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10010108 CITY OF CUPERTINO BUILDING PERMIT C CONTRACTOR:GENMOR PLUMBING PERMIT NO.10010108 BUILDING ADDRESS: 10666 ROSEWOOD RD APT A,B,C,D 2552 SEABOARD AVE DATE ISSUED:01/25/2010 OWNER'S NAME: ESSEX PROPERTY TRUST PHONE NO:(408)855-8348 SAN JOSE,CA 95131 NER'S PHONE: 6508495835 r ELECT PLUMB 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG �j CH r RESIDENTIAL COMMERCIAL rLicen License Class Lic.# � ME CH Date for JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT he provisions of I hereby affirm that I am licensed under oon 3 of the Business&tProfessions (commencing with Section 7000)of Div Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the followconsent to ing two declarations: I have and will maintain a certificate�on 3700 of the Labor Code,for the Compensation,as provided for by Se Sq.Ft Floor Area: Valuation:$2500 performance of the work for which this permit is issued. provided for by I have and will maintain Worker's Compensation Insurance,as p Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31643005.10666 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the Ceo ar d state laws relating IT EXPIRES IF WORK IS ation is NOT STARTED correct.I agree to comply with all city and county ordinances PERM n and hereby authorize representatives of this city to enter THIN 180 YS OF PERMIT IS OR to building construction, purposes. (We)agree to save WI upon the above mentioned property for inspection DAYS LAST CALLED INSPECTION. p 180 indemnify and keep harmless the City of Cupp said City inconsequenceof the s, _ 1 costs,and expenses which may accrueagainst understands and will comply v / � Date: granting of this rmit. Additionally, pp Issued by: with all non oint urce regulations per the Cupertino Municipal Code,Section 9.18. Date Signatur RE-ROOFS: All roofs shall be inspected prior to any roofing material being ins lltaed. new materials is (J OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove a I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. Date: the following two reasons: y employees with wages as their sole compensation, Signature of Applicant: I,as owner of the property,or m will do the work,and the structure is not intended or offered for sale(Sec.7044, COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) ALL ROOF COVER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements Sections 05 under Chapter 25533,and 25534.95 of the I will maintaii declarations: CodeChapter 9.12 and the Health& Cert of Consent to self-insure for Worker's California Health Cupertino Municipal Code, I have and will maintain a C compliance with t phazardous ma Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle em t hazardous air l• Comp equipment or devices performance of the work for which this permit is issued. Additionally,should I use equip Area Air Quality Management District I will I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Section 3700 of the Labor Code,for the performance of the work for which this Aainmpliance with the Cupertino Municipals 3 e,Chapter 9.12 and the ety Code,Sections 25505,25533,and permit is issued. is I certify that in the performance of the work for which this ec permit 1Wo Worker's th a agent: r" ` not employ any person in any manner so as to become subject t Date: Compensation laws of California. If,after making this certificate of exemption, I must become subject to the Worker's Compensation provisions shall of the Labor ode revoked. CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this perm I hereby affirm that there is a construction lending agency for the performance of work TIFICATION for which this permit is issued(Sec.3097,Civ C.) APPLICANT CER certify that I have read this application and state that the above information laws relating Lender's Name I c fY with all city and county ordinances and correct.I agree to comply building construction,and hereby authorize representatives of thi s city osave er Lender's Ad ress to g for inspection purposes.(We) g upon the above mentioned property P ARCHITECT'S DECLARATION Znify and keep harmless the City of Cupertino against inconsequenceof the judgments, d as public records. and expenses which may accrue against s h' plans shall be use p granting of this it. dditionally,the applicant understands and will comply I understand my p with all non- int sour regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. �_C26 Date Signatur CITY OF CUPERTINO atg OPERATOR: P PERMIT RECEIPT COPY # 1 5 ITEMS OF 40 Sub: Blk: Lot: Seo; Twp: Rng: , • . • . 31643005 .10666 APN • 01/25/2010 DATE ISSUED. . . . . - - BS000009612 RECEIPT REFERENCE ID 10010108 SITE ADDRESS • 10666 ROSEWOOD RD APT A'B'C'D SUBDIVISION . : CUPERTINO CITY . • • IMPACT AREA • • . . • , , , , ; ESSEX PROPERTY RD APT A-D OWNER ; 10656 ROSEWOOD ADDRESS • • • • " CUPERTINO, CA 95014 CITY/STATE/ZIP • • • RECEIVED FROM ALLAN UY GENAROMORALS LIC # 27101 • • ' CONTRACTOR • " GENMOR PLUMBING COMPANY • " 2552 SEABOARD AVE ADDRESS • • • " ' ; SAN JOSE, CA 9 5131 CITY/STATE/ZIP . (408) 855-8348 TELEPHONE PD-TO-DT THIS REC NEW BAL - T QUANTI'T'Y AMOUNT--- ___------- ----____00 0 .00 FEE ID UNI _- ---------- - 1 . __---- 1 . 00 0 .00 0 .00 _____--- ---- 2, 500 .00 0 .00 21.00 0 .00 1BCBSC VALUATION 1.00 21.00 0 .00 0 .63 0.00 WATER SERVICE 0 . 63 42 . 00 1BPWSVCS 2, 500 .00 00 0 .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 ----__--- DESCRIPTION WATER ID ---------------------------- 106 SEWER & 103 LIFER 507 FINAL PLUMBING CITY OF CUPERTINO I 4.. KEPIPE/SEWER/MAIN SERVICE CITY OF PERMIT APPLICATION FORM CUPEkl INU Date: APN # re din ArM Building Address:. Phone#: Owner's Name PC) 0 64. Phone#: e� Co ractor: 6 Fax#: 9 Phone#.:. Contact: Fax#: C40V Tri-(aTl Contractor License#: Cu ertino Business License#: Job Description: VJ&N- VV\CkV\ Residential ❑ Commercial ❑-- Valuation: jExpr ess St........... I 1 1 ❑ Large aMajor❑ Project onion o Green Building: Please complete relevant pf the Green Building Checklist & attach it to the Building: index. 71 application or if applicable, include in plan set& the she 13 Green.Buil- Quantity Fee ID Fee Description Fee Permit.Type Group IPCSEWER commercial building P ICPSS sewer/sanitary sewer —T1B 1 PREPIPE Commercial re-pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT IBCBSC Cal Bldg Standards Commission TYPES Fee P IBSEISMICOM Seismic Commercial I — Revised 01/07/09 —- ----------- f 7 ' CITY OF C SERVICE REP--IPE/SEWERIMMN FEE SCHEDULE CUPEf�T1NO Fee Permit Type Quantity Fee ID Fee Description Grou Commission B ALL PERMIT 1 BCBSC Cal Bldg Standards Comm TYPES Fee P 1BSEISMICR Seismic Residential P 1RPSS 1PRSEWER Residential building sewer/sanity sewer P 1RPRP 1 PRRE pjpE Residential re-pipe Per fixture P 1CPWS or 18PWSVCS Water Service 1RPWS �- P 1 PPRS EWG Private Sewage Disposal System P 1PCESS Cesspool 1 BPWATER Install/al ter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASR.ES Residential Gas Piping System P 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets ERMITFEE Plumbing Permit Fee Issuance P IPP LMBLNCK Plumbing Plan Check P 1P 1PLMBINSP Other Plumbing/gas Ins p• P OC Travel &Documentation Fee B IT RAVD B 1BUSLIC Business License Community Development 10300 Torre Avenue o CA 95014 Cupertino)777 scat. ( Telephone Fax(408)777-3333 CtT1f OF XPEkTINO • artment Buildin De S PERMIT # OB ADDRE c �� J cqst) l Q CP co PHONE # L " T) Z:5Lt`� —SQA ,�- ILLI, OWNER'S NAME: �5 # 5� 85 U -`11 r✓ CTOR: o r ��,yvlbr FAX Ccs GENERAL CONTRA lM I am not using any subcontractors: Signature Date • le subcontractors and complete the WE in information: Please check a licab BUSINESS LICENSE # SUBCONTRACTOR BUSINESS N 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 e Date O ner/Contractor Signature