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10010113 CITY OF CUPERTINO BUILDING PERMIT 69 MAPLEWOOD RD APT A,B,C,D CONTRACTOR:GENMOR PLUMBING PERMIT NO: 100101 l3 BUILDING ADDRESS: 106 DATE ISSUED:01/25/2010 2552 SEABOARD AVE OWNER'S NAME: ESSEX PROPERTY TRUST PHONE NO:(408)855-8348 SAN JOSE,CA 95131 vER'S PHONE: 6508495835 ELECT PLUMB 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG License Cl s Lic.# ME CH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT I hereby affirm that I am licensed un el ion 3 of the Business&e provisi!ons of tProfessions (commencing with Section 7000)of Div 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 the Labor Code,for the -insure for Worker's Compensation,as provided for by Section 3700 of Valuation:$2500 performance of the work for which this permit is issued. Sq.Ft Floor Area: rovided for by I have and will maintain Worker's Compensation Insurance,as p Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31643003.10669 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state o t the above es and state laws relating n PERMIT ation is EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county construction,and hereby authorize representatives of this city to enter WITHIN DAYS OF PERMIT ISSUANCE O to building cses. agree to save upon the above mentioned property for inspection ertino again liabilitiejudgments, 180 DA OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cup g e of the costs,and expenses which may accrue against said understands and will comply Date: ity in consequeric e . . dditionally,the applicant granting of this.pe p Issued by: with all non-po sourc regulations per the Cupertino Municipal Code,Section 9.18. � Date r Signature RE-ROOFS: All roofs shall be inspected prior to any roofing matto remove all new matenalsifor L OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. Date: the following two reasons: their sole compensationSignature of Applicant: I,as owner of the property,or my employees with wages as , will do the work,and the structure is not intended or offered for sale(Sec.7044, S TO BE CLASS"A"OR BETTER Business&Professions Code) ALL ROOF COVERING 1,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 Sections 25505, undo and 25534.er69I of the maintain declarations: Chapter 9.12 and the Health& in a Certificate of Consent to self-insure for Worker's California Health Cupertino Code, I have and will maintain compliance with p Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. P performance of the work for which this permit is issued. Additionally,should I use equipment ora Air Quality Management District I will p provided for by I have and will maintain Workers Compensation Insurance,as p contaminants as defined by the Bay Are Chapter 9.12 and the mainta' c pliance with th ns uperti 25533,rand 25534icipal e� Section 3700 of the Labor Code,for the performance of the work for which this l &S e Code,Sectio permit is issued. no Hea h' I certify that in the performance of the work for which this ec of the issued, O er or orize ent: n in an manner so as to become sub�e Date: not employ any person y Compensation laws of California. If,after making this certificate l oexemption,Cod n rovisions of the must become subject to the Worker's Compensation forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENC performance of work's I hereby affirm that there is a construction lending agency fort e p APP LICAN T CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certifythat I have read this application and state that the above information stal do relating Lender's Name correcI agree to comply with all city and county ordinances natives n this city to enter Lender's Address to building construction,and hereby authorize p purposes.(We)agree to save upon the above mentioned property for inspection ARCHITECT'S DECLARATION -mnify and keep harmless the City of Cupertino against liabilities,judgments, ,,and expenses which may accrue against caaild City in consequence understands and will of I understand my plans shall be used as public records. granting of this pe i.Additionally,the apple with all nulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. r-- Date J1- Signaturzl!LL CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 60 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31643003 .10669 DATE ISSUED. . . . . . . 01/ 0 RECEIPT # . . . . . . . . . : BSO000096 13 REFERENCE ID # . . . : 10010113 SITE ADDRESS 10669 MAPLEWOOD RD APT A,B,C,D SUBDIVISION : : : _ _ : . CUPERTINO CITY . IMPACT AREA . . . . . . : OWNER ESSEX PROPERTY TRUST 10696 ROSEWOOD RD APT A ADDRESS -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-REC- --NEW-BAL- FEE ID UNIT QUAN _ ---------- ---------- --- ______ -------- --------- 0 . 00 1. 00 0 . 00 VALUATION 2, 500 . 00 1. 00 21. 00 0. 00 1BCBSC 1. 00 21. 00 0 .00 0, 00 1BPWSVCS WATER SERVICE0 .63 0 .00 0 . 63 1BSEISMICO VALUATION 21500 . 00 0 .00 42 . 00 0 . 00 1.00 42 . 00 42 . 00 0 . 00 00 42 . 00 1PPERMITFE FLAT RATE 1. 0 . 00 _---___ 1TRAVDOC FLAT RATE ________-- ---------- ---------- --- 0 . 00 106 .63 0 .00 106 .63 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---- -------- ---------------------------- -------- ---------- 106 SEWER & WATER 103 UFER 507 FINAL PLUMBING I CITY Of OF CUPERTINO REPIPE/SEWE RIMAIN SERVICE UP T N PERMIs�PL ICATION FORM Date: APN # (� I L-3 1 — 0 1 Building Ad 1 (0( Phone#: Owner s Nar,,,%, , _ Phone #: Cc-(�r,� , j 1 ��L� Contractor: - - Fax#: Phone #: Contact: -o Fax 4: Contractor License Cupertino Business License#: Job Description: Commercial Residential ❑ Valuation: e5D � Ma o StandarLarr d ❑ Large 'P ❑ Project Size: Express ❑ to the ' n of the Green Building Checklist & attach it Green Building: Please complete relevant portio • nlicahle. include in plan set & the sheet index. apJL nl�cat�on nr�f a p, Green Building Points: Type • Fee Permit yp ' Fee ID Fee Description Quantity Grou P 1CPSS 1PCSEWER Commercial building sewer/sanitary sewer 1CPRP l BPREPIPE Commercial re-pipe per fixture P GASCOM Commercial Gas Piping System P 1P 1-4 Outlets B ALL PERMIT 1 BCBS C Cal Bldg Standards Commission TYPES Fee P 1 BSEISMICOM Seismic Commercial Revised 01/07/09 CITY OF ......................................... CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE CUPERTINO Quantity Fee ID Fee Description Fee Permit Type Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P r 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 )777-3228 Telephone(408 Fax(408)777-3333 CITY OF DUPE INO • BuildyingDeartm ant PERMIT # P JOB ADV3 � c PHONE # 5 OWNERS NAME: FAX # GENERAL CONTRACTOR: �' r I am not using any subcontractors: Date Signature • tractors and co lete the f ollowin information: Please check applicable subcontractors E BUSINESS LICENSE # SUBCONTRACTOR BUSINESS NAM 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 ka,20 Date owner/Contractor Signature