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10010110 UPERTINO BUILDING PERMIT 10110 CITY OFC PERMIT NO:100 _D CONTRACTOR:GENMOR PLUMBING E ISSUED:01/25/2010 BUILDING ADDRESS: 10657 ROSEWOOD RD APT A DAT 2552 SEABOARD AVE PHONE NO:(408)855-8348 OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131 .vER'S PHONE: 6508495835 � PLUMB BUILDING PERMIT INFO: BLDG ELECT o LICENSED CONTRACTOR'S DECLARATION L COMMERCIAL Lic.# MECH RESIDENTIAL License Class j Date '— JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT Contractor hereby affirm that am licensed nder the provisions of Chapter 9 I Y (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 worker's rations: I have and will maintain a certificate of consent3700 of the Labor Code,for the Valuation:$2500 Compensation,as provided for by Sectio Sq.Ft Floor Area: performance of the work for which this permInsurance,as prois vided for by I have and will maintain Workers CompensationOccupancy Type: Section 3 700 of the Labor Code,for the performance of the work for which this APN Number:31643004.10657 permit is issued. APPLICANT CERTIFICATION EXPIRES IF WORK IS NOT STARTED that I have read this application and state that the above information a PERMIT EXPI NCE OR I certify with all city and county ordinances and state laws relating IT ISSUANCE correct.I agree to comply hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERM INSPECTION. to building construction,and h Y purposes. (We)agree to save OM LAST CALLED INS upon the above mentioned property for in purp 180 DA of Cupertino against liabilities,judgments, indemnify and keep harmless the City in consequence of the �_ ` accrue against said City� 1 C Date: costs,and expenses which may applicant understands and will comply l granting of th ermit. Additionally,the app Issued by: no oin ource regulations per the Cupertino Municipal Code,Section with all 9.18. ` Date Signature RE-ROOFS: if a roof 11 be inspected prior to any roofing material being installed.all ew materiialslfor All roofs shall p agree to rem OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I tJ inspection. hereby affirm that I am exempt from the Contractor's License Law for one o Date: I her y Applicant: the following two reasons: Signature of App f the property,or my employees with wages as their sole compensation, I,as owner o will do the work,and the structure is not intended or offered for sal ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) A I,as owner of the property,am exclusively contracting with licensed contractors to DISCLOSURE construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS perjury one of the following three ad the hazardous materials requirements under 33 and 25534 9I will5 of hmaintair I hereby affirm under penalty of pe y I have re Code,Sections 255059 25 declarations: Chapter 9.12 and the Health& cate of Consent to self-insure for Worker's California Hw with the Cupertino Municipal Code,handle hazardous material. I have and will maintain a Certificate b comp should I store or ha as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a) Compensation, ued. ' Hall should I use equipment or devices which emit hazardous air provided for by Additio Y, the Bay Area Air Quality Management District I will performance of the work for which this permit is iss cont as defined by Chapter 9.12 and the ensation Insurance,as pro ertino Municipal Code, I have and will maintain Worker's Comp mai co liance with the Cup Section 3700 of the Labor Code,for the performance of the work for which this Heal &Sa ty Code,Sections 25505,25533,and 25534. permit is issued. iz gent: at in the performance of the work for which this permit issued, O er � Date: I certify that manner so as to become subject to not employ any person in any this certificate of exemption, Compensation laws of California. If,after makingprovisions of the Labor Code,I must ' ct to the Worker's Compensation p ed revoked. CONSTRUCTION LENDING AGENCl'erformance of work become subject agency for the p forthwith comply with such provisions or this permit shall be deema construction I hereby affirm that there is Sec 3097,Clending g Y KATION for which this permit is issued APPLICANT CERTIFICATION ation is Lender's Name that I have read this application and state that the band staove te laws relating I certify t 1 with all city and county ordinancesto enter Lender's Address correct.I agree to comply resentatives of this city to building construction,and hereby authorize rep u poses.(We)agree to save upon the above mentioned property for inspection p rp judgments, ARCHITECT'S DECLARATION '-mni and keep harmless the City of Cupertinost sid against iti in tconsequence of the s shall be used as public records. and expenses which may accrue against said City granting of this pe Additionally,the applicant understands and will comply I understand my plan with all non-poi sourc regulations per the Cupertino Municipal Code,Section Licensed Professional 9 9.18. Date Signature CITY OF CUPERTINO atg � OPERATOR: P PERMIT RECEIPT COPY # 1 5 ITEMS OF 45 sub: Blk: Lot Sec: Twp: Rng: • . • . . 31643004 .10657 APN • 01/25/2010 DATE ISSUED. • • • • " BS000009609 RECEIPT # REFERENCE• ID• #' • . ; 10010110 10657 ROSEWOOD RD APT A-D SITE ADDRESS SUBDIVISION • : : : . . . ; CUPERTINO CITY • • IMPACT AREA • • • • • ' • • , , , ; ESSEX PROPERTY TRUST A-D OWNER ; 10657 ROSEWOOD ADDRESS • • • • " " ; CUpERTINO, CA 95014 CITY/STATE/ZIP • • • ALLLAN UY LIC # 27101 RECEIVED FROM • " ; GENARO MORALS CONTRACTOR • • • ' ' ' ; GENMOR PLUMBING COMPANY • " " • • ; 2552 SEABOARD AVE ADDRESS • • " " ; SAN JOSE, CA 95131 CITY/STATE/ZIP . : ; 408) 855-8348 TELEPHONE THIS REC NEW BAL - QUp,NTITY AMOUNT--" _______PD-TO-DT- ----__---0 ----""x .00 FEE ID UNIT __-------- 0 . 00 1 . 0 _---- 1 . 00 21 . 00 0 .00 ___------ 2, 500 .00 00 0 .00 63 0 . 00 1BCBSC VALUATION 1. 00 21 , 0 .00 0 . 0 . 00 1BPWSVCS WATER SERVICE 0 .00 0 .63 42 ,00 2, 500 .00 00 0 . 00 1BSEISMICO VALUATION 1 .00 42 , 0 .00 42 . 00 -___ 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 106 .63 0 .00--- _--- ---- FLAT RATE ___---- - 106 .63 1TRAVDOC TOTAL PERMIT : DESCRIPTION -----___ VOICE ID VOICE ID DESCRIPTION 106 _--_--___ ---- SEWER & WATER 103 LIFER 507 FINAL PLUMBING CIT y OF CUPERTINO SERVICE PIPE/SEWERMNAIN RE CITY OF PERMIT APPLIC ATION F ORM CUPEkTINO Date: APN # I " .. C-) ILA )C�v A Building Address: D- C(o Phone Owners Phone#: (W, llA Contractor: rlrl Fax#: I Phone#: �qjo o6) C Contact: Fax#: Contractor License#: A � Cu ertino Business License Job Description: R;Iu� Commercial �-� Residential M Valuation: Z- Project Size: Express ❑ Standard❑ Large Major F1 Building Checklist & attach it to the Green Building: Please complete relevant portion of the Green application or if applicableg include in Plan set & the sheet index. Green Building Points: Fee Permit Type Quantity Fee ID Fee Description Grou 1CPSS P IpCSEWER Commercial building sewer/sanitary sewer fixture P 1CPRP 1BPREPIPE Commercial re-pipe per 1PGASCOM Commercial Gas Piping System P 1-4 Outlets dards Commission B ALL PERMIT IBCBSC Cal Bldg Stan TYPES Fee P IBSEISMICOM Seismic Commercial Revised 01/07/09 C ITY OF C U pEKTIN O y ICESER RE.PlptISEWEWMA IIEDULE 17Y Of FEE SC CUPERTINO Fee permit Type Fee Description Grou antiFee ID ALL PERMIT Quty B ld Standards Commission TYPES BCBSC Cal B g 1 Fee P Seismic Residential 1BSEISMICR P 1RPSS Residential building 1PRSEWER sewer/sant sewer P 1RPRP Residential re-pipe Per fixture IP IPE P 1CPWS or pWSVCS Water Service IRpWS 1B p �✓ a Sewage Disposal System pnvat 1 PPRSEW G P SS Cesspool 1PCE p Instal alter Water Pipe 1 BPW ATER P TURF Plumbing Fixture 1BPFIx p Residential Gas Piping System 1PGAS�S 1_4 Outlets P Ga, piping System 5+ Outlets 1BPGAS G P P Plumbing permit Fee Issuance . 1ppERIViITFEE P plumbing Plan Check IP CK P 1PLMBINSP Other Plumbing/gas Insp. B IT DOC Travel &Documentation Fee _ B 1BUSLIC Business License Community Development 10300 Torre Avenue a''t Cupertino CA 95014 m_ri� ., x Telephone(408)777-3228 _. . ._F Fax(408)777-3333 CITY O .;UPEkTINO M.V4ABuilding Depart ent JOB ADDRESS: PERMIT # cx�>\ CA - I�Dbm ` OWNER'S N � ONE #C Sc: �- .�,,, PH (f - O � GENERAL CONTRACTOR: FAX # I am not using any subcontractors: r 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 `Tle z ) 1 ) 0 Owner/Contr c of Signature Date