06090083CITY OF CUPERTINO
BUILOINGDIVISION PERMIT
CONTRACTOR NFJORMATIQN
1a, hi rh ;."•t ,.. , s eA R ?i e.m3rl T 1
BUILDING ADDRESS:
RICHARD KIM CONSTRUCTION
PERMITND'06090083
10094 JUDY AVE
OWNER'S NAME:
PERMIT ISSUEDATE
DONG CHUL CHO
2340 MONACO
09/12/2006
NE:
SANITARY NO. CONTROL NO.
(408)206-8369
ARCHmiCT/ENGINERR:
BUILDING PERM" INFO
BLDG ELECT PLUMB MECH
as
LICENSED CONTRACTOR'S DECLARATION
-
Job Description
1lterobY Oman thal l aro lkmnwd under provisions afCMpter 9 (commencing
with Section 701111) of Division Sof the Butircssuld Professfow Code, arta my fescue is
y
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InmBmroaod.raL "JCLhyLf
Lkenw Class Lie. Y
INSTALL TEMPORARY POWER POLE /
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Do. A Contractor_ DI(GtA Kink roc
ARCHITECTS DECLARA1..Yc
I understand my plans shall M used u public rocords
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R.S� e
Licensed P ofcssional
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ON
DECLARATION
Oat
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I am cUIIDER m
I Mushy .(Seco dial 11. except from U Law far
I:
COnions
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my
Cam: Any city or wanly
ng moron. (Section ]o L3, Business and r Co Any c
mi
. des -1 Seracture
which prosu mmnlW, err mash
which roquirM a permit 1.re emWMCL sits,
$100
�,
ed
priorwsl issuance,alto applicant for sohbomb'mrilea Law uetemem
the Ne
Sq. Ft. Floor Area
Valuation
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punctual to previsions of
$
(c crancingwthSectinataNepmvivisMofdcicBusawsiandPnwLaw(Chapler9
Seafm 7 and the basis n 3 of al egad maand Professions, Cade) or
(cat he is cover,
diet M u comps IMmfrom and Ne buu for the alleged vmptiml. Any violation of
r
Occupancy Type
Section 7031.5 by any applicant far a permit object+Ne applicant to a civil penalty of
mat come than firs hundred dollars (M),
0 1, as awneraf Ne propc9y, army employees with wages as their sale compeMNon,
e
Required Inspections
wmdalheworLLndthcswaumunmimmndedaranem fortale(Sw.7ow.Bmimas
Nd PrefeatlOM Cade: The Comuamaes Lica¢ Law does rot apply m M Owner of
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property who boilelsofimproves thercocand who doessuch work himself or through his
own employees, provided that such impravemwm of nutimenmd oro0cred foraho If.
however, the building orlmprovemwt is old within arc year of acrophobia. the ownner-
bolder, will have tM burden of proving that M did not build or improve for purpose of
ab.).
0 I. as owner of the property, am exclusively contracting with licensed wntrawon to
canatncl the project (Sec. 7094. Basin... and Professions Cade:) The Cantsxmr, Li-
cense Law does oat apply in w Owner of property woo Mibi or improve Neswn, and,
who controls far such prejeGV with a comYClm(s) licensed pumb ant b the Confiscates
Lice. Law.
❑ I un earept under See . B& P C for flow mown
canerDate
WORKERS COMPENSATION DECORATION
1 hereby aff on under permlty of pedury ane of ate following declarations:
1 have and will msinuim • CiedOunte of Cabal in self-insum fu Workees Cast
,Orion. a provided for by Section 3700 of the Labor Code, for the performance of out
work for which Nbs permit is bawd.
0 I have and will maintain Warkees Compensation Insurance, as acquired by Section
37W of the Labor Com, far the performance of the work for which this permit a iuued.
'
My Workees Campenaadon Inseminate, artier and Policy num rue:
Camber. N�✓3 c Paltry No,
CERTIFICATE OF EXFMPI70N FROM WORKERS
COMPENSATION INSURANCE
-
(Thu=mica reed cot M completed if the Permit is forma hundred dollar ($100)
or teal
1 ardfy the, in the performance of the work for which thb Permit is issued. I shall not
cmployanyperioninanymanncrwuwbecmnswbjwfwtMWorkere Compe m
Lawa of Caiifamia. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Uchapfion, you should
become object to Ne Workees Compensation provisions of the Labor Cads you must
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forthwith comply with such provisions or this permit shall M accrued avarice.
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CONSTRUCTION LENDING AGENCY
1 hereby eftirm that Nem u a cavwninn lending agency for the Performanco of
>
do wark for which this permit Is Wood (Sec 3097, Civ. C.)
QLendces
Name
Isnderl Address
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1 certify that 1 Mrs fund this application our sum that are above inromuuun is
—coned.
l agree to comply with all city and county ordinances and sac laws relating to
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Wilding construction, and hereby authorim representatives or this city to enter upon the
ahuvc-mcmioned properly for inspection purposes.
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(We) agree to ave, indemnify and keep harmless Oar City of Cupertino against
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liabilitia,judgmenb,eosb and cabana which may in any way.. agaiMI saidCity
in COMicquenee of Ne granting of this permit.
APPLIC UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT
SOUR GU TfONS.
Issued by:6Date
�/�1°6
(
Re-roofs C7
Type of Roof
Signuum of ApplicanifComucwr Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fuwm building occo anuwro or handle houuaoua material
u dented by the Cupertino Municipal Codc. Chapter 9.12, and the Halth and Safety
Cam, Seedan 25532(a)7All
roofs shall be inspected prior to any roofing material being installed.
[:3 Y. ANO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of future building Owupaml use equipment or mvlcos which
craft hazardous air conumimnla as mOncd by the Bay Area Air Quality Management
all new materials for inspection.
DiNict7
DYa Nu
I have real the husrduusmateriais lequicmcna under Chapter 6.95 ofihe Califor.
nia HunlN&SafelyCodc,ScciOM255W,21533wd23534.lo&m ndthairthe building
data WE cunenlly naw a Icnant, Nal It u my responsibility to notify he wcuP"t of the,
requimmc chmadubtactZwiaanwaffiCcrtiracalcoroaffy
Signature of Applicant Date
9" �
All roof coverings to be Class "B" or better
Owner or wiharied,gam DOW
Ll
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:(
D D q4 � A tFJ• �I
PERMIT # GD
O ao �3
OWNER'S NAME: P6h w
PHONE # 7,o6 --9.3 6
GENERAL CONTRACTOR: r?( /A-219 147wl C005.T
FAX # :b f) 626 —r3
I am not using any subcontractors: ZK'� o�
Signature Date
Please check applicable subcontractors and complete the following information:
21
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
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN I.......: 37511010.00
DATE ISSUED.......: 09/12/2006
RECEIPT #.........: 36014
REFERENCE ID # ...: 06090083
SITE ADDRESS .....: 10094 JUDY AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: DONG CHUL CHO
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: RICHARD KIM
CONTRACTOR .......: RICHARD KIM LIC # 28210
COMPANY ..........: RICHARD KIM CONSTRUCTION
ADDRESS ..........: 2340 MONACO DR
CITY/STATE/ZIP ...: SAN 'JOSE,, CA 95124
TELEPHONE ........: (408)206-8369
IFEE ID UNIT QUANTITY
---------------------------------
BTEMP FLAT RATE 1.00
EPERMITFEE FLAT RATE 1.00
TOTAL PERMIT :
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
62.10
----------
0.00
----------
62.10
----------
0.00
38.37
0.00
38.37
0.00
----------
100.47
----------
0.00
----------
100.47
----------
0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 100.47 VISA
TOTAL RECEIPT : 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
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•CITY OF
CUPERTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
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APN # SIS—) —
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Date: T / /
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Building Address/
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EPERMITFEE
Owner's Name: CGS
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Contractor:
Phon
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License #:
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Contact:
Phone:
Cupertino Business License #:
Building Permit Info:
Elect
Job Description:
Residential
Commercial ❑
Cost of Project: Vb D y
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Qty. if
Applicable Fee ID
Fee Description
Fee Group
n
LJ
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
n
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