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10010081 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010081 BUILDING ADDRESS: 10658 MAPLEWOOD RD APT A,B,C,D DATE ISSUED:01/25/2010 2552 SEABOARD AVE OWNER'S NAME: ESSEX PROPERTY TRUST PHONE NO:(408)855-8348 SAN JOSE,CA 95131 IER'S PHONE: 4088558348 .. CONTRACTOR'S DECLARATION RMIT INFO: BLDG r ELECT PLUMB ❑ LICENSED CONTRA BUILDING PE License Class—C Lic.# ��. MECH RESIDENTIAL COMMERCIAL Contractor Date 7 .TOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT 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. 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 Valuation:$2500 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APN Number:31643003.10658 A-D Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information isRMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating PE to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keepharmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the Y J'� granting of thinf��i t. Additionally,the applicant understands and will comply Date: g gy: with all non- nt rce regulations per the Cupertino Municipal Code,Section Issued b ..- 9.18. Date Signature RE-ROOFS: DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is Li OWNER-BUILDER DE installed without 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 inspection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 2 ode Chapter 33,and 25534. 1 will 9 12 and the Health&maintain I have and will maintain aance with Compensation,as provided for by Section 3700 of the Labor Code,for the SafetycomplCode Section 25532(a)should Istore or handle hazardous material. P Safety performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this main in compliance with the Cupertino M 3 and 25534unicipal e�Chapter 9.12 and the permit is issued. H th Safety Code,Sections 25505,2553 , I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's wner o ized age Date: oG AJ 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm 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 eaes and stave te laws relating ation is Lender's Name correct.I agree to comply with all city and county to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION unify and ke harmless the City of Cupertino against liabilities,judgments, and exp ses hich may accrue against said City in consequence of the granting of s permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. g g with all no point so ations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Date Signature CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 60 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 .10658 A-D DATE ISSUED. . . . . . . : 0100 RECEIPT # . . • • • • . . . : BS0000096 13 REFERENCE ID # 10010081 SITE ADDRESS . . . . . : 10658 MAPLEWOOD RD APT A,B,C,D SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST ADDRESS . . . . . . . . . . : 10696 ROSEWOOD RD APT A-D CITY/STATE/ZIP . . . . CUPERTINO, CA 95014 RECEIVED FROM . . . . : ALLAN UY CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 QUANTITY AMOUNT PD-TO-DT THIS--------- C- -_NEW-BAL- FEE ID UNIT 4 ---------- ---------- -- _______ --------- -- ------- 1 . 00 VALUATION 0 . 00 1.00 0 . 00 1BCBSC 21. 00 0 .00 21. 00 N 2, 500 . 00 1.00 0 .00 1BPWSVCS WATER SERVICE 0 . 63 0 . 00 0 . 63 0.00 1BSEISMICO VALUATION 21500 . 00 0 . 00 42 . 00 0 .00 1 .00 42 . 00 42 . 00 0 . 00 00 1PPERMITFE FLAT RA'Z'E 1 . 42 . 00 0 . 00 -__ 1TRAVDOC FLAT RATE --------- ---------- ---------- ------ 106 . 63 0 . 00 106 .63 0 . 00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION--------- -------- --- ------------------------ -------- -------- 106 SEWER & WATER 103 UFER 507 FINAL PLUMBING CITY OF CUPERTINO I coo o� I ._,:� REPIPE/S EWEIN SERVICE CITY OF PERMIT APPLICATION FORM CUPEkTINO [�AKPN Date: 'N � C_ 94:-;0 t Building Address: 110 �A Phone#- Owner's Name: LZ�-- 1111 4- ell, Phone#: ) `�'t � f Contract Vic c . Fax#: �- Phon � � �,��'� �� e#: Contact: Fax#: -------------- Contractor License#: Cupertino Business License#: Job Description: IIt�L R bm/n�_V\� Commercial Residential F-1 Valuation: 4 ; Project Size: ExpressF] StandardLJ Large Major❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit.Type Gr2yp IPCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets IBCBSC Cal Bldg Standards Commission B ALL PERMIT — Fee Commercial P TYPES IBSEISMICOM Seismic Comm Revised 01/07/09 0-FCUP ERTIN0 CITY E/SEWE IN P Pxr, FEE SCnEDULE CUP R. E T1N0 Fee permit Type Fee Description Grou YT Fee ID ALL PERM Quantity Commission B TypES Cal Bldg Standards 1BCBSC Fee P SEISMICR Seismic Residential P 1RPS S 1B Residential building sewer 1RPRP 1PRSEWER Sewer/sanita sew p Re, re-pipe Per fixture 1PRREp�E R P 1CPWS or CS Water Service 1RP'W S 1BPw'SV l System P .i IPP RSEW G private Sewage Dlsposa Y P S Cesspool 1PCES P Install/alter Water Pipe 1 BPW ATER P URE Plumbing Fixture 1BPFIXT P 1PGASRES R esidential Gas Piping System 1-4 Outlets P pi ing System 5+ Outlets 1BPGAS Gas p P plumbing P errnit F ee Issuance IPP FEE P P Plumbing Plan Check IP LNCK P 1PLMBINSP other plumbing/ gas Insp. B Travel S., Documentation Fee - IT 0C Tra B 1BUSLIC Business License Community Development 10300 Torre Avenue F Cupertino CA 95014 w 'd Telephone(408)777-3228 Fax(408)777-3333 CITY OF '"UPEkTINO Buildl"�Dyepartment OB ADDRESS: ' PERMIT # OWNERS NAME: E�� PHONE # L�5 � -5C6-5 S eA GENERAL CONTRACTOR: W, FAX # (-�05 c. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner Contractor Signature