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10010103 Y OF CUPERTINO BUILDING ING PERMIT PERMIT NO:10010103 OD RD APT A,B, , BUILDING ADDRESS: 10678 MAPLEWO CD CONTRACTOR:GENMOR PLUMBING 2552 SEABOARD AVE DATE ISSUED:01/25/2010 OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131 PHONE NO:(408)855-8348 NER'S PHONE: 6508495835 �— BLDG ELECT PLUMB LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: 5 9 r r—45 COMMERCIAL� License Class Lic.# MECH RESIDENTIAL Date '" JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT Contractor I hereby affirm that am licensed un 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 onsent to for two declarations: I have and will maintain a certificate°�on 3700 of the Labor Code,for the Valuation:$2500 FAPN Ft Floor Area: performance of the work for which this permit is issued. as provided for by I have and will maintain Worker's Compensation the erformance of the work for which this Occupancy Type: Section 3700 of the Labor Code,for p Number:31643004.10678 permit is issued. APPLICANT CERTIFICATION W0�IS NOT STARTED I certify that I have read this application and state that the es and aabove te laws relating PERMIT EXPIRES IF with all city and county ord IT ISSUANCE OR correct.I agree to comply WITHIN 180 DAYS OF PERM to building construction,and hereby authorize representative S(We this to savter ED INSPECTION. upon the above mentioned property for inspection purposes. ments, 180 DAYS FROM LAST CALL indemnify and keep harmless the City of CupertindoCgainntclOn consequence of the /U costs,and expenses which may accrue against said h' o ds and will comply Date c the applicant understan granting of this pe it. Additionally, Issued by' with all non-po' t s urce regulations per the Cupertino Municipal Code,Section 9.18. �,..�i1,�� i Date� (� Signature RE-ROOFS: All roofs shall be inspected prior to any roofing material emo a all installed. ew materialsof ifor LJ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. Date: the following two reasons: Signature of Applicant: I as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, COVERINGS TO BE CLASS"A"OR BETT Business&Professions Code) acting with licensed contractors to ER ALL ROOF I,as owner of the property,am exclusively contr construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE affirm under penalty of perjury one of the following three i I have read the hazardous materials requirements 25533,andnder Chapter 25534.9I will maintain I hereby 5 of the aff declarations: nsent to self-insure for Worker's California Health&Safety Code,Sections 255059hapter 9.12 and the Health& I have and will maintain a Certificate of Co f the Labor Code,for the compliance with the Cupertino Municipal Code, provided for by Section 3700 o Safe Code,Section 25532(a)should I store or handle hazardous material. Compensation,as h' equipment or devices which emit hazardous air performance of the work for which this permit o issued.satprovided for by Additionally,should I use equip Area Air Quality Management District I will contaminants as defined by the Bay Chapter 9.12 and the I have and will maintain Worker's Compeuof the work for which this maintain compliance with the Cupertino Municipal Code, Section 3700 of the Labor Code,for theperformance Health S fety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is iorker'shal Ow r t iz ent: /tel not employ any person in any manner so as to become subject to Date: !CJ Compensation laws of California. If,after making this certificate Labor Codexemptiol must ENCY P become subject to the Worker's Compensation provisions oft CONSTRUCTION LENDING A forthwith comply with such provisions or this permit shall be deemed revoked. I hereby eb 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 have read this application and state that the above informationlaws relating Lender's Name I certify thatordinances and state correct.I agree to comply with all city and county ent to building construction,and hereby authorize representatives of this city to saveer Lender's Address upon the above mentioned property for inspection purposes.(We)agree judgments, ARCHITECT'S DECLARATION �.nify and keep harmless the City of Cupertino against liabilities, a used as public records. and expenses which may accrue against said City in consequence of the l I understand my plans shall b granting of p e it.Additionally,the applicant understands and will comp y with all non oint s rce regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Q --Je Date � Signatur CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 60 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643004 .10678 DATE ISSUED. . . . . . . 01003 RECEIPT #. . . . . . . . . : BS000096 REFERENCE ID # 10010103 SITE ADDRESS . . . . . : 10678 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 QUANT _ ---------- ---------- --- _____ ------- --------- 0 .00 1 . 00 0 . 00 -- 2, 500 .00 1 .00 21 . 00 0 . 00 1BCBSC VALUATION 1 , 00 21.00 0 .00 1BPWSVCS WATER SERVICE 0 .00 0 . 63 0 . 00 2, 500 . 00 0 .63 42 .00 0 . 00 1BSEISMICO VALUATION 1 . 00 42 . 00 0 .00 0 . 00 1PPERMITFE FLAT RATE 42 . 00 0 .00 42 .00 - 1 .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 CITY OF CUPERTINO MAINSERVICEREPIPE/SEWE .- RI CITY OF PERMITT APPLICATION FORM CUPEk*1 INU Date: APN 5 C)C> -Suilding Address: C� . t ou I )t)(4 Phone#: Owner's Name: Phone#: r Contractor: Fax#: CPhone#: ��j<�� 1�—Z��-� Contact: Fax#: off Contractor icense#: -�Fl Cu ert Job Description: Residential ❑ Commercial Valuation: I Large' Major............................... Project Size: Exprif]!!3E��i D Stan M r F� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the t & the sheet index. application or if applicable,include in plan se Green Building Points: Quantity Fee ID Fee Description Fee permit.Type Group�e Permit 13UI3 IPCSEWER7sewer/sanitaryommercial building P 1CPSS sewer 1CPRP 1BPREPIPE Commercial re-pipe per fixture P IPGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT IBCBSC Cal Bldg Standards Commission TYPES Fee IBSEISMICOM seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO ao INSERVICE A- REPIPE/SES�no� F--- SCHEDULE CUPEf�T1N0 Fee Permit Type Quantity Fee ID Fee Description Grou ' 'on B ALL PERMIT SC Cal Bldg Standards Commission TYPES � 1BCB Fee P 1BSE ISMICR Seismic Residential P 1RPSS 1P RSEWER Residential building sewer/sanitaq sewer fixture P IRPRP Residential re-pipe per 1PRREPIPE P 1CPWS or 1 .PWSVCS Water Service IRPWS G Private Sewage Disposal System P 1 PPRSEW P 1PCESS Cesspool ATER Install/alter Water Pipe P IBP W P 1BPFIXTURE Plumbing Fixture 1 PGASRES Residential Gas Piping System P 1-4 Outlets utlets P 1 BPG AS Gas Piping System 5+ 0 P 1 PPERM ITFEE Plumbing Permit Fee Issuance P 1PLMB LNCK Plumbing Plan Check P 1P LMBINSP Other Plumbing/gas Ins p• Travel & Documentation Fee B IT OC ` B 1BUSLIC Business License Community Development 10300 Torre Avenue Y.. Cupertino CA 9501 Telephone(408)777-3228 =_ Fax(408)777-3333 CITY OF ,"UPE TINO In De artm ant B-u'old'* � o -� PERMIT # JOB ADDRESS: 1 C ` PHONE # 0 OWNER'S NAME: ' , FAX # (p er L-`� D 3 GENERAL CONTRACTOR: 1 vly 0, A) I am not using any subcontractors: Date Signature Please check applicable subcontractors and com lete the f ollowi.n information: EO I SUBCONTRACTOR BUS INESS 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/ Wa1lpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock ile Date Owner/Con ctor Signature