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07080227 TY OF CUPERTINO �� TQ Z `QTI * BUILDING DIVISION PERMIT PERMIT NO, DNGA D ESS: OMEGA CONSTRUCTION 07080227 04Dl LOCKWOOD DR UNIT B PERMIT L9SUE DATE ERIS NAME: 08/27/20.07 KENJI ARITA 451 FENLEY AVE SANITARY NO. CONTROL NO. aE: (408) 243-0404 BUILDING PERMIT INFO BLDG ELECTMECH 'HITECr/ENGINEER: PLUMB LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(Commencing REPI PE WITH C UPPER INSIDE HOUSE Section 7000)of Divisi 3 of the Business and Professions de,a m icensc is ill force and effect. OMEGA PAID FOR BL nse C Lle'0 Contractor RCHITECTS DECLA I understand my plans shall be used as public records :nsed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the owing reason.(Section 7031.5,Business and Professions Code:Any city°r county ich requires a permit w construct,alter,improve,dcmoltch,or repair any structure Valuation u lei its issuance.also requires the applicant for such permit to file a signed statement Ft.Floor Area 2 O O 0 t he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S9' immcncing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type t he is exempt therefrom and the basis for the alleged exemption.Any violation of ]\limber :tion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 34229040 .U t more than five hundred dollars($500). I,as owner of the property.or my employees with wages as their sole compensation, Required Inspections do the work,and the structure is not intended or offered for sale(Sec.7044,Business d Professions Cote:The Contractor's License Law floes not apply to an owner of operty who builds or improves thereon,and who does such work himself or through his m employees,provided that such improvements are not intended or offered for sale.if, rwever.the building or improvement is sold within one year of completion.the owner- ailder will have the burden of proving that he did not build or improve for purpose of dc.). ]I.as owner of the property,am exclusively contracting with licensed contractors to anstruct the project(Sec.7044,Business and Professions Code:)The Conitac 01 s Li- :rise Law does not apply to an owner of property who builds or improves thereon,and. rho contracts for such projects with a contractor(s)licensed pursuant to the Contractor's icense Law. am exempt under Sec B&P C for this Mason ]I Date )wner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- ation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ]I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance4. e.work for which this permit 031 is issuedMyWorker's Compensation ura amPolicy n herCarrier. No.: CA F EMP FRO W S' COMPENSATION INSURANCE (rhis section need not be completed if the permit is for one hundred dollars(5100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as m become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT-.If,atter making this Certificate of Exemption,you should become subject m the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY °f I hereby affirm that there is a construction lending agency for the pe rformance the work for which this permit is issued(Sec.3097,Civ.C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection Purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way acerae against said City Date iA�PPLICANT consequence of the granting of this pe It• -------- UNDERSTANDS AND ILL COMPLY Wl1H ALL NON-POINT Issued by: ... u Arlo S. Z Re-roofs Signature of Applican actor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE Y 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(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Y� tutuNebuilding If a roof is insta.led without first obtaining an inspection,I agree to remove Will the applicant or occupant use cyuipmcnt or dcviccc which emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmcnt all new materials for inspection. District? OYes Nu 1 have read the hazardous materials requirements under Chapter 6.95 otthe Califor- nia Health&Safety Cote,Sections 25505,25533 and 25534.1 understand that if the building Date dries not currently have a tenant,that it is my res onsihility to notify the occupant nt the Signature of Applicant require ich must be met Aria ane [ eruftcate Occupancy. All roof coverings to be Class"B" or better ftlz� arc Owner or authorize agent CITY OF CUPERTINO REPIPE/ _ /SAN SERVICE F PERMIT APPLICATION FORM 6Z2 CUPEIZTINO Date: c> N# � � '2 � �d �-I U - O � l Building Address: oo \ IC4 Phone#: -- Owner's Name: �`'� i,icenSe #: Pholze: p.�,-- Contractor: Phone: J, Cupertino Business License#: Contact: Building Permit Info: Bldg Elect El Amb ❑ ❑ Job Description. , C a ornmercial ❑ Residential Cost of Project: —�-- Qty. if Fee Description Fee Group Applicable Fee IDBUILDING BPERMFEE B.dg. Permit Fees PLUMBING Gas Piping System Fee BPGAS PLUMBING ppERMITFEE P umbing Permit Issuance PLUMBING BPREPIPE Repi e of Fixtures PLUMBING Pblg. Fixture pLUMBING BPFIXTURE Main Water Service BPWSVCS PLUMBING C. BPSEWER ewers PLUMBING BPSEWAGE sewage Disposal BUILDING BUSLIC Business License r CITY OF CUF'ERTINO OPERATOR: CathyS PERMIT RECEIPT COPY # 1 ITEM 2 OF 2 Sec: Twp: Rng: Sub: Blk: bOt: 34229040 .02 APN • " " ' DATE ISSUED. • • • • " 08/27/2007 : BSO00002482 RECEIPT #. " ' 07080227 REFERENCE ID # • • SITE ADDRESS 10411 LOCKWOOD DR UNIT B SUBDIVISION • • . . . . . CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . KEN�I ARITA OWNER : 1041.4 LOCKWOO ADDRESS D DR UNIT A CUp�;RTINO, CA 95014 CITY/STATE/ZIP • • RECEIVED FROM OMEGA CONSTRUCTION JUN,; HUH LIC # 22317 CONTRACTOR OME7A CONSTRUCTION COMPANY • • • 1 FENLEY AVE ADDRESS . . . . 4SE, CA 95117 CITY/STATE/ZIP : S55 AN JOjo 43, C TELEPHONE • • • ' 404 THIS REC NEW BAL - tiMOUNT PD-TO-DT ---- ---------- FEE ID UNIT - QUANTITY _---------- ---------- -----40 .79 -_0_00 ------ 40 .79 0. 00 - ---- - ------ 1.00 -------- --------- 0. 00 PPERMITFEE FLAT RATE ------- . 0. 00 40 .79 40 .79 TOTAL PERMI`r AMOUNT REFERENCE NUMBER_- METHOD OF PAYMENT ------------- ----- ----------------- 81.58 CREDIT CARD --------------- 81 .58 TOTAL RECEIPT : VOICE ID DESCRIPTION--------- VOICE ID DESCRIPTION- ------ -------- ------ OICE -- ------------ 502 FINAL PLUMBING ENERGY 301 ROUGH PLUMBING 507 FINAL PLUMBING