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10010096 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19990 OLIVEWOOD ST APT A-D CONTRACTOR:GENMOR PLUMBING PERMIT NO: 10010096 OWNER'S NAME: ESSEX PROPERTY TRUST 2552 SEABOARD AVE DATE ISSUED:01/25/2010 NER'S PHONE: 6508495835 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB �>3License Class Lic.#_ _ MECH r RESIDENTIAL COMMERCIAL Contractor Date J—ow —lo JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT I hereby affirm that I am er licensed un the provisions of Chapter 9 (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 two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. For Area: Valuation:$2500 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31643003.19990 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-p urce regulations per the Cupertino Municipal Code,Section Issued by Date: 9.18. Signature Date J RE-ROOFS: L, OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain m liance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Healt &Safe Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's O u o ' age / Date: Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save -nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expens ich may accrue against said City in consequence of the granting of this ermit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-p int sour a regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional — Signature ,k - Date � CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 45 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31643003 .19990 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT # . . . . . . . . . : BS000009609 REFERENCE ID # 10010096 SITE ADDRESS . . . . . : 19990 OLIVEWOOD ST APT A-D SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ESSEX PROPERTY TRUST ADDRESS . . . . . . . . . . : 10696 ROSEWOOD RD APT A-D CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ALLLAN UY CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT- -THIS-REC- NEW-BAL- ---------- ---------- ---------- ------------ 2, 500 . 00 1 . 00 0 . 00 1 . 00 0. 0 1BCBSC VALUATION 1.00 21 . 00 0 . 00 21 . 00 0 . 00 1BPWSVCS WATER SERVICE 0 . 63 000 0 . 63 0 . 00 . 1BSEISMICO VALUATION 2, 500 . 00 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PPERMITFE FLAT RATE 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1.00 42 . 00 0 .00 TOTAL PERMIT 106 .63 0 .00 106 .63 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ -------- ------ -------- -------- 103 UFER 106 SEWER & WATER 507 FINAL PLUMBING C1�; f i C) 09 CITY OF CUPERTINO R-uDTDu/c'� 'VER/MAIN SERVICE >. 1\L1 x-1L/IJL� PERMIT APPLICATION FORM CUPERTINO 1 APN # „ �� Date: j Building Ad ress: - ,' 6 )C- vw & C� 1�J Owner's Name: Phone #: t�,1 ,,� � q. Phone C ntractor: �� Fax Phone Contact: �) Fax#: Contractor License Cupertino Business License #: Job Description: Residential ❑ Commercial Valuation: eD— J Project Size: Express ❑ Standard EJ Lc,,1rge 9--' Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Green Buildin Points: • Fee Permit Type Quantity Fee ID Fee Description Grou IPCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1 BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets CBSC Cal Bldg Standards Commission B ALL PERMIT 1 B Fee TYPES I BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF. CITY OF CUPERTINO REPIPE/ SEWER/MAIN SERVICE FEE SCHEDULE CUPERTINO Qy ualitii Free ID r ee Description Fee Permit Type Group 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1 PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or � 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P ----------- I PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P ITv A��r,nr Tiu"�el �• Locumentation Fee B iii r Lvv 1 BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1Tlf OF Fax(408)777-3333 _U PEkTINO Building Depart ent JOB ADDRESS: I PERMIT # 9�0 'IctqCio apt c� .�L� �� 9&0/c/ � Db � OWNER'S NAME: X53,5,X PHONE #6 O-d L- ;;Iq 9 GENERAL CONTRACTOR: ., . ,,�-,� 2; C- FAX# S-0 - 9's-0 - I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Fa 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 6Zn�erC-ontractor i ature Date