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10010097 CITY OF CUPERTINO BUILDING PERMIT • 19960 OLIVEWOOD ST APT A,B,C,D CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010097 BUILDING ADDRESS. OWNER'S NAME: ESSEX PROPERTY TRUST 2552 SEABOARD AVE DATE ISSUED:01/25/2010 1ER'S PHONE: 6508495835 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 R'S DECLARATION FO: BLDG ELECT r PLUMB OT ❑ LICENSED CONTRALTO BUILDING PERMIT IN License Class :3 Lic.# MECH RESIDENTIAL COMMERCIAL Date � .— Contractor JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT I hereby affix in 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: 1 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:31643003.19960 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnifyand keep harmless the City of Cupertino against liabilities,judgments, i80 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of th* rmit. Additionally,the applicant understands and will comply - Date: with all no oint ource regulations per the Cupertino Municipal Code,Section Issued by. 9.18. Signatur j ..1 Date & [ V _ RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is LJ OWNER-BUILDER DECLARATION 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: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Workers Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safetcompliance ode Section 25532(a)should Intoe oral ehandle 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 maintain co pliance with the Cupertino25533 and 25534e'Chapter 9.12 and the permit is issued. Health& of ty Code,Sections 25505, I certify that in the performance of the work for which subject tois t is theWorker'sued,I shall Ow or thor ed ent: employ an person in any manner so as to become J not p y Y P 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 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 above and state 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 Minify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expenses which may accrue against said City in consequence of the granting of this it.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non- int s urce regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signatur Date- / CITY OF CUPERTINO 5 ITEMS OF 60 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 .19960 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT #. . . . . . . . . : BS000009613 REFERENCE ID # . . . : 10010097 SITE ADDRESS . . . . . : 19960 OLIVEWOOD ST APT A,B,C,D SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST ADDRESS . . . . . . . . . . : 10677 OLIVEWOOD 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 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 COY Of CITY OF CUPERTINO REPIPE/SEWED MAIN SERVICE cuPERTIPERMIT APPLICATION FORM Dater � i Ll [WAPN # OZ) .00 � Building Addr ss. C4,Bull g `I kk Phone #: Own 's Nam e �' �j Phone #: f- Contractor: Fax#: ?� 1,Ay\)UI one #: Contact: (� Fax 4: �� b c1 Contractor License Cu ertino Business License #: ti Job Description: Residential Commercial F-1 Valuation: Mayor rd ❑ Large ❑ Project Size: Express ❑ Standa Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the the sheet index. application or if applicable, include in plan set& Green Buildin Points: ' tion Fee Permit Type uantity Fee ID Fee Descrip Q Grou 1 PCSEWER Commercial building P 1CPSS sewer/sanitary sewer l BPREPIPE Commercial re-pipe per fixture p 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT I BCBSC Cal Bldg Standards Commission TYPES Fee P IBS IS ICOM Seismic Commercial Revised 01/07/09 • CITY O CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE CUETN Quantity Fee ID Fee Description Fee Permit Type Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSFISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP IBPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P IPCESS Cesspool P 1 BPWATER Install/alter Water Pipe P I BPFIXTURE Plumbing Fixture P 1 PGASRFS Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P I PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P j 1 TRAVDOC Travel & Documentation Fee B I 1 BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 w Telephone(408)777-3228 Fax(408)777-3333 ClTlf OF :UPETINO Building Depart e nt JOB ADDRESS: 5�5`0/y PERMIT # O 34- OWNER'S NAME ,5� W - rw PHONE # -- ' �( � .� GENERAL CONTRACTOR: FAX # - - 3 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 it .-/0 Owner/Contrac or ign e Date