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10010106 1. CITY OF CUPERTINO BUILDING PERMIT PERMIT NO:10010 106 -D CONTRACTOR:GENMOR PLUMBING ISSUED:01/25/2010 BUILDING ADDRESS: 10716 ROSEWOOD RD APT 2552 SEABOARD AVE DATE OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ' NER'S PHONE: 6508495835ELECT PLUMB IT INFO: BLDG OR'S DECLARATION BUILDING PERM FLICENSED CONTRA c� COMMERCIAL � 3 < � / MECH RESIDENTIAL License Class Lic. ✓cam IN SERVICE REPLACEMENT Date JOB DESCRIPTION:WATER MA Contractor ter 9 I hereby affirm that I am licensed under the provisions of Chap (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. dec I herey b affirm under penalty of perjury one of the following Worker's as provided for by Sect rations: I have and will maintain a certificate°f consent to self-insure forion 3700 of the Labor Code,for the Valuation:$2500 Compensation, Permit.is issued. Sq.Ft Floor Area: performance of the work for which this p provided for by I have and will maintain Worker's Compensation Insurance,as p h this APN Number:31643005.10716 Occupancy Type: section 3700 of the Labor Code,for the performance of the work for which permit is issued. APPLICANT CERTIFICATION SIF WORK IS NOT STARTED that I have read this application and state that the above information a PERMIT EXPIRE CE OR I certify 1 with all city and county ordinances and state laws relating IT ISSUANCE correct.I agree to comply hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERM INSPECTION. to building construction,and Y purposes (We)agree to save mentioned property for inspection pure ies judgments, DAYS FROM LAST CALLED INSP upon the above m 1$� indemnify and keep harmless the City of Cupertino againntconsequence of the costs,and expenses which may accrue against understands and will comply Date: granting of this ermit. Additionally,the applicantertino Municipal Code,Section Issued by: with all non- int ource regulations per the Cup 9.18. Date Signature RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is or RATION without first obtaining an inspection,I agree to remove all new materials 0 OWNER-BUILDER DECLA installed inspection. hereby affirm that I am exempt from the Contractor's License Law for one o Date: I h y Applicant:------------------' the following two reasons: Signature of App r of the roperty,or my employees with wages as their sole Sec compensation, I,as owner p will do the work,and the structure isnot intended or offered for sale ALL ROOF COVERINGS TO BE CLASS"A„OR BETTER Business&Professions Codes I,as owner of the property, exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE .95 of the construct the project(Sec.7044,Business&Professions Code). under Cha ter 6 m under penalty of perjury one of the following three I hereby affil I have read the hazardous materials 25505,requirements25533,and 25534. I will maintain declarations: Chapter 9.12 and the Health Certificate of Consent to self-insure for Worker's Californiance Health h the Cupertino Municipal Code, hap hazardous material. I have and will maintain a comp should I store or ha as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a) Compensation, ' sued. ' Hall should I use equipment or devices which emit hazardous air Additionally, Area Air Quality Management District I will performance of the work for which this permit is is rovided for by contaminants as defined by the Bay Chapter 9.12 and the I have and will maintain Worker's Compensation of Insuas rance, for which this maintain compliance with the Cupertino 25533,and Municipal5534e, Section 3700 of the Labor Code,for the performanceHealt afety Code,Sections 255 permit is issued. permit is issued,I shall rite ent: that in the performance of the work for which this p j0 I certify t Date: ro employ any person in any manner so as to become subject at of exemption,I not p y Compensation laws of California. If,after making provisions ns of the Labor Code,I must ONSTRUCTION LENDING AGENCY become subject to the Workers CompensationP C the performance of work's that there is a construction lending agency for ith comply with such provisions or this permit shall be deemed revoked. affirm t forthw p I hereby for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name that I have read this application and state that the above information is I certify with all city and county ordinances and state laws relating 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 unon the above mentioned property of Cupertino against liabilities,judgments, lnify and keep harmless the City in of the fans shall be used as public records. and expenses which may accrue against said City 1 I understand my p Perm .Ad itionally,the applicant understands and will comp y granting of this p Cupertino Municipal Code,Section with all non-points urce r ulations er the Cup Licensed Professional 9.18. / Date Signature CITY OF CUPERTINO RECEIPT OPERATOR: patg PERMIT COPY # 1 5 ITEMS OF 40 Rng: Sub: Blk: Lot: Sec: Twp: ; 31643005 .10716 APN DATE ISSUED: : : : : : : 01/25/2010 : BS000009612 RECEIPT # ; REFERENCE ID # 10010106• • • 10716 ROSEWOOD RD APT A-D SITE ADDRESS SUBDIVISION • • . . . ; CUPERTINO CITY . • • • • IMPACT AREA • . , , , ; ESSEX PROPERTY RDUST APT A-D OWNER • • , • . ; 10716 ROSEWOOD ADDRESS • • • • • . . . . ; CUpERTINO, CA 95014 CITY/STATE/ZIP ALLAN UY LIC # 27101 RECEIVED FROM • • " ; GENARO MORALS CONTRACTOR GENMOR PLUMBING COMPANY . . . . . . . ' 2552 SEABOARD AVE ADDRESS . • • • • . . . " SAN JOSE, CA 95131 CITY/STATE/ZIP • • ; (408) 855-8348 TELEPHONE . • • • • THIS REC NEW BAL QUANTITY AMOUNT -PD_TO_DT_ ______---- ---------- FEE ID UNIT 4___--____ _--------- 00 1 .00 0 . 0 . 00 --------- ------- ----- 2, 500 .00 1 . 00 21 . 00 0 .00 VALUATION 21 . 00 0 . 00 0.00 1BCBSC 1.00 0 . 00 0 .63 1BPWSVCS WATER SERVICE 2 500 .00 0 .63 42 . 00 0 . 00 0 .00 0 . 00 1BSEISMICO VALUATION 42 . 00 1.00 0 .00 42_00 1pPERMITFE FLA 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 OF CUPERTINO N SERVICE PIPE/SEWE C,I-T'Y OF PERMIT APPLICATION FORM LUPE TINO Date: U) I APN # 4:3 c) A . Buildin Ad esu: Phone L Owner s Name: 77�L ..........I) Q'), Phone#: �. }�`:) �;, Contract r. Fax#: Ljj Phone Contact: Fax#: C r� Contractor License#: Cu ertino Business License#: Job Description: C Commercial Residential ❑ valuation: Star ard Large ❑- Project Size: portion of the Green Building Checklist & attach it to the Green Building: Please complete relevant application or if g include in plan set & the sheet index applicable Green Building Points: Fee Permit Type Quantity Fee ID Fee Description Grou ICPSS 1PCSEWER Commercial building P sewer/sanitary sewer P JCPRP IBPREPIPE Commercial re-pipe per fixture IPGASCOM Commercial Gas Piping System P 1-4 outlets B ALL, PERMIT IBCBSC Cal Bldg Standards Commission TYPES Fee P IBSEISMICOM Seismic Commercial Revised 01/07/07 CITY OF CUPERTINO ��:,�:� IN SERVICE RE PIPE/BENNE In oFEE SCHEDULE CUQEkTINO Fee Permit Type Quantity Fee ID Fee Description Grou Commission B ALL PERMIT BCBSC Cal Bldg Standards Comm TYPES t 1 Fee f P 1BSEISMICR Seismic Residential P 1RPSS 1PRSEWER Residential building sewer/sanitary sewer fixture P 1RPRP 1PRREPIPE Residential re-pipe per 1CPWS or P 18PWSVCS Water Service 1RPWS EWG Private Sewage Disposal System P 1PPRSp P 1PCESS Cesspool PWATER Install/alter Water Pipe P 1B 1 BPFIXTURE Plumbing Fixture P System P 1P GASRES Residential Gas Piping y 1-4 Outlets P 1B PGAS Gas Piping System 5+ Outlets RMITFEE Plumbing Permit Fee Issuance P 1PPE 1 PLMBLNCK Plumbing Plan Check P as Ins P 1PLMBINSP Other Plumbing/g P• OC Travel &Documentation Fee B 1TRAVD B 1BUSLIC Business License Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF UPEkTINO D e artment Buld In v � - PERMIT # JOB ADDRESS: C1. PHONE # OWNER'S NAME: GENERAL CONTRACTOR: FAX# zo�to I am not using any subcontractors: Signature Date subcontractors and complete lete the ZZE n information: Please check applicable BUSINESSLICENSE #SUB CONTRACTOR 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 4rowner/Co Z_�Date n ac _Signature