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10010112 U13ERTINO BPERMIT NO: 10010 UILDING PERMIT 112 CITY OFC A-D CONTRACTOR:GENMOR PLUMBING ISSUED:01/25/2010 BUILDING ADDRESS: 10667 ROSEWOOD RD APT 2552 SEABOARD AVE DATE OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ✓NER'S PHONE: 6508495835 PLUMB BUILDING PERMIT INFO: BLDG ELECT LICENSED CONTRACTOR'S DECLARATION COMMERCIAL License Clas Lic.# � 1� MECH RESIDENTIAL Date "" JOB DESCRIPTION:WATER MAIN SEERVICE REPLACEMENT Contractor her affirm that I am licensed under the provisions s Business&of tProfessions I y (commencing with Sections 000in) l force of vand effect. Code and that my license I hereby affirm under penalty of perjury one of the following two kecl rations: I have and will maintain a certificate of cn sent to self-insure for 3700 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 peTmit is issued.ation Insurance,as provided for by I have and will maintain Workers Comp Occupancy Type: Section 3 700 of the Labor Code,for the performance of the work for which this APN Number:31643004.10667 permit is issued. APPLICANT CERTIFICATION SIF WORK IS NOT STARTED that I have read this application and state that the ces and ate laws relating PERMIT EXPIRE CE OR ation is I certify 1 with all city and county ordinanIT ISSUANCE correct.I agree to comply WITgIN 1 DAYS OF PERM INSPECTION building construction,and hereby authorize representatives this to aver CALLED INSP to b g for inspection purposes. OM LAST upon the above mentioned property. of Cupertino against liabilities,judgments, 180 DA indemnify and keep harmless the City in consequence of the costs,and expenses which may accrue against said City _ Z6- I Date: Additionally,the applicant understands and will comply by: granting of this it. Ad Issued 1 non- int so rce regulations per the Cupertino Municipal Code,Section with al ti 9.18. Date Signature RE-ROOFS: e inspected prior to any roofing material being inall new materialsed.If a roof forAll roofs shall b P inspection,I agree to remove � OWNER-BUILDER DECLARATION installed without first obtaining an p inspection. hereby affirm that I am exempt from the Contractor's License Law for one o Date: I he y licant: the following two reasons: Signature of App of the property,or my employees with wages as their sole Sec.7044ation, I,as owner will do the work,and the structure is not intended or offered for saleALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Codam exclusively contracting with licensed contractors to I,as owner of the property, HAZARDOUS MATERIALS DISCLOSURE 6.95 of the construct the project(Sec.7044,Business&Professions Code). Chapter Under m under penalty of perjury one of the following three I hereby affirm I have read the hazardous materials ons 25505525533,and 25534. I will maintain declarations: Cupertino Municipal Code,Chapter 9.12 and the Health Certificate of Consent to self-insure for Worker's Califance�with the Cupty handle hazardous material. I have and will maintain a Cert comp should I store or as provided for by Section 3700 of the Labor Code,for the Safety Code,Section I use a a) Compensation, issued. Additionally,should I use equipment or devices which emit hazardous air performance of the work for which this permit is Area Air Quality Management District I will I have i an Compensation Insurance,as provided for by contaminants as defined by the Bay Chapter 9.12 and the I have and will maintain Worker's Comp ance of the work for which this maintain compliance with the Cupertino 5533,and 25534Municipal e� Section 3700 of the Labor Code,for the perform Code,Sections 2550 , Health&Safety permit is issued. ued,I ll I certify that in the performance of the work for which this permit is iWorker'sha Owner or authorized agent: Date: not employ any person in any manner so as to become subject to Compensation laws of California. If,after making this cert ificat is or Code, must LENDING AGENCY Compens provisions of the CONSTRUCTION become subject to the Worker's Compensation pagency for the performance of work's comply with such provisions or this permit shall be deemed revoked. firm that there is a construction lending g y forthwith P Y I hereby of for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name that I have read this application and state that the above information e I certify with all city and county ordinances and state laws relating correct.I agree to comply d hereby authorize representatives of this city to enter Lender's Ad ress to building construction,anfor inspection purposes.(We)agree to ,rnn the above mentioned property Cupertino a ainst liabilities,judgments, ARCHITECT'S DECLARATION -nnify and keep harmless the City of g in consequence of the fans shall be used as public records. accrue against said City 1 I understand my p _.,.s,and expense "A may applicant understands and will comp y granting of this ermit.',Additionally,the 11 non- nt sourcq regulations per the Cupertino Municipal Code,Section Licensed Professional with a p 9.18. ,�., _'"1�`i� Date Signature CITY OF CUPERTINO ERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 45 P COPY # � 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . • „ • • : 31643004 .10667 DATE ISSUED. • • • • " 0112512010gS000009609 RECEIPT # • • " ' 10010112 REFERENCE ID # • • • SITE ADDRESS 10667 ROSEWOOD RD APT A-D SUBDIVISION . . • • • • • CITY CUPERTINO IMPACT AREA . . . . . . OWNER ESSEX PROPERTY TRUST OW 10647 ROSEWOOD RU ADDRESS . • • • • • . " CUPERTINO, CA 95014 CITY/STATE/ZIP . • • RECEIVED FROM . . . . : ALLLAN UY LIC # 27101 CONTRACTOR GENARO MORALS GENMOR PLUMBING COMPANY ADDRESS 2552 SEABOARD 95131 CITY/STATE/ZIP • • SAN JOSE, C (408) 855-8348 TELEPHONE . . . . . . . • 00 42 . 00 THIS REC NEW BAL QUANTITY AMOUNT PD-TO-DT _----- ---------- FEE ID UNIT----- ---------- ---------- ---------- ---- 1 . 00 0 . 00 ---------- -_ 2500 .00 1 . 00 21 . 00 0 .00 1BCBSC VALUATION , 21.00 0 .00 0 . 00 SERVICE 1. 00 0 .00 0 .63 1BPWSVCS 2, 500 . 00 0 .63 42 . 00 0 . 00 1BSEISMICO VALUATION 42 . 00 0 .00 0 . 00 1PPERMITFE FLAT RA'Z'E 1 .1 .00 00 42 . 00 0 . ---------- 1TRAVDOC FLAT RATE 00 0____------ ------ . 106 .63 0 .00 106 .63 0 . 0 TOTAL PERMIT : VOICE ID DESCRIPTION -----_- VOICE ID DESCRIPTION_------__ --__-___ --------------------- ------------------- __--- __ -_ --------------- 106 SEWER & WATER 103 UFER 507 FINAL PLUMBING A + CITY OF CUPERTINO /SEV�E N SERVICE REPIPE CITY OF APPLICATION FOP:M CuPE ?INo PERMIT Dat APN ## � , Ad Building ess Phone#: - io ) ) '� r ( CL Owner s Name* Phone#: Fax#: Contractor: Phone Contact: Fax#: Contractor License#: Cu ertino Business License#: Job Description: Commercial Residential ❑ valuation: ` Major ❑ Standard❑ Large Project Size: Express[] attach it to the levant onion of the Green Building Checklist & Green Building: Please complete re pet & the sheet index. Grinclude application or if applicable, in plan s Green Building Points: Fee Permit Type - • Fee ID Fee Description Grou Quantity 1CPSS EWER Commercial building P 1PCS - - sewer/sanitary sewer P 1CPRP 1BPREPIPE Commercial re-pipe per fixture 1PGASC OM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT Cal Bldg Standards Commission TYPES 1BCBSC Fee P 1BSEISM ICOM Seismic Commercial 6 Revised 01/07/09 . CITY OF CUPERTINO SERVICE REPIPE/SEWERMAIN FEE SCHEDULE CUPEf�T1N0 Fee Permit Type Fee ID Fee Description 7 Quantity Grou Commission B ALL PENT Cal Bldg Standards Co TYPES 1BCBSC Fee P 1BSEISMICR Seismic Residential building P 1RPSS 1 PRSEWER Residential bu g sewer/sanitary sewer P 1RPRP 1P RREpIpE Residential re-pipe per fixture P 1CPWS or 1BPWSVCS Water Service 1RPWS ------------- PRSEWG Private Sewage Disposal System P 1P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets p 1BPG AS Gas Piping System 5+ Outlets 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Ins P• P VDOC Travel &Documentation Fee B 1 TRA B 1 BUSLIC Business License Community Development 10300 Torre Avenue Cupertino CA 95014 €a Telephone(408)777-3228 Fax(408)777-3333 CITY 0� v V PEkTIN0 • Deartment Buildin PERMIT # OB ADDRESS: 1 OC - PHONE # OWNERS NAME: ' GENERAL CONTRA CT R-- (�V �� -w AX F # lZo l� 4 I am not using any subcontractors: afore Date Sign retractors and com lete the follow in information: Please check a licable subcontractors E BUSINESS LICENSE # SUBCONTRACTOR BUSINESS NAM 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 I Z v Date Owner/Contractor Signature