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07030007 CITE'OF CUPERTINO BUILDING DIVISION PERMIT GdaGCIRINT{4RMTI()N< BUILDING ADDRESS: PERMIT NO. 6354 BLACKWOOD DR CUPERTINO PLUMBING 07030007 OWNER'S NAME: PERMIT ISSUE DATE MYOUNG KANG 1300 DELL AVE STE C 03/02/2007 ;NE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION O O ul P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description .ZLU with Section 7000)of Division 3 of the Business and Professions Code,and my license is COPPER RE] I P E ? y in full force and effect 1"1 1��v r ? License Class Lic.# r�� E Date Contractor `^" T,( a ARCHITECTS DECLARATI ,a V 1 understand my plans shall be used as public records H Licensed Professional m< OWNER-BUILDER DECLARATION a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county uwhich requites a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation r t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4500 y 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 PV Number Occupancy Type not more than five hundred dollars(M). 36917052� O, p y yp ❑I,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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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:)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. ❑I am exempt under Sea B&PIC.for this reason Owner Date 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 Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. dve 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 carrier and Policy number are: SANITAKY Cartier::; ✓1)Q M►► Policy No.:T-'I9��0&63 CERTIFICATE OF EXEMPTION FROM 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.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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of (Y the work for which this permit is issued(See.3097,Civ.C.) Q Lender's Name Z Lender's Address U 0 I certify that 1 have read this application and state that the above information is Iy r correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding 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 �Ft liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. URCER PEGUT UNDERSTANDS NON-POINT Issued by: Date URCE RLAT S:�"- _-;� -2"v Re-roofs Signature of A 5.nZ*6UFDate /' OMATERIALS DISCLOSURE Type of Roof the applir future building occupant store or handle hazardous material as defined by the Cupertino Municipal c,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ❑Yes ❑Nu All roofs shall be inspected prior to any roofing material being installed. will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as dcfi cd by the Bay Area Air Quality Management all new materials for inspection. District? Cl Yes Nu 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 ha ran that i ier s risibility to notify the occupant of the rcyuircmc st be t w o crtificatc of Occupancy. _cc_�, Signature of Applicant Date Own t'rauthorizedageni Date All roof coverings to be Class"B"or better CITY OF CUPERTINO 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36917C52 . 00 DATE ISSUED. . . . . . . : 03/02/2007 RECEIPT #. . . . . . . . . . BS000C,00585 REFERENCE ID # . . . : 07030(07 SITE ADDRESS 6354 BLACKWOOD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MYOUNG KANG ADDRESS . . . . . . . . . . : 6354 BLACKWOOD DR CITY/STATE/ZIP . . . : CUPER` INO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : CARDI2�, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPER"INO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE, STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) : 53-0618 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 4, 500. 00 :-15 .56 0. 00 115 .56 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT -53 .93 0. 00 153 .93 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development 10300 Torre Avenue '` ` ' • ' Cupertino CA 95014 Telephone(408)777-3228 Cilli OF Fax(408)777-3333 `WEkTINO Buildin r Department JOB ADDRESS: PERMIT# �4 1510-C `DC. -R-00co^1 OWNER'S NAME: MQUrlk5l KOY)Q PHONE# GENERAL CONTRACTO FAX# 3 _ 2_67 �am.not using any subcontractors: Signai ure Date Please check applicable subcontractors and com letE! 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 Owner/Contractor Signature Date 7,7RCITY OF CU PERTINO �3 -1 OF REPIPE/ : /IdAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: Build' Address: r' 4 Owner's Name: Phone#: _Q G -. tj nt ctor: Phone: License#: on act: 0Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑r� Job Description: Residential Commercial ❑ Cost of Project: �- -- Dov Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Fiping System Fee PLUMBING PPERMITFEE Plum)ing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING