10010099 CITY OF CUPSRTINO BUPERMIT NO.
ILDING PERMIT • 10010099
ENMOR PLUMBING
DATE ISSUED:01/25/2010
BUILDING ADDRESS: 10659 MP,pLEWOOD RD APT A,B,C,D CONTRACTOR.G2552 SEABOARD AVE 55-8348
PHONE NO:(408)8
OWNER'S NAME: ESSEX PROPERTY TRUST SAN JOSE,CA 95131
• 08495835 r PLUMB
IER'S PHONE. 65 ELECT
TOR'S DECLARATION BUILDING PERMIT INFO: BLDG COMMERCIAL
LICENSED CONTRAC RESIDENTIAL
Ej MECH
Lic.# f -1�
License Class
Date 6 -16 JOB DESCRIPTION:WATER MAIN SERVICE REPLACEMENT
contractor' der the provisions of Chapter 9
I hereby affirm that I m licensed un
with Section 7000)of Division 3 of the Business&Professions
(commencing
Code and that my license is in full force and effect-.
one of the following two declarations:
of
I hereby affirm under penalty perjury
ill maintain a certificate of consent to self-insure for
o Worker's
the Valuation:$2500
I have and w Section 3700 of the Labor
Compensation,as provided for by Sq.Ft Floor Area:
Perm,ion
is issued. provided for by
performance of the work for er which Compensation Insurance,asp Occupancy Type:
I have and will maintain W which this 31643003.10659
Section 3700 of the Labor Code,for the performance of the work for APN Number:
permit is issued.
APPLICANT CERTIFICATION above information is IF WORK IS NOT STARTED
location and state that t PENT EXPIRES
I certify that I have read this with
1 city and county ordinances and state lawns relating
S OF PERMIT ISSUANCE OR
correct.I agree to comply and
h r ty representatives of this city t WITHIN 180 DAY
onstruction,and hereby authorize rep oses. (We)agree to save AST CALLED INSPECTION.
to building c for inspection pure 180 DA OM L
upon the above mentioned property. of Cupertino against liabilities,judgments, � 1
indemnify and keep harmless the City m consequence of the '� Date:
accrue against said City
costs,and expenses which may licant understands and will comply Issued by:
granting of this ermit. Additionally,ter the Cupertino Municipal Code,Section
with all non-p nt \urce regulations p
F
9.18.
Date
/--:�"— RE-ROOFS: installed.If a roof is
Signature roofing material being
inspected prior to any agree to remove all new materials for
All roofs shall be an inspection,I ag
installed without first obtaining
� OWNER-BUILDER DECLARATION Law for one of inspection.
t from the Contractor's License Date:
I hereby affirm that I on exempt Signature of Applicant:
the following two reasons:
or my employees with wages as thei salee Sec pensation,
I,as owner of the property, OR BETTER
work,and the structure is not intended or offered for ( ALL ROOF COVERINGS TO BE CLASS"A"
will do the A
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 DISCLOSUREr 6.95 of the
one of the following three
have read the hazardous materials requirements 50525533,and 25under C110 534. I will maintain
affirm under penalty of perjury I ha Code,Section
I hereby Chapter 9.12 and the Health
declarations: compliance with the Cupertino Municipal Code,
d Consent to self-insure for Worker's California Health&Safety a or handle hazardous material.
comp should I store
I have and will mamtam a Certificate o Safety Code,Section 25532(a)
Provided for by Section 3700 of the Labor Code,for the should I use equipmentMana ement District I will
or deviceswhich emit hazardous air
Compensation,as p permit is issued. Additionally,shthe Bay Area Air Quality
performance of the work for which this p rovided for by contaminants as defined by Chapter 9.12 and the
ensation Insurance,as
for which this compliance with the Cupertino Municipal Code,
1 have and will maintain Worker's Comp per of the w maintain comp
Labor Code,for the p Health afety Code,Sections 25505,25533,and 25534.
Section 3700 of the L H
permit is issued. ri agent: C2 —/6
I certify that in the p
erformance of the work for which this permit is issued, O e o u Date: '
not employ any person in any manner so as to become subject to e
Of California. If,after making this certificate of exemption,de,I must LENDING AGENCY
Compensation laws Compensation provisions of the Lab CONSTRUCTION
become subject to the Worker's Comp enc for the performance of worl
with such provisions or this permit shall be deemed revoked.
forthwith comply I hereby affirm that there is a construction Sec 3097,Civ lending agency
f
for which this permit is issued
APPLICANT CERTIFICATION ation is Lender's Name
e read this application and state that the ab and ate laws relating
I certify that I have and county ordinances
Address------------------
correct.I agree to comply With all city
authorize representatives of this city to enter Lender's A ress
to building construction,and hereby inspection purposes.(We)agree to save
e for insp � bilities,judgments, ARCHITECT'S DECLARATIO
upon the above mentioned property Cupertino against lea
and keep harmless the City of Cup public records.
unify in consequence of the plans shall be used as p
and expenses which may accrue against said City 1 I understand my
f this rrriit.Additionally,the applicant understands and will comply
granting o Cupertino Municipal Code,Section Licensed Professional
with all non- 'nt s urce regulations per the Cup
9.18. Z
Date / � —
Signatur
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
5 ITEMS OF 60 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31643003 .10659
DATE ISSUED. . . . . . . : 01/25/2010
RECEIPT # . . . . . . . . . : ES000009613
REFERENCE ID # . . . : 10010099
SITE
ADDRESS 10659 MAPLEWOOD RD APT A,B,C,D
SUBDIVISION . CUPERTINO
CITY • • • • • • •
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . : ESSEX PROPERTY TRUST
ADDRESS 10696 ROSEWOOD RDAPTA-D
CITY/STATE/ZIP CUPERTINO, CA 954
RECEIVED FROM . . . . : ALLAN UY
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
CO : 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
QUANTITY AMOUNT ---
FEE ID --_UNIT'----- ---------- ---------- ---------- --------- -----0 .00
---- - 1. 00 0 . 00 0 . 00
1BCBSC VALUATION 2, 500 .00 21. 00 0 . 00 21 . 00
100 0 . 63 0 . 00
.
1BPWSVCS WATER SERVICE 0 . 63 0 .00 0 . 00
SMICO VALUATION
2, 500 .00 0 .00 42 . 00
1BSEI1.00 42 . 00 42 . 00 0 . 00
1PPERMITFE FLAT RATE 1.00 42 . 00 0 .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
OF
.....................................
CITY OF CUPERTINO
REPIPE/SEWED
MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
Date: 1 1
APN
# 7� FI_c_n Add ess: �
Building (1C,)(,)1LA
g �� C
Phone #: _ r6,L-1 c� 'S(6 5�J
Owner's Name: �c.)
G Phone #: L
Con ctor: - Fax CO}
Phone #: G ill �� I -�
Contact: )173-09
Fax #
Contractor License
Cu e
rtino Business License
Job Description:
Residential
Commercial �
❑
Valuation: 4,7 ..........................
................................... j El
FGreen
ze: Express ❑ Standard ❑ Large Ma or
nt portion of the Green Building Checklist & attach it to the
dding: Please completereleva n or if applicable, include in plan set & the sheet index.
Green Building Points:
Fee Permit Type
Quantity Fee ID Fee Description
Grou
�CF�7tIFR eI%.IIL 1 building
P 1CPSS
Cort-n rcia.
sewer/sanitary sewer
P 1CPRP
1 BPREPIPE Commercial re-pipe per fixture
1 PGASCOM
Commercial Gas Piping System P
1-4 Outlets B ALL PERMIT
1BCBSC Cal Bldg Standards Commission TYPES
Fee P
1 BSEISMICOM Seismic Commercial
Revised 01/07/09
CITY OF
CUPERTINOCITY OF
REPIP
E/SEWER/MAIN SERVICE
FEE SCHEDULE
CUPERTINO
Quantity Fee ID Fee Description Fee Permit Type
Qu ty
Group-
1 BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
-4 1BSEISMICR Seismic Residential P
1 PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
lBPWSVCS Water Service P 1CPWS or
1RPWS
1 PPRSEWG Private Sewage Disposal System P
1 PCESS Cesspool P
1 BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1 PPERMITFEE 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
ion,-, Community Development
k 10300 Torre Avenue
w
nk; Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
;UPEkTINO
Building Department
JOB ADDRESS: gS-0A/ PERMIT # C) 0 C)
OWNER'S NAME: 5e res PHONE # 6,S"c) 117
GENERAL CONTRACTOR: ,ate FAX # e5-z - qS-j>3
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Tile
Owner/Contractor Signature Date