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07090019 77 7777777777777 CITY OF CLJPERTINOPERMIT � � BUILDING DIVISION g PERMIT NO. BUiLDf8al) �EsLOCKWOOD DR UNIT B OMEGA CONSTRUCTION 07090019 l PERMIT ISSUE DATE OWNER'S NAME: KENJI ARITA 451 FENLEY AVE SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECr/ENGINEER: REPLACE WATR HEATER W NEW W BLDG ELECT PLUMB MECH a C) LICENSED CONTRACTOR'S DECLARATION oDescription UJ P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z Uwith Sccfon 7000)of Di'' n 3 of dtc Business of Codd,a y license is =H in full force and effect �r Z License Class Lie # o Dam Contractor F ARCH CTS DECLARATIO i a< I understand my plans shall he used as public records )WV ' U.H Licensed Professional O a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the .O O following reason.(Section 703 1.5,Business and Professions Code:Any city or county % which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z} prior to its issuance,also requires the applicant for such permit to file a signed statement e Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's Valuation License Law(Chapter 9 q t= (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or 492 that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for WorkcesCompcn- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compe ation suance c err and Policy n Fr f Carrier. Policy No.: ERTIFICATE OF EXEMPTION FROM S COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'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 2 CONSTRUCTION LENDING AGENCY (.�rA I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 0 Lender's Address 1 certify that I have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws relating to U building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned properly for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit. �. APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by Date SOU. L�WJA � 7 C Re-roofs Signature of ApplicantIC tractor IDam Type of Roof ' HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munic' al Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:]yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminan as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? 0 Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is.my respo 'bility to notify the occupant of the require be met or toof a 'ficatc of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner or au(horized agcn m CITY OF CUPERTINO CITY IF PERMIT APPLI��ATION FORINT CUPER`TINO PN# Date: Building Addres : ailing Address (if different from building address): ck� 4- %t'. lk ?.-� Owner's Name: � � T��� Phone Contractor: License#: 0RE - A Contact: �_ Phone: C400 upertino Business License#: . ,y c) Ea� Fax: Building Permit Info: Bldg ElElect El Plumb Mech El Job Description: KAokt6 Residential l � Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Gr' : Type of Construction: Please check this box if the project is a second-story addition: El -oject Size: Standard ❑ Large ❑ Major ❑ Quanti Fee ID F-e Description Fee Group BAPPLOTHER 0-her A liances MECHANICAL BBOILERI Boil,-.r<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX C instruction Tax BUILDING BCONSTAX Ind/off/Comm/Quasi BUILDING BCONSTAXBQ Con Tax for BQ Zone BUILDING BCONSTAXH F[otel and Motel BUILDING BCONSTAXR Con.;tax—Resi/Mobile BUILDING BELEC1000 Elec, 600V <= 1000A ELECTRICAL BELEC1001 Elf,c 600V> 1000A ELECTRICAL BELEC200 Elec s5vcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 L CITY OF CUPERTINO CITY OF PERMIT APPLICATION FOM CUPEkT INO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME Neve Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW A_ttno spheric Vacuum PLLTN BTNG BPCESSPOOL Cesspool PLUMBNG BPERMFEE Bldg Permit Fees BUILDING MIXTURE IIN2 Fixture PLUMBING BPGAS Gas F i ing System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan heck Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewalze Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP 'kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo:?umace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res A pliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl., Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT ReI air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of CITY OF C UPERTINO CUP Ty I ® PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ver tilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOI Seismic Commercial BUILDII G BSEISMICRE SAsmic Fee Reg BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tern orary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC E.ectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plwabing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of CITY OF CUPERTINO 4 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34229040. 02 DATE ISSUED. . . . . . . : 09/ )5/2007 RECEIPT #. . . . . . . . . : BSO)0002557 REFERENCE ID # . . . : 07030019 SITE ADDRESS 10414 LOCKWOOD DR UNIT B SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KENJI ARITA ADDRESS 10414 LOCKWOOD DR UNIT A CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM OME3A CONSTR. CO CONTRACTOR . . . . . . . : JUN3 HUH LIC # 22317 COMPANY . . . . . . . . . . : OMEGA CONSTRUCTION ADDRESS . . . . . . . . . . : 451 FENLEY AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95117 TELEPHONE . . . . . . . . : (408) 243-0404 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ----- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34.86 0. 00 BPSEWER SEWER SYSTEM 1. 00 21.58 0. 00 21 .58 0. 00 . BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 BSEISMICRE VALUATION 500. 00 0.50 0. 00 0.50 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 67 .73 0. 00 67 .73 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 124. 67 #4818 --------------- TOTAL RECEIPT 124. 67 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildirt De artment JO ADD ESS: PERMIT # ��� 0 7 OWNER'S NAME: E4) i �- T ' PHONE # GENERAL CONTRACTOR: L6f N LC FAX # I am not using any subcontractort"` -�` 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 Date Oner/Contractsr- 'gnature w