05070088 CITY QF CUPERTINO t' sv-ep,';.<:• }x3'�b 5.
s BUILDING DIVISION PERMIT .CONTRACTORINFORMATION:
�.
BUILDING ADDRESS: KIM ' S CUSTOM BUILDER PERMI I'NIb 5070088
4 AT.C'AT.DF ROAD
ER'S NAME: PERMIT ISSUE DATE
YOUNG KIM 260 E VERGINIA AVE 07/14/2005
PHONE: SANITARY N0, CONTROL NO.
(408) 999-0333
ARCHOECT/ENGINEER BUILDING PERMIT INFO
Br, ELECT PLUMB MEOCH
°o o LICENSED COhmUCTOWS DECLARATION 'a.
nmC 1 hereby affirm that 1 an licensed under provisions of Chapter 9(commencing Job&eseri`ption
<W with SeCllOn 7I I fDi iaivn 3of the BuLneaanO_Profcssiutu Code �ylicenx ss ��
I,R(forte and cn Oct. v 'f �2l TEMP POWER UNDERGROUND (��
j�_ Date , Cl Le.• t
=w Date Contractor
ARCHITECTS DECLARATION
S�u 1 on crsun y plans sh 11 W uaav u puhlic men/w �—
C Uccnsed Poulorural A/��r✓ — /�/f/y�sA�/® //
S OWNER- LDER eConTION all,
0 0 1 hereby
reaso .('Sere tin 11. ucmpt from the Contractor's s Code: c Law for the �v" J
-C]O whowngmoon.(Sailor iB3str Business and Ro. criu Co dc:Any city otcuumy
m�a which requires a issuance.also re cnutmd alma Improve,de Permit t w mash any summm S 7 5
prior
=C that he sr' ensed alm requires lheapphoof for Corset om's rile
anda Laedsummem ry
EsG thnhc lading wit pursuant to the of Division of the cBuutorili Prof Law(Chapter
Code)or
Sq. Ft. Floor Area "d �� Valuation
eI- (commencing with Section 7")of Drvlsion Jnf the Business and Professions Cnde)ur
y
that hen esempt therefrom and the bests for the alleged me mpdon.Any violation of _
Section 7031.5 by eery applicant for a permit subjects the applicant to a civil penally of 3 G rO0 Occupancy Type not moe Nn five hundred dolar( 0).
❑1.u owner of the propcny,or my cmplaycu with wage as Theo sole compewtien,
will do the work.end the suumum actor',Lt.d L we t l nod apply in an onam nut
and crtywh oW Code.The improves tuctof,Liaise Law uch not apply f m owner of Required Inspections
com mr who Wilds provided that lh unproved who deer dumend k...fri edlfar aid M,
owne the uiprovided thatsuchimpro id within yearoedmpicom.for sales,
Wilder however.the building or improvement m xltl within one year of mpro a for due owe of
ode).
will have the burden of proving Net W did Iwl Wild or improve five purpose of
salt).
❑1.as owner at the property,am exclusively contracting with licensed Contractors on
convect the pre en(Sec.704a,Business and Profesvons Cade)The Contractor's Li.
CCnx Law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such PMACM with a contractor(s)licensed pursuant to On Contractors
Llcmte Law
❑I am exempt under Sce ,B&P C far this mason
40, Data
WORKER'$COMPENSATION DECl,A0.AData
1 hereby alTUm under penalty of psdury one of tic following declarationa
l have and will maintain aCerufieme of Cmuent to self-msum for Worker's Compcn-
sarmn,u provided for by Section 37W of use La v r Code,far the Perform..of the
work for which Nu per n t is Issued.
❑1 have and will maintain Worker's Compensation Insurance,as mquimd by Section -
3700 of the Labor Coq for the pedaemmee of the work for which this permit is issued.
Workr' C ER T F AT nn�nlor and Y OlicylWrL
co mo. Policy No.� ii
z-o
0 x
MON FROM WO ERS'
COMPENSATION INSURANCE
ClTUmcuon need not W completed site permit is Intone hundred dollars(SI W)
or less.)
1 crioN Net in the performance of tha work for which Nu Iermi,is issued,l,hall nut
employ any person in any manner as as to become subject m IW Workers'Compensation
Laws of Callfosnm Data
Applicant
NOTICE TO APPLICANT:1f.after making this Cemficate of Exemption,you should
become subject to the Worker's Compensation p wnsions of the Labor Code,you must
.,O faMwM comply with such provisions or tits permit shall W deemed revoked.
'z uj CONSTRUCTION LENDING AGENCY
[-+ l hereby alErm that there is a ewuvuetmn lending agency,for the performance of
C
she work for which m¢perm,,a retied(Sce.3097.Co,C.)
W Q Lender's Nam^
]z lender's Add,
U Q 1 unify this I haw read this application and sum tin the above informauun is
W P comm.I agree in comply with all city and county arcinaeeces and state laws relating to
0U Wilding com uctron,and hereby xthonee mproacnuuves of ties City m enter upon tic ,y`Y],/t(�(/] //I
W in consequence property for imphis Permit.
(~ LL lubthti(we) men u.costs indemnify ndex iuuwh chin less the City of Cupertino against
h g pc may y way ucmc against sand City
U,Z, APPLIC NT of UNDERSTANDS of this pcemil. y.the riant^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NQQQNNN-POINT Issued b Date '
SOURCEREGU ION . � /' I 1
_ I t4_I C { Re-roofs
Slgnnurc of Appli onRDOUS l Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IW ,Cart noor fnum ipalCo e.Chapter vote or handle heeaNaus material
fined io IW Cupemno Mumcipel Code,Chapter 9 12.and the Health and Safety
Screen 25532(a)?II �`u p p y g being installed.
py, r All roofs shall be inspected prior to an roofing material bein
Will the applicant or I7 building If a roof is installed without first obtaining an inspection,I agree to remove
pp g occupant use equipment w dcvicu which g
emit ha env,air emiumm7NLI
defined by tic Bay Aura Air Quality Management all new materials for inspection.
DrsuieR
❑Ycs I hove re al the hat erials requirements under Chapter 6 95 of the Calder.
ma Health&Safety Code.Sections 25505.35537 and U53 lundersundthesdNe Wilding
does not currently have a anon,that it is my responsibility to no'fy IW occupant of the
mquimmen wine W met poor m Issuance of a Cc re f Occu
^� `� /3C � Signature of Applicant Date
Owner waumom,eda n 1 Df All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Zo' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: L f -'I I PHONE # Lk ' qqq 0 3 3 3 I
GENERAL CONTRACTOR tLl Y A`5 l`r,<I cr Rucl .i r�I FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
® SUBCONTRACTOR I BUSINESS NAME BUSINESS LICENSE #
-Gakinets&Millwork
Cerra inishirig
IIectrical
/ Excavasi�n
Fen g I /U"-
ooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
( Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
I, I Paving I i
Plastering
Plumbing I I,
Roofing I .
Septic Tank
Sheet Metal
Sheet Rock
�I I Tile
Owner/Contractor Signature Date
0 54y0v g 8'
CITY OF CUPERTINO
• TEMP POWER
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: ^ f r r
`
Owner's Name: Vhone #:
Contract Q� \ hoRRe: L. -6 ���n�?? License #:
1 I A S �u f'� o r� v xn: i
Contact: I� I \Phone: q'i Q 1 Cupertino Business License#:
� l
Building Permit Info:
Elect
Job Description:
Residential(Nr— 'J Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING J