit for near building. D sxPRisss ❑ PLANNING PL&N REVIEW
_Commercial Bldgs_'_ProYide a completedTiazardous Materials Disclosure D STAN'DARb ❑ PraLrewoxics
form if any Hazardous Materials.aie being"used as tial##of this project ❑ r axG ❑ DEPT
_Copy of Planning Approval T.eiter or Meeting wit st Plannnig prior to ❑ ❑ S4NTTARY sEwERDIsrRicT
submittal of Building Permit application. MAaox
MEONMENIT_4111EALTH
BIdgAPp_'2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19900 Olivewood st#B DATE: 06/03/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$24,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP
WORK APT B - REMODEL BATHRROM 120 SQ FT • KITCHEN 160 SQ FT • ADD NEW LAUNDRY ROOM
SCOPE UPGRADE ELECTRICAL PANEL AND PLUMBING.
;1,wdc , F'?ar!(,,,cx# .1 0.0 1 hrs $0.00
Llteat. Pc rfait Fee: Permit Fee: IEPERMIT
C1the ;lec�i.Ir�sp. Other PhItnb Irish, Other Elec.Insp. 0.0 hrs $47.00
ilc�cr r/i.�tJ. f>�e� I'lunih. hisp. Fee: (>!<c_
NOTE. This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn7 info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 120 amps Electrical
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $47.00 IBELEC200 Services
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes (E) No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 1 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
unstr-rr(iion I tiX.°
Administrative Fee: 1ADMIN $44.00 C)
Work Without Permit? ® Yes (F) No $0.00 (F)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure
A
Strom-Motion Fee: IBSEISMICR $2.40 5.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $695.00 1STINSP Inspection,Hourly
s - _OPAL FEE: $883.40
$141.40 $742.00 , �: .
Revised: 04/01/2014