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10010111 CUPERTINO BUILDING PERMIT 1 CITY OF PERMIT NO: 1001011 T A-D CONTRACTOR:GENMOR PLUMBING ISSUED:01/25/2010 BUILDING ADDRESS: 10647 ROSEWOOD RD AP DATE 2552 SEABOARD AVE OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131 PHONE NO:(408)855-8348 JER'S PHONE: 6508495835 PLUMB MIT INFO: BLDG ELECT 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PER ., MECH RESIDENTIAL COMMERCIAL 6 License Class Lic.# � Date —� JOB DESCRIPTION:WATER MAIN SEERVICE REPLACEMENT Contractor I hereby affirm that I am licensed under the provisions Chapter f the Business&Professions (commencing with Section s On full fD of vision and effect. Code and that my license herebyaffirm under penalty of perjury one of the following two declarations: I I have and will maintain a certificate of consent to self-insureLabor Code, the Valuation:$2500 provided for by Section 3700 of the L V Compensation,as p Sq.Ft Floor Area: performance of the work for which this Pe�atit iis issued.on Insurance,as provided for by I have and will maintain Worker's Comp Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31643004.10647 permit is issued. APPLICANT CERTIFICATION IF WORK IS NOT STARTED certify that I have read this application and state that the above information is PERMIT EXPIRES OR Ice fy with all city and county ordinances and state laws relating IT ISSUANCE correct.I agree to comply WITHIN 180 DAYS OF PERM INSPECTION. to building construction,and hereby authorize representatives of this to saver CALLED INSP for inspection purposes. (We)agree180 D ROM LAST C upon the above mentioned property of Cupertino against liabilities,judgments, indemnify and keep harmless the City P in consequence of the costs,and expenses which may accrue hea against cant understands and will comply , 2,6- 10 Date: granting of this pe Additionally,the app Issued by: with all non-po' t sou ce regulations per the Cupertino Municipal Code,Section 9.18. � (/ Signature Date RE-ROOFS: TION All roofs shall be inspected prior to any roofing material being installed.If a roof is ARA without first obtaining an inspection,I agree to remove all new materials for Li OWNER-BUILDER DELL installed inspection. hereby affirm that I am exempt from the Contractor's License Law for one o Date: I y Applicant: the following two reasons: compensation, of the property,or my employees with wages as their sole comp Signature of pp 1,as owner ill do the work,and the structure is not intended or offered for sale(Sec.704 , COVERINGS TO BE CLASS"A" `'" ALL ROOF OR BETTER Business&Professions Code) I, as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code HAZARDOUS MATERIALS DISCLOSURE of perjury one of the following three have read the hazardous materials requirements under and 25534.95 of the 1 will maintain I hereby affirm under penalty P I ha Code,Sections 25505,25533, declarations: CaliforniaChapter 9.12 and the Health& Certificate of Consent to self-insure for Worker's with the C pertino Municipal Code, dle hazardous material. I have and will maintain a compliance Com Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or an P permit is issued. Additionally,should I use equipment or devices which emit hazardous air perform of the work for which this pe A the Bay Area Air Quality Management District I will p rovided for by contaminants as defined by Chapter 9.12 and the I have and will maintain Worker's Comr the peration formance o the work for which this maintai o pliance with the Cupertino Municipal Code, Section 3700 of the Labor Code,for the p Healt &Sa ety Code,Sections 25505,25533,and 25534. permit is issued. performance of the work for which this permit is issued,I shall u o ed a ►t: �(f I certify that in the p Date: r employ any person in any manner so as to become subject t of exemption,I Ow r not p y Compensation laws of California. If,after making ovhs ons of the Labor Code,I must come subject to the Worker's Compensation p CONSTRUCTION LENDING AGENCY be performance of work' forthwith comply with such provisions or this permit shall be deemed revoked. affirm that there is a construction lending agency for the fortI hereby aff APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) read this application and state that the above information relating Lender's Name I certify that I have r ordinances and state correct.I agree to comply with all city and county ' nand hereby authorize representatives of this city to aveer Lender's Address to building construct►o , purposes.(We)agree t roe for inspection pure ARCHITECT'S DECLARATION upon the above mentioned p P of Cupertino against liabilities,judgments, unify and keep harmless the City P ►n consequence of the plans shall be used as public records. and expenses which may accrue against said City 1 I understand my dditionally,the applicant understands and will comp y granting of this pe � per the Cupertino Municipal Code,Section with all non-poi our a regulations p Licensed Professional 9.18. Date Signature r CITY OF CUPERTINO ERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 45 P COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31643004 .10647 DATE ISSUED. • • • • " 01/25/2010 ; BS000009609 RECEIPT # . " 10010111 REFERENCE ID # • • • SITE ADDRESS 10647 ROSEWOOD RD APT A-D SUBDIVISION . . . . . . • CITY CUPERTINO IMPACT AREA . . . . . . • ER ESSEX PROPERTY TRUST OWN : 10647 ROSEWOOD ADDRESS . . . . . . . . " CUPERTINO, CA 95014 CITY/STATE/ZIP . • • RECEIVED FROM ALLLAN UY LIC # 27101 CONTRACTOR . . . . . . . : GENARO MORALS COMPANY GENMOR PLUMBING AVE ADDRESS . . . . . . . . . . : 2552 SEABOARD 95131 SAN JOSE, CA CITY/STATE/ZIP (408) 855-8348 TELEPHONE . . . . . . • • AMOUNT PD-TO-DT THIS REC NEW BAL UNIT QUANTITY ----- ---------- ---------- ------0 . 00 FEE ID _ __-------- -- 0 .00 1 . 00 ---------- -------- 2, 500 .00 1 . 00 21 . 00 0 . 00 1BCBSC VALUATION 21. 0 0 .0 0 .00 0 . 00 1. 00 00 0 .63 1BPWSVCS WATER SERVICE 2, 500 . 00 0 .63 42 .00 0 . 00 1BSEISMICO VALUATION 42 . 00 0 .00 0 , 00 1 .00 0 . 00 42 .00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 ---------- 1TRAVDOC FLAT RA'Z'E ---------- ---------- - 106 .63 0 .00 106 .63 0 .00 TOTAL PERMIT VOICE ID DESCRIPTION__------- VOICE ID DESCRIPTION----_---- -_______ ------------------- -------- ----------------- 106 SEWER & WATER 103 UFER 507 FINAL PLUMBING PERTINO CITY OF CU SERVICE REPIPE/SEWERMAIN CITY OF PERMIT APPLICATION FORM Date: APN # A-=. --RL4— C� Building Address: � Phone#: Owner's Name: q_. n Phone#: LL �J %GS- d Contractor: x , Phone#: Z'1 Gj Con act: LLy -,Z-9--{ -� `'1 Fax#: Contractor License#: Cu ertino Business License#: Job Description: Commercial 91. Residential ❑ Valuation: �l Ma'or Standard❑ Large❑ Maj Projectll,, Size: Express ❑ it to the • he Green Building Checklist & attach • • Please complete relevant portion of • Green Building: a include in plan set & the sheet index. application or if appl�cabl , Green Building Points: Permit Type Fee P _ y ID Fee Description Quantity Fee Grou 1CPSS P 1 P CSEWER Commercial building sewer/sanitary sewer P 1 CPRP 1 BPREPIP E Commercial re-pipe per fixture 1PGA SCOM Commercial Gas Piping System P 1-4 Outlets B ALL, PERMIT 1BCBSC Cal Bldg Standards Commission TYPES Fee P 1BSEI SMICOM Seismic Commercial /09 Revised Revised O1/07 . CITY OF CUPERTINO ..� RVICE =} �. RE PIP SE ��n FEE SCHEDUL CUPEk,11NO Fee Permit Type Fee ID Fee Description Quantity Grou Commission B ALL PERMIT 1BCBSC Cal Bldg Standards Co 'TYPES Fee P 1BSEISMICR Seismic Residential building P 1RPSS 1 PRSEWER Residential bui g sewer/sanitary sewer P 1RPRP 1PRREPIPE Residential re-pipe per fixture p 1CPWS or 18PWSVCS Water Service 1RPWS . stem P 1 PPR SEWG ri Pvate Sewage Disposal Sy P 1 P CESS Cesspool 1 BPW ATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets pERMITFEE Plumbing Permit Fee Issuance P 1P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Ins P• P Travel &Documentation Fee B 1 TRAVDOC B 1BUSLIC Business License Community Development 10300 Torre Avenue Cupertino CA 95014 } Telephone(408)777-3228 -' Fax(408)777- 3333 CITY OF -.4U PE TINO 1 din De art Bui PERMIT # � C) ` OB ADDRESS: SSE,' c.� PHONE # C �� S R'S NAME• �`� ��' ��s� , � OVVNE r s FAX# L CONTRACTOR: C-51BA MC �) GENERA L: I am not using any subcontractors: Date Signature Please check applicable sub contractors and complete the f ollowin information: CENSE # NA SUBCONTRACTOR BUSINESS ME BUSINESS LI 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 --------- Date owner Contractor Signature