10010109 UPERTINO BUILDING PERMIT 10109
CITY OFC PERMIT NO:100
-D CONTRACTOR:GENMOR PLUMBING ISSUED:01/25/2010
BUILDING ADDRESS: 10646 ROSEWOOD RD APT A DATE
2552 SEABOARD AVE
PHONE NO:(408)855-8348
OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131
NELECT PHONE. 6508495835 BUILDING PERMIT INFO: BLDG CT PLUMB
LICENSED CONTRACTOR'S DECLARATION COMMERCIAL
0 _7V1I� ) MECH RESIDENTIAL
License Class _
Lic.# 1>
Date r- JOB DESCRIPTION:WATER MAIN SERVICE REPLAC
I Y EMENT
Contractor
hereby affirm that am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 ofa 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 h
ave and will maintain a certificate of consent to self-insure Section 3700 of the Labor Codevfor the Valuation:$2500
Compensation,as provided for by Sq.Ft Floor Area:
performance of the work for which this pe� Insurance,is issued. as provided for by
I have and will maintain Workers CompensationOccupancy Type:
APN Number:31643005.10646
Section 3
700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION IF WOE IS NOT STARTED
that I have read this application and state that the above a state laws relating pEIZ�/jIT EXPIRESNCE OR
I certify 1 with all city and county ordinancesIT ISSUANCE
correct.I agree to comp y hereby authorize representatives of this city to enter WITHIN 0 DAYS OF PERM INSPECTION.
to building construction,and h Y purposes. (oft agree to save S OM LAST CALLED
upon the above mentioned property for inspection pure judgments, 180 D
Cupertino against liabilities,
indemnify and keep harmless the City of Cup said ity in consequence of the
costs,and expenses which may accrue heagainst cant understands and will comply _��-l(� Date:
it. Additionally,the app Issued by:.
granting of Cupertino Municipal Code,Section
with all no -point source regulations per the
9.18. Date '-
6--16
Signature RE-ROOFS:
Il be inspected prior to any roofing material being installed.ll new materialslfor
of is
All roofs shall p inspection,I agree to remove
OWNER-BUILDER DECLARATION installed without first obtaining an P
lJ inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of Date:
two reasons:
the following ith wages as their sole compensation, Signature of Applicant:
1,as owner of the property,or my employees w
he work,and the structure is not intended or offered for sale(Sec.704 , COVERINGS TO BE CLASS"A"OR BETTER
will dot ALL ROOF
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to DISCLOSURE
HAZARDOUS MATERIALS DIS r Chapter 6.95 of the
construct the project(Sec.7044,Business&Professions Code).
under penalty of perjury one of the following three
affirm u p Code,Sections 25505,25533,and 25534. I will maintain
I hereby
I have read the hazardous materials requirements un Health&
declarations: Chapter 9.12 and the
Certificate of Consent to self-insure for Worker's California Healthwith the Cupertino Municipal Code,
hazardous material.
I have and will maintain a Certcomplianceshould I store or
as provided for by Section 3700 of the Labor Code,for the Safety Code,Section I use a a)
Compensation, ued. Additionallyshould I use equipment or devices which emit hazardous air
ce of the work for which this permit is issued � the Bay Area Air Quality Management District I will
performance ensation Insurance,as provided for by contaminants as defined by Chapter 9.12 and the
I have and will maintain Worker's Comp ance of the work for which this maintai ompliance with the Cupertino25533,and 25534e,
Section 3700 of the Labor Code,for the perform Healt & afety Code,Sections 25505,
permit is issued. ent: —Inez
' �`
I certify that in the performance of the work for which this permit 1 e' o ker'shal ner r utho a Date: /
not employ any person in any manner so as to become subject to
this certificate of exemption,I
Compensation laws of California. If,after making I must
d revoked. CONSTRUCTION LENDING AGENCY performance of work'
e subject to the Worker's Compensation provisions of tweLabor
ae or Code, r the e
becom J
forthwith comply with such provisions or this permit shall be I hereby
affirm that there is a construction lending agency o p
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 the Ceo and sate laws relating
I certify 1 with all city and county ordinances
correct.I agree to comply to enter Lender's Address
building construction,and hereby authorize representatives of this city
to b g roe for inspection purposes.(We)agree to save
on the above mentioned pro] rh' a ainst liabilities,judgments, ARCHITECT'S DECLARATION
up harmless the City of Cupertinog
Znify and keep m consequence of the tans shall be used as public records.
and expenses which may accrue against said City 1 I understand my p
granting of this
t.Additionally,the applicant understands and will comp y
h all non-p, int so rce regulations per the Cupertino Municipal Code,Section Licensed Professional
wit -�
9.18.
Date
Signatu
CITY OF CUPERTINO
RECEIPT OPERATOR: patg
PERMITCOPY # 1
5 ITEMS OF 45
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31643005 .10646
DATE ISSUED: : : : : ; : 01/25/2010
: BS000009609
RECEIPT # ; 10010109
REFERENCE ID #
SITE ADDRESS . . . . . : 10646 ROSEWOOD RD APT A-D
SUBDIVISION : : . . . . . CUPERTINO
CITY •
IMPACT AREA . • • • • • •
ESSEX PROPERTY TRUST
OWNER ; 10647 ROSEWOOD
ADDRESS • • • • • . . CUPERTINO, CA 95014
CITY/STATE/ZIP
RECEIVED FROM • " ALLLAN UY LIC # 27101
; GENARO MORALS
CONTRACTOR • " GENMOR PLUMBING
COMPANY . . . . . . . " 2552 SEABOARD AVE
ADDRESS • • • • • . . . ' • ; SAN JOSE, CA 95131
CITY/STATE/ZIP (408) 855-8348
TELEPHONE
PD-TO-DT
THIS REC NEW BAL
UNIT QUANTITY _AMOUNT--- ---------- ---------- ------0 .00
FEE ID ---------- 0 . 00 1.00
---------- --------- 2 500 .00 1. 00 21 . 00 0 .00
BSC VALUATION 21 . 00 0 . 00 0 .00
1BC 1.00 0 . 00 0 .63
1BPWSVCS WATER SERVICE 2 500 .00 0 . 63 42 . 00 0 . 00
1BSEISMICO VALUATION 42 . 00 0 . 00 0 . 00
1.00 0 . 00 42 . 00
1PPERMITFE FLAT RATE 1.00 42 .00 -------
1TRAVDOC FLAT RATE ---------- ----- 106 .63 0 . 00
106 .63 0 .00
TOTAL PERMIT
VOICE ID -DESCRIPTION
_______-_
VOICE ID DESCRIPTION-__-_--_- _------
--------------- 106 SEWER & WATER
103 UFER
507 FINAL PLUMBING
CITY OFC-UpERTINO I oc-A
IN SERVICE
1PE/SEWEA1-
REP
IT APPLICATION FORM
cl-Ty F INO PERM
CUPE T
Date:
APN #
C
Building-Addr Phone-4-
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owner Phone#--LV(t)
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Fax
Contractor: one-R
Contact: Fax
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Contractor
'cense#:
Cu ertino Business Licen
Job Description:
ZN-Vk
Commercial Q'
Residential ❑
Valuation:
Major
❑
Standard❑ Large
project Size: Express compl
Tete relevant portion of the Green Building Checklist & attach it to the
Green Building: Please include in p
appllan set & the sheet index.
ication or if applicable,
Green Buildin Points: Fee PermitType
Fee Description .
GroU
Quantity Fee ID CPSS
Commercial building
IpCSEWEp
R
sewer/sanitary sewer fixture
P 1CPRP
IBPREPIPE
Commercial re-pipe per f
JPGALSCOM Commercial Gas Piping System P ALL PERMIT
1-4 outlets B
IBCBSC Cal Bldg standards Commission TYPES
Fee P
IBSEISN41COM Seismic Commercial
1R evised 01/07/09
.,. CITY OF CUPERTINO
r SERVICE
REPIPE/SEWER/MAIN
LUPE�.F FEE SCHEDULE
QuantityFee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1 PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
1PRREPIPE 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
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/gas Insp. P
1 TRAVDOC Travel & Documentation Fee B
1 BUSLIC Business License B
Commuluty Development
10300 Torre Avenue
4
Cupertino CA 950 28
Telephone(408)777
Y Fax(408)777-3333
Cf OF
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ete the followin information. #
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check a licable subc NAME B U
Please CTOR BUSINESS
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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
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