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10010100 CITY OF CUPERTINO BUILDING PERMIT FBUILDINNG ADDI&SS19986 OLIVEWOOD ST APT A-D CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010100 ADDRESS.• 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 ❑ L BUILDING PE LICENSED CONTRACTOR'S DECLARATION RMIT INFO: BLDG ELECT PLUMB r Lic.# � 9 J / �/ r— RESIDENTIALCOMMERCIAL License Class MECH Contractor Date J -.26 ,'�� of Chapter 9 JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT I hereby affirm that I am licensed under the provisionsp (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. [SEq.:FtFloor 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:31643003.19986 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating PERMIT 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 indemnify and keep harmless the City of Cupertino against liabilities,judgmeents, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence o granting of this ermit. Additionally,the applicant understands and will comply Date: �--� with all non- oint ource regulations per the Cupertino Municipal Code,Section Issued by: 9.18. Signature Date rte" �� RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is V 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 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 Comp ensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino MSafety Code,Section 25532(a)should Ipal C or,Chapter hhazardous 9.12 adinae He lth& 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 Code,Chapter 9.12 and the permit is issued. Heal Safety 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' agen . 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 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 this pe Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-poi sou a regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 10/ � ~�v CITY OF CUPERTINO 5 ITEMS OF 45 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 .19986 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT #. . . . . . . . . : BS000009609 REFERENCE ID # . . . : 10010100 SITE ADDRESS . . . . . : 19986 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 ---------- ------------- ---------- ---------- 1 . 00 0 . 0 1BCBSC VALUATION 21500 . 00 1 . 00 0 .00 00 0 .00 21. 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 21• 1BSEISMICO VALUATION 21500 . 00 0 . 63 0 . 00 0 .63 0 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 • 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 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 ( 1 /0 c!) CITY Of CITY OF CUPERTINO REP IPE/SEWERIMAIN SERVICE CUPERTINO PERMIT APPLICATION FORM A \_13 Date: PN # Building Add s: w c c , I t.3C)0 A . 4�1 Owner's Name: Phone#: Contractor• Phone #: e7 6>��c , t � \ /I L • Fax #: Z Contact: Pho � -- Fax#: Contractor License #: C Cu ertino Business License #: Job Description: Residential ❑ Commercial l!� Valuation: `Tl Project Size: Express ❑ Standard ❑ Large �ajor ❑ 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 --Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES I BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CITY OF CUPERTINO REPI PE/SEWER/MAIN SERVICE FEE SCHEDULE CUPERTINO ti Fee ID Fee Description Fee Permit Type Quantity Grou I BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS I PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P JIPGASRES 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 IPLMBINSP Other Plumbing/gas Insp. P I TRAVDOC Travel & Documentation Fee B I 1 BUSLIC Business License B K Community Development 10300 Torre Avenue a Cupertino CA 95014 y Telephone(408)777-3228 C1T1(OF Fax(408)777-3333 ..UPEkTINO Building Department JOB ADDRESS: oq5,,1q PERMIT # 101 CDC) JR(tylo C) s-� OWNER'S NAME: S 6 e kroe-(4--Z PHONE #66-0 ,- , V V 9-,S_t '3 GENERAL CONTRACTOR: FAX# - Ci I am not using any subcontractors: Signature Date Please check applicable subcontractors and co m lete 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 Q A� "Owner/Contractor Signature Date