10050034CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19990 OLIVEWOOD ST APT A -D CONTRACTOR: BKB CONSTRUCTION, LP PERMIT NO: 10050034
OWNER'S NAME: ESSEX PROPERTY TRUST 2812 TRINITY SQUARE DR STE 110 DATE ISSUED: 07/01/2010
OWNER'S PHONE: 6508151622
CARROLLTON, TX 75006 PHONE NO: (972) 478-2255
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic. b �° ��
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date %
JOB DESCRIPTION: EXTERIOR RE -SIDING TO AN EXISTING APT BLDG,NEW
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
ENTRY TRELLIS,WINDOW,DOOR REPLACEMENT THRU-OUT;SEE
(commencing with Section 7000) of Division 3 of the Business & Professions
10050005 FOR FEES & PLAN CK COMMENTS.
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $68965
Section 3700 of the Labor Code, for the performance of the work for which th,)s
permit is issued.
APN Number: 31643003.19990.A -D
Occupancy Type:
APPLICANT CERTIFICATION
certify that I have read this application and state that the ab ion is
correct. I 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 EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point so c regulations per the Cupertino Municipal Code, Section
9.18.
Issued by: Date:
Signature Date
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❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
hereby affirm that 1 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.
will 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
I 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
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
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 wit 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 & Safe ctions 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, I must
O
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
1 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 er the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
- 0an
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
/0050034-
Date: I
APN # J / - D C� ) �
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Building Address: 7
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Mailing Address(if different from building a ress): I
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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 � e:
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Phone #:
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Contractor:
Contractor:
Phone:
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Fax: &50 "'3zo ^
Contractor License #: f�� t��-J ( ekx;( 61
Cupertino Business License #: 2
Contact: i A4 M/ P one: &5,70• $a z • bg &S
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Residential Commercial ❑
Job Description: &k4—,
Building Permit Info:
BldgZ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
II/III/V-A ❑ IUIII B, IV -HT, V -B K�
-' I
Valuation: Square Footage:
_
dl 1� S
Project Size: Express ❑ Standard ❑ 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 www.builditgreen.or14
Revised 07/14/09