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07080215 C ITY OF CUPERTINO gp,GTC?�2 IEC} MTIQl . ILDING ISIVISION PERMIT PERMIT NO. 6UILDrQa'f`rSLOCKWOOD DR UNIT A OMEGA CCNSTRUCTION 07080215 �J(}l[} PERMITISSUE DATE OWNER'S NAME: KENJI ARITA 451 FENLEY AVE SANITARY NO. CONTROL NO. JE: (408) 24-': -0404 BUILDING PERMIT INFO ARCHITECI7ENGINEER: BLDG ELECT PLUMB MECH a a 0 a cd Z LICENSED CONTRACTOR'S DECLARATION Job Description Wo I hereby affirm that I am licensed under provisions of Chapter 9(commencing CHANGE i X PAI�TEL (1 0 0A) z w with Scction 7000)of Divrsjpr�3 of the Business and Professi Co ,a my license is y in fun force and e[fecL Lic# C� OMEGA PAID FOR BL 8/24/07 License Class _- p Date Contractor F w ARC ITECI S DECLARA N 1 understand my plans shat)he used as public records iyU U.h Licensed Professional ;a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the :p o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires alt a permit to construct, er,improve,demolish.or repair any structure Valuation i'4 ti prior to its issuance,also requires the applicant for such permit to file a signed statement j Ft.Floor Area $1800 z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl i t=- (commencing with See tion 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 4 2 2 9 0 4 Number not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds of improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sate.If, however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contactors L i- who contractLaw s for such pes not roje cts cts with a c ntractor(s)licensed an Owner of property who pursuanProves thereon,and. to the Convxtors License Law. B&P C f this reason ❑I am exempt under Sec. Owner r WORKER'S COMPENSA DELI-ARATION I hereby affirm under penalty of .jury one of the following declaration: J]have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work Cor which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Cod%,for the performance of the work for which this permit is issued. My Workers C in.1s1 'on i rance carte and Paticy on her am -� Cartier. Policy No.: RTIFICArE F EXEMPTION FROM 0 ERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dotlars($100) or less.) I certify that in the performance of the work for which this permit is issued.Ishan not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. ,Z� CONSTRUCTION LENDING AGENCY (�r. 1 hereby affirm that there is a construction lending agency for the performance of x> the work for which this permit is issued(Sec.3097,Civ.C.) L a A Lenders Name 4+ Lender's Address J I certify that 1 have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to C building construction,and hereby authorize representatives of this city to enter upon the. ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hr/] liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WI COMPLY WITH ALL NON-POINT Issued l:y: S TIONS. 2q( Re-roof; Signature of App t t/Contractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12•and the Health and Safety Code,Section 25532(a)? All rool's shall be inspected prior to any roofing material being installed. ❑Yes o If a roo�is installed without first obtaining an inspection,I agree to remove will the applicant or future building occupant use equipment or devices which .:mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑.Ycso 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is responsibility to notify the occupant of the Date require i must be met prio to issu ce o a Certificate_flx .try- Signature of Applicant All roof coverings to be Class"B" or better o auth tc gent Date CITY OF C UPERTINO C1TYOF PERMIT APPLICATION FORM CUPEk INO C-7 o 2-If PN# � 0 � 2 � "� ' ate: 3N ZZ D`� v- Bui ding ddress: %lailin ddress (if different from building address): �I �e S o� Owner's Name: , TA Phone#: � J l O �_Contrac_tor- o ��- License #: Contact: 7--�� 1�1 Phone: O upe Fax: o rtino Bus�nen�#:� 4 D Building Permit Info: C Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if theproject is a second-story addition: El roject Size: Standard ❑ Large ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boilcr> 1M to 1.75 M Btu MECHANICAL BBOILER5 E oiler> 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In j/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD :anergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: CathyS 3 ITEMS OF 7 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34229040 .01 DATE ISSUED. • • • • • • : 08/24/ 007 RECEIPT #. . . . . . . . . . 0SCO0002 467 REFERENCE ID # . • • 215 SITE ADDRESS 101114 LOCKWOOD DR UNIT A SUBDIVISION . . . . . . CITY CU-3ERT INO IMPACT AREA . . • • • • • OWNER . . . . . . . . . . . . : KEJJI ARITA ADDRESS . . . . . . . . . . : 10414 LOCKWOOD DR UNIT A CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHUNG HUR CONTRACTOR . . . . . . . : JUNG HUH LIC # 22317 COMPANY . . . . . . . . . . : OFEGA CONSTRUCTION ADDRESS . . . . . . . . . . : 4E1 FENLEY AVE CITY/STATE/ZIP . . . : SIN NJOSE,C 4 CA 95117 TELEPHONE ( - FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - - - ---------- _ _ --- ------------- ------1. 00 29 .43---- ----------- ----- 0. 00 29 .43 0.00 BELEC200 METERS 0 .50 0. 00 0.50 0. 00 BSEISMICRE VALUATION 1, 800.00 0. 00 40.79 0. 00 1. 00 40.79 __ EPERMITFEE FLAT RATE __ ------ -------- ---------- ---------- 70 .72 0. 00 70.72 0. 00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ --------------- ---------------------- -------- ----- 304 ROUGH ELECTRICAL 103 UFER 505 FINAL ELECTRICAL