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06100181CITY OF CUPERTINO CTQR It}IMAT�N�'. BUILDING DIVISION PERMIT BUILDING ADDRESS: OMEGA CONSTRUCTION PERMIT NO 06100181. 22702 LIBERTY OAK LA PERMIT ISSUE DATE OWNER'S NAME: HONG PIAN 451 FENLEY AVE 10/26/2006 SANITARY NO. CONTROL NO. 3NE: (408)243-0404 BUILDING PERMIT INFO ARCHITECf/ENGINEER: BLDG PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and f scions od and my license is in full force and effect INSTALL 2 2 0 V 5 0 AM P OUTLET License lass Lic.B Date Contractor WLffhftcTS DECLA I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county $850 which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement 9 g Ft. Floor Area Valuation q that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 r not more than five hundred dollars ($500). ❑ 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 We. 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:) Tne 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. [31 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 for which this permit is issued. ❑ I have and will maintain Workcr'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 C mpe ' t In ce ca rand Policy number arc / Cartier: Policy No.: (/ ERTIFICATE OF EXEMPTION FROM W RKERS' 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 7 forthwith comply with such provisions or this permit shall be deemed revoked. D CONSTRUCTION LENDING AGENCY 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.) ~ Lender's Name L.cndees 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 Jbuilding construction, and hereby authorize representatives of this city to enter upon the ahovc-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 34 n liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permtt. �v Z -� APPLICANT UNDERSTANDS AND WI COMPLY WITH ALL NON -P INT Issued by: Date SO�REGAT71ONRe-roofs stV Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof ` Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M pal Code. Chapter 9.12, and the Health and Safety Code, Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes No 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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Nu ❑ Yes 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 rcspmVihility to notify the occupant f the Date rc u' whic mel riortoi w_ t teor� p Signature of Applicant U mulclot All roof coverings to be Class "B" or better Owncr or autho . rDate CITY OF CUPERTINO 2m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232039.00 DATE ISSUED.......: 10/26/2006 RECEIPT #.........: 36565 REFERENCE ID # ...: 06100181 SITE ADDRESS .....: 22702 LIBERTY OAK LA SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ...... OWNER HONG PIAN ADDRESS .......... CITY/STATE/ZIP ...: , RECEIVED FROM JUNG HUH CONTRACTOR .......: JUNG 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 --------------------------------- BREMMISC FLAT RATE 1.00 -------------------- 27.58 0.00 27.58 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 850.00 0.50 ---------- 0.00 0.50 ---------- ---------- 0.00 TOTAL PERMIT ---------- 67.65 0.00 67.65 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------------ ----------------- ------------ OTHER 67.65 VISA TOTAL RECEIPT 67.65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 ---- FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL CITY OF CUPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: L`". OAAr- L0 PERMIT # OWNER'S NAME: r PHONE # GENERAL CONTRACTOR0 Wb FAX # I g any not using subcontractors: O 6 Iam n �IEe ate nlAaca rt,�ti ari»licahle subrnntractnm and complete the following information: y� 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 Owner/Contractor Signature Dat CUPEkTINO CITY OF CUPERTINO 0001$I PERMIT APPLICATION FORM CPN # Fee Description Date:� �� l / � /� Building Address: -Mailing Address (if different from building address): 0 D, _4 L� - MECHANICAL _._ Owner's Name: � A � I G 1 Boiler > I OOK to 500K Btu Phone #: cl9 BBOILER3 Contractor: � � r r MECHANICAL License #: Boiler > IM to 1.75 M Btu Contact: Phone: (`L�,, 5— RI 3Cupertino Business License#: MECHANICAL Fax: Construction Tax BUILDING BCONSTAX Building Permit Info: BUILDING BCONSTAXBQ Bldg ❑ Elect X1 Plumb ❑ Mech ❑ BCONSTAXH Job Description: -' ` I i)Do � v D BCONSTAXR Residential ` 1 Commercial ial ❑ BELEC 1000 Sq.Ft. Floor Area: ELECTRICAL Sq.Ft.: Elec 600V > 1000A Cost of Project:�5 BELEC200 Occupancy Groin: ELECTRICAL Type of Construction: Energy Please check this box if the project is a El Q-0 Energy Add Multi second -story addition: BINVESTIGA Project Size: Standard Large ❑ Major ❑ BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= I OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3