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10010095 r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19980 OLIVEWOOD ST APT A,B,C,D CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010095 OWNER'S NAME: ESSEX PROPERTY TRUST 2552 SEABOARD AVE DATE ISSUED:01/25/2010 NER'S PHONE: 6508495835 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ��' J Lic.# MECH c.� F RESIDENTIAL COMMERCIAL j Contractor Date !'r626 -10 I hereby affirm that I am licensed nder the provisions of Chapter 9 JOB DESCRIPTION:WATER MAIN SERVICE 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 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 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:31643003.19980 A-D Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED 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 keep harmless 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 granting of thi a it. Additionally,the applicant understands and will comply with all non- int s rce regulations per the Cupertino Municipal Code,Section Issued Date: 9.18. Signature Date RE-ROOFS: U OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is 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: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this conta ' is as defined by the Bay Area Air Quality Management District I will mai ain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. He th&S fety Code,Sections 25505,25533,and 25534. 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 O r aut Compensation laws of California. If,after making this certificate of exemption,I Date: V 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 above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating 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 -unify 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 thispe nS Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-p nt sour regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date ��^�� CITY OF CUPERTINO 5 ITEMS OF 40 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 .19980 A-D DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT 4 . . . . . . . . . : BS000009612 REFERENCE ID # . . . : 10010095 SITE ADDRESS . . . . . : 19980 OLIVEWOOD ST APT A,B,C,D SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST ADDRESS . . . . . . . . . . : 10647 ROSEWOOD RD 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 853 . 04 VISA --------------- TOTAL RECEIPT 853 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 106 SEWER & WATER 507 FINAL PLUMBING CITY Of ........................................ CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM -1 APN # Date: I Building Address: ° 0q,�-)C) poc� A Owner's Name: Phone #: (=Osu) 4 o ON..:Ali Contractor: Phone #: I � � e,3` C--NAVNV%JV Fax #: --f-Z,-I--U19 Contact: Phone #: CqZ )) :fit D_Zq Lt J C� Fax #: Contractor License#: Cupertino Business License #: Job Description: Residential ❑ Commercial (� Valuation: Z G� ) t Project Size: Express ❑ Standard ❑ Large FtfK 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 Grou 1 PCSEWER Commercial building P ICPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P ICPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE UPERTIN Quantity Fee ID Fee Description Fee Permit Type Grou 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT I Fee TYPES 1 BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1 BPWSVCS 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 I 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 =}; 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 '%UPEkTINO Building Department JOB ADDRESS: �P/v PERMIT #lo%qqo C&II10-41elo"'I / - OWNER'S NAME:Ee5,9X � �.�`� 7rvs.�- PHONE # - GENERAL CONTRACTOR: 7; FAX# 4SO 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 Owner/Contractor Signature Date