03010160 CITY OF CUPERTINO
BUILDING DIVISION PERMIT `CONTRACTOR INFORMATION:'_'
BUILDING ADDRESS: KALLIO CONSTRUCTION PERMITNO.
21602 COLUMBUS AV 030 0160
,— INER'S NAME: 1666 ENGLISH DR APPLICATION SUB DATE
NANKIN GARY C AND SUSAN M 01/28/2003
PHONE: (408) 873-9777 SANITARY NO. CONTROL NO.
ARCHITECDNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
On. LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby arfmn that I am licensed under prp�ons of Chapter 9(commencing p
With Satin ]Iplq of Division 3uf the Baineaea�rsvfcssinm Code,end my lieenu is
inraur .neer( 7g5 REDO SHOWER/ADD FAN LIGHT
Lrec FINALE®
�� 1 G Lk.N
G z F, Oam CanuamIt
q$Q�6 CHITEC'S DEC ATION
OWU lundcrs.nd my plain shallbouud as public records APR 1 7 2003
WG Licensed Professional
QQ OWNER-BUILDER DECLARATION
QQaa��ya I herchy offing that I am exempt from the Comm mm's License Law for the
a�00 following Mason.(Section 7031.5,Business and Professions Cods:Any city or county BUILDING
%§OL which inquires a Permit to consumer.alter,improve,droughts,or repair any structure
FZot prior in its laaUarem,BIw Rgnlrea die applicant(or mets Permit to rile a signed statement
£ss< 1ba,Mis licensed pu.0An,nNe pmismas if the Cnnuactur,[.I..LAW lChapror 9 Sq. Ft.Floor Area $2(Vfil@atlon
elF$ (commencing with Sectio 7")o'Division 3ofthe Business and Prefessimns C.Ic)or
J! the,W"'exempt therefrom and the bub for the alleged exemption.My violation of
section]011.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not...than Eve hundred della.($500). Occupancy Type
Q I,ammorofthe property,or my employees with wages a their sole compensation,
Will do the work,end the suuc,ure ism,intended orofremd for sale(Sec.7044,Business
and Pro(essioa Code:The Consractoh License Law does not apply to an owner of 102 - PIERS equlred Inspections
property who Wilds orimproves thereon,and whodassuch work himselforfh s ugh his
ownemployees,provided that such improvements Am not intended oroRered forests.If. 103 — UFER
however.the building or improvement issold within one your ofcamplation.the owner. 1O4 — REBAR
Wilder will have the burden of proving that he did not Wild or improve for purpose of
Age.). 105 - ANCHOR BOLTS
1,as owner of the property,am exclusively contracting with licensed conuselors to 106 - SEWER & WATER
consumer the project(Sec.7W,Business and Professions GMn:)The Contractor's U.
cense law does not apply to an owner of property who Wilds or improves themes.and 202 - UNDERFLOOR PLUMBING
who contracts for such projncu with A contractors)licensed pu.vant to the Contractor's
License Law. 203 - UNDERFLOOR MECHANICAL
lamexemptunder Sec. ,BRPCforthismuon 204 - UNDERFLOOR FRAME
net Data 205 - UNDERFLOOR INSULATION
WORK ER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby athrm under penalty of perjury one of the following decimations: 302 — TUB & OR SHOWER
❑1 have and will maintain a Certificate ofConsent to u1&insam for Wn dao sCompem
cation,in provided for by Settle 37M of the Labor Code,for Ba performance of,he 303 - ROUGH MECHANICAL
work for which this permit is Issued. 304 — ROUGH ELECTRICAL
❑ I have and will maintain Worker's Compensation luurance,As acquired by Section 3 05 — FRAME
3100 of da labor Cade,for the performwc of the work for which this permit is issued.
My Worker' Compensation Insurance carver and Polity number am: 306 — HOLDOWNS
er: fpTt FvnuD
ATEP��yy�����;``JJ��<<''.FFRR
o.:T1y'r__(_go0 307 - INSULATION
CERTIFI COMP NSATIONIINSURA CEORKERS' 308 — SHEETROCK
(This section need not Ire Completed done permit is forone hundred dollars IS 100) 309 - EXTERIOR LATH
310 - INTERIOR LATH
I minify that in the performance of the work for which this Permit is issued 1 shall not 311 - SCRATCH COAT
employ any person in any manner an a to become subject m the Wo ori Compensatinn
I.A.of Califomia.Date 313 - ROOF NAIL
Alican
NODCEITO APPLICANT:If.after making this Cenilicale of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation previsions of the Labor Code,you must 502 - FINAL PLUMBING ENERGY
OO I thwi,h comply Willi such pr avisionsnr this permit bull he deemed revoked.
'Z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F
I hereby affirm Oat them is a construction lending.gram,lot the Performance of 504 - FINAL BUILDING ENERGY
a me Work for Which this permit isissued(Sec.31N].CN.C.)
Lenders Name 505 - FINAL ELECTRICAL
W Q
aly7. z Landers Address 506 - GAS TEST
U p 1 certify Nat I have mW,his applicaion and sue that the aWw information is 507 - FINAL PLUMBING
tf. f.. correct.l agree to comply With all city and county ordinances and stone lawn relating to 5 FINAL MECHANICAL
holding construction,and hereby motion.reprcunfmives or this city to enter upon the
U
ohnvmmentianed property for inspection purposes. O9 FIN
(We)agree les siva,indemnify and keep harmless the City of Cupertino Against
L,) liabilities.judgments,cus.and expenses which may in any way acme against said City 5 N (�"
V 7 in consequence of the g.nti ng of this Permit.
g7
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N'ON PrOINT Issued by51 WORKS Date
Z,LVI._LA oy1y�-�.Q-._. J/! fC}�/D Re-roofs
;Di.mD?
nature of ApplicanpContramor /Dal
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant afore ser handle barerdeus mamriai
defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
de,Sermon 255321a)] All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will thea Bean or future building deco m use If a roof is installed without first obtainingan inspection, I agree to remove
pp 8 W ea Air nter Management
p g
i,haaardous air Conmminan0 u dc0nc0 by the Bay Arca Air Quality Mawgemem all new materials for inspection.
C]Yea
1 have mad the Wgudous materials requirements under Chapter 6.95 of the Califnry
m.HcelN At Sorely Coak,Sations 25N15.25533 and 25534.1 understand than if the Wilding
does not currently have a tenant,that it is my respomihility to ' the occupant of the
real ntswhknmug heme,Priarpiananaafecerdnaaaor S Date
owner or aathaae agent I„e All roof coverings to be Class "B"or better