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10010107 CITY OFCUPERTINO BUILDING PERMIT PERMIT NO: 10010 107 _ A-D CONTRACTOR:GENMOR PLUMBING E ISSUED:01/25/2010 BUILDING ADDRESS: 10676 ROSEWOOD RD AP 2552 SEABOARD AVE DAT 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� � �� MECH RESIDENTIAL � � Lic.# License Class R _ Date JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT Contractor I hereby affirm that am licensed un er the provisions the Business pte Professions (commencing with Section 7000)of Division 3 Code and that my license is in full force and effect. ur er one of the following two declarations: I hereby affirm under penalty of p j Y have and will maintain a certificate of consent to self-insure Code,for the Valuation:$2500 I Section 3700 of the La Compensation,as provided for by Sq.Ft Floor Area: performance of the work for which this pe� Insurance,as is issued. provided for by I have and will maintain Workers compensation31643005.10676 Occupancy Type: ' n 3700 of the Labor Code,for the performance of the work for which this APN Number: Sectio permit is issued. APPLICANT CERTIFICATION S IF WORK IS NOT STARTED that I have read this application and state that the ab ces and state laws relating PERMIT EXPIRE OR I certify 1 with all city and county ordinances IT ISSUANCE correct.I agree to complyto enter WITHIN 18 AYS OF PERM o building construction,and hereby authorize representatives(We this to save T CALLED INSPECTION. t roe for inspection purposes. 1VI LAS upon the above mentioned property'�', of Cupertino against liabilities,judgments, 180 DAY indemnify and keep harmless the City to consequence of the d ex ens which may accrue against said City inconunderstands and will comply -fj lJ Date: costs,anp the applicant granting of thi perms Additionally, Issued by: with non oint source regulations per the Cupertino Municipal Code,Section wit 9.18. > Signature Date l RE-ROOFS: inspected prior to any roofing material being installed.new materials oof i for All roofs shall be p agree to remove all n OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I � inspection. affirm that I am exempt from the Contractor's License Law for one of Date: I hereby affi ]scant: the following two reasons: compensation, r of the property,or my employees with wages as their sole ec 7044, Signature o pP I,as owner will do the work,and the structure is not intended or offered for sale ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Codes exclusively contracting with licensed contractors to I,as owner of the property, construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE .95 of the c ter 6 der penalty of perjury one of the following three n I have read the hazardous materials requirements 2550525533,and 25534. I will maintain I hereby affirm u P Code,sections declarations: Cupertino Municipal Code,Chapter 9.12 and the Health& Certificate of Consent to self-insure for Worker's Calif 1 ance with the C Pty handle hazardous material. I have and will maintain a Certcomp should I store or h Provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a) Compensation,asp issued. ' nal] should I use equipment or devices which emit hazardous air permit is i Additionalrealy, Management District I will performance of the work for which this p Provided for by 's Compensation Insurance,as p contaminants as defined by the Ba er no Muni�c pa Code,Chapter 9.12 and the I have and will maintain Worker p maint ' ompliance with the p 3700 of the Labor Code,for the performance of the work for which this mai & fety Code,Sections 25505,25533,and 25534. Section permit is issued. agen t in the performance of the work for which this permit is Wo kei'Shall O er o ut or Date: I certify that not employ any person in any manner so as to become hisscertificate of exemption,I Compensation laws of California. If, after making deemed revoked. CONSTRUCTION LENDING AGENCYerforrnance of work's subject to the Worker's Compensation provisions of thee Labor Code,I must become 1 enc for the p forthwith comply with such provisions or this permit shall be e I hereby affirm that there is a construction lending agency for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION ation is Lender's Name that I have read this application and state that tea °and state laws relating I certify with all city and county ordinances Address------------------ 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 p ARCHITECT'S DECLARATION unman the above mentioned property. °f Cu Cupertino against liabilities,judgments, �,nify and keep harmless the City p in consequence of the plans shall be used as public records. accrue against said City and expenses which may applicant understands and will comply I understand my p granting of th1 4 in rceaegulataons per the Cupertino Municipal Code,Section Licensed Professional RA- with all non � _ 9.18. Date Signatur CITY OF CUPERTINO ERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 45 P COPY # = 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31643005 .10676 DATE ISSUED. • • • • " 01/25/2010gS000009609 RECEIPT #. " 10010107 REFERENCE ID # • • • SITE ADDRESS 10676 ROSEWOOD RD APT A-D SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . WNER . . . . . . . . . . . . : ESSEX PROPERTY UST A-D O 10676 ROSEWOOD RD ADDRESS . . . . . . . . . CUPERTINO, CA 95014 CITY/STATE/ZIP . • • RECEIVED FROM ALLLAN UY LIC # 27101 CONTRACTOR GENARO MORALS COMPANY GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 PD-TO-DT THIS REC NEW BAL UNIT QUANTITY AMOUNT ----- ---------- ---------- FEE ID ------- ---------- ----- 1 . 00 0 . 00 ------------- --- 1.00 0 .00 0 . 00 VALUATION 21500 . 00 0 .00 21 .00 1BCBSC 1. 00 21. 00 0 .63 0 . 00 1BPWSVCS WATER SERVICE 0 . 63 0 . 00 0 .00 2, 500 . 00 0 .00 42 .00 1BSEISMICO VALUATION 1 .00 42 . 00 42 . 00 0 .00 1PPERMITFE FLAT RATE 42 . 00 0 .00 -- ----______ 1 .00 _ -------- 1TRAVDOC FLAT RATE ---------- --------- 106 .63 0 .00 106 . 63 0 .00 TOTAL PERMIT AMOUNT REFERENCE NUMBER METHOD OF PAYMENT _______________ -------------------- ___ _ __ ----------------- 959 .67 VISA CREDIT CARD _______________ 959.67 TOTAL RECEIPT DESCRIPTION DESCRIPTION VOICE_ID ____________________________ VOICE ID ________ ---------------------------- 106 SEWER & WATER 103 UFER 507 FINAL PLUMBING �,�� CITY OF CUPERTINO � c� 1 � t�� REPIPE/SEWERIMAIN SERVICE .�.. CATION FORM CIT OF CUPE PERMIT APPLI TINO ------ CAP-1 LP Date: APN# C) � ux� Building Addr CA , L� Phone#: 0000 Owner's Name: � ��,- Phone#: Contractor: #: � Faxf D-VI Ck S Phone#: CqtR) Contact: Fax#: z,-1 Contractor cense#: 16� 5 CA co Cuertino Business License#: Job Description: Commercial [� Residential 0 Valuation: r,, k or❑ Standard❑ Large Maj Project Size: Ex press portion of the Green Building Checklist & attach it to the Green Building: Please complete relevant application or if applicable, include in plan set & the sheet index. Green Buildin Points: Fee Permit Type Quantity Fee ID Fee Description Grou ICPSS 1PCSEWER Commercial building P sewer/sanitary sewer P JCPRP 1BPREPIPE Commercial re-pipe Per fixture IPGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT 1BCBSC Cal Bldg Standards Commission TYPES Fee P IBSEISMICOM Seismic Commercial Revised 01/07/09 CITY OF CUPERTINO T :fir SERVICE REPIPE/SEWEBiMIN U'n°fFEE SCHEDULE CU PEkTINO • e Descri tion Fee Permit Type FQuantity Fee ID Fe p Group Cal Bldg Standards Commission B ALL PERMIT 1 BCBSC g TYPES LFKee 1 BSEISMICR Seismic Residential P 1PRSEWE R Residential building P IRPSS sewer/sP 1RPRP 1PRREpIpE Residential re-pipe per fixture S Water Service P 1CPWS or 18PWSVC IRPWS P 1PPRSEWG Private Sewage Disposal System 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFI XTURE Plumbing Fixture P 1 PGASF Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P ----------------- 1TRAVDOC Travel & Documentation Fee B B 1 BUSLIC Business License Community Development 10300 Torre Avenue K._ Cupertino CA 95014 408 Telephone( )777-3228 3 -3 33 Fax(408)777 ems,.w� CiT1f OF .,UPE T{NO d*In D e artm a nt B PERMIT #too jOB ADD R S. � � �� -�•�� PHONE OWNERS NAME: �, l U� 4i ��'? FAX# GENERAL CONZ' OR= (- W '�' Z subcontractors: Date I am not using any Signature com complete the f ollowin information: a licable subcontractors and BUSINESS LICENSE # Please check BUSINESS NAME SUBCONTRACTOR Cabinets &Mi1lwork 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 Date er/Contracto Signature