06050041 CITY OF CUPERTINO
BLNLDING DIVISION PERMIT 0RINF,0
BUILDING ADDRESS: K & M DEVELOPMENT INC 11RMI77NO.06050041
un
7556 KIRWIN LA
OWNER'S NAME: PERMT71SSUEDATE
DERRICK LAU 1060 WEST HILL CT 05/04/2006
NE: SANITARY NO. CONTROL NO.
(408) .253-9787
ARCHITECT'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o . C=
LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under Prervisiturs OrChfulater 9(com
ownci.,
mfthS..wn7OpO).fDivIsmm3odftR * wel Code lavylkwasai.
unful INSTALL TEMPORARY POWER POLE
j e1 Ll..
all Do.
I understood my plans man be used as,public records
sad Licensed Profew...I
OWNER-BUILDER DECLARATION
I h...by jda.that I am exempts ft Ctenuraels Lice..Law for the
.a following mem..(Some.703 L.J.Business and Preparations CoCde:Any city of county
which notim a Mmit m construct,ahm.Improve.damollsh.or repair my abructure $1200
primu,its Issuance,shot requires the applicant for such permit in rile a signed stmencrit Valuation
ppm that he is licensed pursuant to ft pomillons of the Contractor's Lica.Ls.(Chapter 9 Sq.Ft. Floor Area
(commencing with Section 7000)of Division?of ft Business and Preficul Code)or
thad he Is exampt thendficam and the basis An the allqcd counnupdon,Any VIOIWM of
Section 7031.5 by try applicant for a permit subjects the APPILCIat W A civil Penalty Of AFN Ntflthbtr Occupancy Type
mt mom then five hundred dollar(SSW).
0 1,asowner afDie property,ormy croploymewith mum,
win do the work.and then WmWm is wt intended butuffanni formic(Sec.7044,Bissimad,
andPrOlessionsCade:'notOcartacem'slicca law&MOOLIPP1710211Damm Of Required Inspections
property who build,u imPtowa thenen.and who dao such arearit himself ser through his
awnmplayeo,proAdedflMl=bimp"M umwtinr,ndedwaffendfas.h'-If.
ubvgo
Wonder will have the bunum of proving that M did mt build or improve,for purpose of
son.).
0 1.U mumser of On prop my..m ewitutively connecting with Homestead COMMU003 W
constrouct the project(Sm 7044.Bmincss,and Praflassions cadet)The Contractors Li-
sue
.Law ones..,"ply m an Owmm�of propose,who hands Or inspronsts;daemon.and
who contracts for such projects with a cortunwhor(s)licented panown,W the Currencies
Lt..Law.
0 Imessemptundo See. ..B&PC(ser this mom
Owner Dam—
WORKERS COMPENSATION DECLARATION
41 1 thereby anions under Penalty of Formal,unne of the following doolonatione:
0 1 ham and will maintain a canincam.rcmeamw self-humm for Workers Compen.
urian,as provided for by Section 3700 of the Labor Code,for the performance of ft
wort for which this permit is Issued.
0 1 have and Will maintain Worker's Compensation Insuramm,as respdrand by Section
37OO.ftbc Labor Code,four th,P"iftemoss.Often wants for Which this Pont,is issued.
My Worker's Compensation Issumnes,carrier and Policy number
Carriers Policy No.;/-'5
CERIITATEMPTION FROM WORIfERS'
COMPENSATION INSURANCE
mile sectio mand nothecomplaned little scowl Is forousc hundred dollars($100)
or hum.)
I certify dum in the paufammunce of the Work for which this permit is issued.I send mor
employ any person In my amorms,u W b===bject on ft Workerns'Claraproolefte,
Laws at Califimuma.Case
Applican,
NOTICE To APPLICANT'.If.&Act making this Ccoufficaft of Emumpohn.you should
Income swim W the Wonlim's Compenduadon provisions of ft LAW Code,you a=
z forthwith=reply With=11 Plantations Of this permit"I ba domed reveled.
\ CONSTRUCTION LENDING AGENCY
1 hereby dnm that ft.is 4 commachum latudim,.,me,for ft perforwrom Of
Ffi ft work for which ders permit I.throw(Sec.3(67.Civ.C.)
Lenders Name
Lralce,Addma;
J Q I canify that I have mad Oda application and sum thou the wom information I.
I, correct.I 8,rm W comply with all city and county ordirsoccor mul sum laws totaling be
U building construction,and hereby Auft.11011M ropmaeboslime Of this City to enter upon the
awn-tramd,mcd Properly for inspection tompOsas.
(We)agree to an,indemnify and Jeep hatemblesS ft City Of Cupertino against
W liabilities,judimcros,costs and expenses,which may In my way acemot against We City
U
Z APPLICANT UNDERSTANDS
f tAhiNs Drselt.
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE Ns. Re-roofs
A Dole
US MATERIALSDISCLOSU Z Type of Roof
Will the spit future building amouprosolumm of butualthe haaammus material
r."a"Code Chapter
'1 2
as;defiraw by ft Cupertino Municipal Code.Chapter 9.12,and ft Health and Safety
Cods.McUon 255324)? All roofs shall be inspected prior to any roofing material being installed.
0y.
Wit ft a lu'roo. If a roof is installed without first obtaining an inspection,I agree to remove
or
,fuh
will ft applicant f.h<MbujIdi.j occupm,.equipment a devices Which
cmlt hZLrdow air counuchinucts a dcfiwdd by the Day Am Air Quality MusulgComn' all new materials for inspection.
Districtl
Ily.
than mall Ota huaiihmm.mfialsmquimmems under Chpw6.95ofthe Cal lla-
niaP=Ith&Safety Cade,Soctiom,25505,25533W25534.1undersand dwirtic building
dws,mt currently how.Maori.des,It Is my responsibility ut notify ft oompant of the
Museum of a Certificate of C�CUP-,P-,,6 Signature of Applicant Date
.pthaAm agent Date
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
! % Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
WUPEI�TINO
Buildin g Department
JOB ADDRESS: PERMIT#
7Ss• /z ;r-4 . Cri 060Sao C-(/
OWNER'S NAME: 2(,c-- La PHONE # Z S3 - 7
GENERAL CONTRACTOR: G FAX #
I am not using any subcontractors: --(—ap
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
Owne ontror Siggature Date
CITY OF CUPERTINO
*m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35922029 . 00
DATE ISSUED. . . . . . . : 05/04/2006
RECEIPT # . . . . . . . . . : 34241
REFERENCE ID # . . . : 06050041
SITE ADDRESS . . . . . : 7556 KIRWIN LA
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DERRICK LAU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : KARIE LAU
CONTRACTOR . . . . . . . : MARTHA KANG LIC # 22244
COMPANY . . . . . . . . . . : K & M DEVELOPMENT INC
ADDRESS . . . . . . . . . . : 1060 WEST HILL CT
CITY/STATE/ZIP . . . :, CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 253-9787
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 .47 0 . 00 100 .47 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO O(D Dt j 00 L-
TEMP POWER
•CUPEIiT1NO PERMIT APPLICATION FORM
APN# Date:
S o
Building Address:75-z Lanc,
Owner's Name: Phone #:
l - 879- 72
Contractor: Phone: License #:
14101 L�
Contact: Phone: Cupertino B si ess License#:
�,�� `ice �ia.✓G .49vF. 390. s /2 222
Building Per/mit Info:
Elect
Job Description:
Residential Conunercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•