The URL can be used to link to this page

07030070 CITY OF CUPERTIlNO BUILDGNG DIVISION PERMITI1FC}RMATI®1�1` PERMIT NO. BUILDING ADDRESS: 21872 HERMOSA AVE K & M DEVELOPMENT INC 07030070 OWNER'S NAME: PERMIT ISSUE DATE JOSEPH YEN 1060 WEST HILL CT 03/09/2007 SANITARY NO. CONTROL NO. )NE: (408) 253-9787 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 p Q LICENSED CONTRACTOR'S DECLARATION Job Description V p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z iv with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPORA-.2Y POWER POLE ?'y in full force and effea.6 f�i v�Z License Dde Lam•r r n Date ContracWr '''// ''1'✓� ARCHITECT'S DEC R 10 i a< Ind my plans shall be used as public records )yU ' U.H Licensed Professional 0, OWNER-BUILDER DECLARATION J I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county < which requires a permit to construct.alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement ,Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q $500 e t-- (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or i r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 716 0 5 L �Number Occupancy Type not more than five hundred dollars($500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do thework.and the structure is notintended ortiffered forsale(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 I.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: - - ,j I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I 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 Compensation Insurance 9 Insurancecarrier an�licy number are: Carrier: CER'TGT _,9yolicy No.:5 � lOFEXE FIiONFRO LO IFI WORKERS' 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,1 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z'— CONSTRUCTION LENDING AGENCY 1 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 Lender's Address U O 1 certify that 1 have read this application and state that the above information is 'r correct.I agree to comply with all city and county ordinances and state laws relating to nU building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. O (We)agree to save,indemnify and keep harmless the City of Cupertino against HCe) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. ►'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU S. 3 Re-roofs Sig h ontractor are HAZARDOUS MATERIALS DISCLOSU E Type of Roof 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 roofs shall be inspected prior to any roofing material being installed. 0 Yes Will the applicant or future building occupant use equipment or devices which If a roof I's installed without first obtaining an inspection,I agree to remove At hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? p� 0 Yes S I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements wPc t be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better 0wn or authorized age D CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 35716051.00 DATE ISSUED. . . . . . . : 03/09/2007 RECEIPT #. . . . . . . . . BS000000660 REFERENCE ID # . . . : 07030070 SITE ADDRESS . . . . . : 21872 HERMOSA AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JOSEPH YEN ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MARTHA KANG LIC # 22244 COMPANY . . . . . . . . . . : K & M DEVELOPMENT INC ADDRESS . . . . . . . . . . : 1060 WEST HILL CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (4C8) 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 100.47 VISA --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF C+UPERTINO au ' IP POWER CUPEY OF PERMIT APPL[CATION FORM -Ie�voo�1 APN # / �)�J Date: J Building Addyss: �i 7Q2 Owner's Name: Phone#: Contractor: T Phone. License#: Contact: Phone: Cupertino Business License #: Building Permit Info: Elect ��''7i�c��.9�- ��=2 ��G� ��✓s,/��7;o ../ Job Description: Residential Commercial ,❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC F usiness License BUILDING