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10010083 - – CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010083 BUILDING ADDRESS: 19930 OLIVEWOOD ST APT A-D DATE ISSUED:01/25/2010 2552 SEABOARD AVE OWNER'S NAME: ESSEX PROPERTY TRUST PHONE NO:(408)855-8348 SAN JOSE,CA 95131 NER'S PHONE: 6508495835 LDG ELECT PLUMB ❑ LICENSED CONTRACTORS DECLARATION r BUILDING PERMIT INFO. B F License Cl Lic.# 3 t MECH RESIDENTIAL COMMERCIAL Contractor Date—Lia" I hereby affirm th0at am licensed nder the provisions of Chapter 9 JOB DESCRIPTION:WATER MAIN SEREVICE REPLACEMENT (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 sure for two edeclarations: I have and will maintain a certificate of consent to se 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:31643004.19930 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT 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 harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep costs,and expenses which may accrue against said City in consequence of the of rmit. Additionally,the applicant understands and will comply Date: granting with all no point urce regulations per the Cupertino Municipal Code,Section Issued by; 9.18. Signature Date RE-ROOFS: roofing material being installed.If a roof is Li OWNER-BUILDER DECLARATION All roofs shall inspected prior to any g 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: loyees with wages as their sole compensation, Signature of Applicant: I,as owner of the property,or my emp will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with 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: rtificate of Consent to self-insure for Worker's California Health&Safety Code,Sections Code Chapter 33,and 25534. 1 will 9 12 and the Health&maintain I have and will maintain a Cecompliance Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,with on 25532(a)should Istore or handle hazardous material. P h' 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 maintain compliance with the Cupertino Municipal 3 a d 25534e,Chapter 9.12 and the permit is issued. He afety Code,Sections 25505,25 , I certify that in the performance of the work for which this perme t oft is the sued, 'shall O er o u hted age �) person in an manner so as to become subs !/ not employ any p Y Date. 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 rthwith coinP Y 1 with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING fo AGENCY rformance of work's I hereby affirm that there is a construction lending agency for the pe APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is state laws relating Lender's Name correct.I agree to comply with all city and county ordinances and 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 keep harmless the City of Cupertino said City nntconsequence othe judgments, and ex which may accrue ag plans shall be used as public records. L� jng o his pe t.Additionally,the applicant understands and will comply I understand my n-point so rce regulations per the Cupertino Municipal Code,Section Licensed Professional Date/—C2 CITY OF CUPERTINO 5 ITEMS OF 45 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643004 . 19930 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT # . . . . . . . . . : BS000009609 REFERENCE ID # . . . : 10010083 SITE ADDRESS . . . . . : 19930 OLIVEWOOD ST APT A-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 . . . . : ALLLAN UY CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- 1BCBSC VALUATION 21500 . 00 1. 00 0 .00 1 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 21. 00 0 . 00 21 . 00 0 . 00 1BSEISMICO VALUATION 21500 . 00 0.63 0 .00 0 . 63 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---- TOTAL PERMIT 106 . 63 0 .00 106 .63 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 106 SEWER & WATER 507 FINAL PLUMBING C)(DI �! CITY OF CUPERTINO ... ... REPIPE/SEV'VEh►/M AIN SERVICE CITY F CUPEkTINO PERMIT APPLICATION FORM q3 •APN # Date: UC ) Buildiniz Address: Owner's Name: Phone#-. (ce JA Phone#: Contractor* 041111-n li4/1 Cr Fax#: -. Contact: Phone# ��,� ��. l_�'1�l Fax#: - ` �f:�) Z -(�� `� Contractor License#: Cupertino Business License Job Description: u- Residential ❑ Commercial ❑'' Valuation: Project Size: Express E] Standard ❑ 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: Fee Permit Type Quantity Fee ID Fee Description Group IPCSEWER Commercial building P 1CPSS sewer/sanitary sewer IBPREPIPE 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 —TYPES IBSEISMICOM Seismic Commercial P Revised 01/07/09 a CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPCITY TI�10 FEE SCHEDULE QuantityFee ID Fee Description Fee Permit Type Grou 1BCBSC Cal Bldg Standards Commission B ALL PERMIT TYPES Fee _ 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 18PWSVCS Water Service P 1CPWS or -� 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES 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 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development s ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 U P E kT I N 0 Building Department OB ADDRESS: PERMIT# OWNER'S NAME: -- , -TYu�t. PHONE # GENERAL CONTRACTOR: r4 c. FAX # 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 L I I Owner/Con for Signature Date