10010118 RTINO BUILDING PENT • 10010118
CITY OF LUPE PERMIT NO.
CONTRACTOR:GENMOR PLUMBING E ISSUED:01/25/2010
DAT
BUILDING ADDRESS: 10706 ROSEWOOD DR APT A-D 408 855_g348
PHONE NO.( )
OWNER'S NAME: ESSEX PROPERTY TRUST 2552 SEABOARD AVE SAN JOSE,CA 95131
• 08495835 PLUMB
.�1ER'S PHONE. 65 ELECT
CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ,. IAL
� LICENSED CONTRAC � COMMERCIAL
MECH RESIDENTIAL
License Class
Lic.#
J OB DESCRIPTION:REPLACE WATER MAIN SERVICE
Contractor provisions of Chapter 9
I hereby affirm that I am licensed under the
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
der penalty of perjury one of the following Worker'ls rations:
I hereby affirm un
I have and will maintain a certificate of consent to self-insure or Valuation:$2500
n as provided for by Section 3700 of the Labor Code,for the S .Ft Floor Area:
Compensation, p permit is issued. q
performance of the work for which this p provided for by
Compensation
Insurance,as p Occupancy Type:
I have and willmaintain
the a bor Code,for the performance of the work for which this APN Number:31643005.10706
Section 3700 of the Lab
permit is issued.
APPLICANT CERTIFICATIOa ove information is IF WORK IS NOT STARTED
lication and state that th PERMIT EXPIRES
I certify that I have read this app and county ordinances and state laws ren eying OF PERMIT ISSUANCE OR
correct.I agree to comply with all city WITHIN 18 DAYS
construction,and hereby authorize representatives of this re to save
' con ores. (we)agree LAST CALLED INSPECTIO •
to building roe for inspection pure OM
upon the above mentioned property
Ci of Cupertino against liabilities,judgments,the 180 DAY
indemnify and keep harmless t h' in consequence Date:
expenses which may accrue against said City'
costs,and exp 11 the applicant understands and will comply issued b
granting of this ririi. dditiona y, Y
with all non- int source'regulations per the Cupertino Municipal Code,Section
9.18. .� ,.—
Date
RE-ROOFS: installed.If a roof is
Signature roofing material being
All roofs shall be inspected prior toany
roofsinspection,I agree to remove all new materials for
ER-BUILDER DECLARATION installed without first obtaining an
[J O�'�'N inspection.
m exempt from the Contractor's License Law for one of Date'.
I hereby affirm that I a licant:
the following two reasons:or my employees with wages as their sole compensation, Signature of App
I,as owner of the property, OR BETTER
d the structure is not intended or offered for sale(Sec.704 , BOF COVERINGS TO BE CLASS"A"
will do the work,anALL R
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 DISCLOSUR 6.95 of the
one of the following three
' r have read the hazardous materials requirements
and 255under Chapte 34. I will maintain
affirm under penalty of perjury I ha Code,Sections
I herebyhapter 9.12 and the Health
declarations nce with the Cupertino Municipal Code,
c Consent to self-insure for Worker's CaliforniaCalifo;a is Health&Safety or handle hazardous material.
de Compliance
I have and will maintain a Certificate of Co Code,Section 25532(a)should I store
PTO for by Section 3700 of the Labor Code,for the Safety should I use equipment or devices which emit hazardous
District I will
Compensation,as pr Additionally,show Area Air Quality Management
rovided for by the Bay Chapter 9.12 and the
performance of the work for which this pensation Insurance,asp contaminants as defined by Cupertino Municipal Code,
is maintain •pliance with the Cup
I have and will maintainWorker
e,for the erformance of the work for which this Sa ety
Code,Sections 25505,25533,and 25534.
Section 3700 of the LabHealt
permit is issued. I shall
ut ri agent: `V
that in the performance of the work for which this
of the Worker's
O Date:
I certify manner so as to becomes �
not employ any person in any is certificate of exemption,
Compensation laws I
of California. If,after making this I must
provisions of the Labor Code, CONSTRUCTION LENDING AGENCYerformance of work';
become subject to the Worker's Compensation a enc for the p
with such provisions or this permit shall be deemed revoked. C
forthwith comply I hereby affirm that there is a construction(Sec. 097,Civ din) g Y
for which this permit is issued
APPLICANT CERTIFICATION ation is Lender's Name
e read this application and state that the above�a stateorm
laws relating
I certify that I hav and county ordinances
correct.I agree to comply with all city representatives of this city to enter Lender's Ad ress
construction,and hereby authorize rep agree to save
to building for inspection purposes.(We) g _ARCHITECT—' _upon the above mentioned property Cupertino against liabilities,judgments,
mify and keep harmless the City of Cup public records.
accrue against said City in consequence of the laps shall be used as
and expenses which may applicant understands and will comply I understand my p
granting of this pe dditionally,the app
' source egulations per the Cupertino Municipal Code,Section Licensed Professional
with all non-poi
9.18. --
Date
> e�
Signature
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: Patg
5 ITEMS OF 40 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31643005 .10706
DATE ISSUED. . . . . . . : 01/25/2010
RECEIPT # . . . . . . . . . : BS000009612
REFERENCE ID # 10010118
SITE ADDRESS . . . . . : 10706 ROSEWOOD DR APT A-D
SUBDIVISION
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . •
OWNER ESSEX PROPERTY TRUST
ADDRESS . . . . . . . . . . : 10706 ROSEWOOD DR APT A-D
CITY/STATE/ZIP CUPERTINO, CA 950
RECEIVED FROM ALLAN UY
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY • " " : GENMOR PLUMBING
2552 SEABOARD AVE
ADDRESS • " ' SAN JOSE, CA 95131
CITY/STATE/ZIP • ' (408) 855-8348
TELEPHONE . . • • • • • •
QUANTITY AMOUNT
PD-TO-DT THIS REC- NEW BAL
-
UNIT ---____- ----_----
FEE ID _--- ---------- ---------- ------o-oo - 1. 00 0 . 00
_ ------ ------ 2, 500 . 00 1 . 00 21 . 00 0.00
1.0
1BCBSC VALUATION 0 21 . 00 0 . 00
1BPWSVCS WATER SERVICE 0 .00 0 . 63 0 .00
2, 500 . 00 0 .63 42 . 00 0.00
1BSEISMICO VALUATION 1 .00 42 . 00 0 . 00 0 . 00
1PPERMITFE FLAT RATE 42 . 00 0 .00 42 . 00 ---
1TRAVDOC FLAT RATE 1.00 _----106 .63----- -------0 .00_-- ---- __-- ------- •
106 . 63 0 . 00
TOTAL PERMIT
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION -------- ----------------------------
-------- ----------- --------------- 301 ROUGH PLUMBING
106 SEWER & WATER
507 FINAL PLUMBING
CITY OF
CUPERTIN O
RE
RIMAIN SERVICE
PIPE/SEWS
CITY' F PEF�IT APPLICATION FORM
CUP KTINO
Date:
APN # /C� • 1
Buildi Address: -In V\;v-
�);uA Phone#*.
Owner's Nam
Phone#..
Contractor: Fax#:
/V1 VY\A)r Phone#-. cjtty?)) -7,C1
Contact: Fax#:
eAl)
Contractor License#:
Cu ertino Business License#*
Job Description:
Commercial
Residential ❑
valuation,
............
[�
Express ❑ Stan Majol"
❑
Project Size: Express Tete relevant portion of the Green Building Checklist & attach it tothe
Green Building: Please coMP
application or i ,include in plan set& the sheet index.
f applicable
Green Buildin Points: Fee Description Fee Permit.Type
Quantity Fee ID Grou ICPSS
IpCSEWER Commercial building P
sewer/sanitary sewer P 1CPRP
IBPREPIPE commercial re-pipe per fixture
1PGASCOM Commercial Gas Piping System P ALL PERMIT
1-4 Outlets Commission B
IBCBSC Cal Bldg Standards TYPES
Fee P
IBSEISMICOM Seismic Commercial
Revised 01/07/09
CITY 0-F CUPERTINO
SERVICE
E/SEvE
RINW
N
REFIF
DULE
of FEE SCHE
CUpERTINO
Fee Permit Type
Fee Description Grou
ALL PE
Quantity Fee ID RMIT
Q
1BCal Bldg Standards Commission B TYPES
Fee i CBSC P
ICR Seismic Residential
1BSEISM P 1Rpss
ER Residential building
sewer/sanitarysewer
1PRSEW P 1RPRP
Residential re-pipe Per fixture
1PRREP�E P 1CPWS or
18PWSVCS Water Service P 1RPWS
e Sewage Disposal System
1PPRSEWG
private
P
1PCESS Cesspool
R Install/alter Water Pipe
P
1BPWATE P
Plumbing Fixture
1B
PFIXTURE
System
P
1 P GASRE
S Residential Gas Piping 1-4 outlets 5+ Outlets P
GAS Gas Piping System
1BP p
11 E Plumbing Permit Fee Issuance
1pP11 111`ERMITFE P
plumbing IP LMBLNCK Plu g Plan Check
as InsP.
1 PLMB
Sp Other Plumbing/g P.
Travel &Documentation Fee
B
IT RAVDOC B
1B
USLIC Business License
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408 777-3228
)
Fax(408)777-3333
CITY OF
.;UPE QT
rtMent
Build*
n De a
PERMIT #
JOB ADDRESS: �(t00 CA.%0.P
PHONE # ��0) �-
OV ERAS NAME: FAX # C(�: �-- 1
CONTRACTOR: C2 VX1 ' `�- ►�1,�
GENERAL I
I am not using any subcontractors: Date
Signature
sand co lete the f ollowin information:
Please check a livable subcontractor BUSINESS LICENSE #
SUBCONTRACTOR OR BUSINESS NAME
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
Date
caner/Contra r Signature