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03010160 (2) CITY OF CUPEO k, BUILDING DIVISIONSION PERMI_ NTRACTOR INFORM,A �'• BUILDING ADDRESS: KALLIO CONSTRUCTION PERM IT NO. 21602 COLUMBUS AV 03010160 OWNER'S NAME: 1666 ENGLISH DR APPLICATION SUR DATE NANKIN GARY C AND SUSAN M 01/28/2003 PHONE: (408) 873-9777 SANITARY NO. CONTROL NO, ARCHITEMENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O00 LICENSED CONTRACTOR'S DECLARATION O O O O z�F I heathy affirm Nat I am license under=J,.Urof Chapter 9(cnmmcrvem, Job Description y�8 with Sectio 7000).fMvisam3ofthc Hounessa fession Cute, admyliccone is in full it of /— `' REDO SHOWER ADD FAN LIGHT ��N�LE� Z. i. zo'a? Lncc CI tCnM SJ 7II A N Da crsuiml my plan shall he used as public ATI,recorda sL f >owV APR 11- 2003 FLLo� Licensed Moreau...I g OWNER-DUILDER DECLARATION �pp p a P I hereby affirm that I am exempt from the Contractor's License Law for the IISLLUY�®9�p� w po following mason.(Section 7031.5.Business and Professions Code:Any city or county ®® u els�tll' n K m( which requires a Notait I,contra,alter,improve,demolish.for repair any structure Fiy prior to its issuance.alsn requires the applicant for such permit to file a signed statement < that heislicensed pursuanttotheprovisions(IfthcContractoraLicenselawlChapmr9 Sq. Ft. Floor Area $2YM(Dation Wro (commencing with Section 70W)(if Division 3 of the Business and Praafessions Code)or y Net he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7831.5 by any applicant for a Permit subjects the applicant o a civil penalty of nal mote man five hundred do][..(SSW). be Occupancy Type ❑1,as owner of Ne property,or my employees with wages as their sole compensation. will do the work,and the structure is no intended or offered for sale(Sec.7044,Business and Professions Code:The Contr4cmes License Law does not apply to an ownar of 10 2 — PI ERS equired Inspections property who builds orimproves thereon,and whodoessuch work himself orthrough his own employees.provided that such improvements are not intended or offered formic.If. 103 — UFER however.the building in improvement is sold within one year of completion,the owner. builder will lout the burden of proving that he did not build or improve for purpose of 104 — REBAR "le) 105 — ANCHOR BOLTS 01.as owner of the pmpeny,am exclusively contracting with licensed commclonm 106 — SEWER & WATER consfact the pmjecl(Sec.744.Business and Professions Code)The Contractor's Li. cense law docs on,apply to an owner of property who builds or improves themon,and 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's Licenc Law. 203 — UNDERFLOOR MECHANICAL ❑ lam exempt under Sec. .B&P C for this.... 204 — UNDERFLOOR FRAME caner Date 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING I hemby affirm under penalty of perjury one of the following dcclmations: ❑]have and will maintain acenieeamofcommrtmxelfinsurefor Worker's Compcn- 302 — TUB & OR SHOWER cation,as promded tar by s«dun 3700 of me labor sae,forme penfnnor a.of the 3 03 — ROUGH MECHANICAL work for whish this permit is issued. 304 — ROUGH ELECTRICAL 1 have and will maintain Worker's Compensation Insurance,n required by Section 3 05 — FRAME 3700of me labor Cole,for the pmformane,of the work for which this permit warned. My worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS er: `Yjwre FvyvD P o v'-go4? u'0 307 — INSULATION CCRTIFICATE OP E UiMPfI^��f�yMm W ORKERS' COMPENSATIONINSURANCE 308 — SHEETROCK (Tbia section need not M1e comported into arnnb is for one hundred dollars($100) 309 — EXTERIOR LATH 1f 1Ca,.) 310 — INTERIOR LATH I certify Nat in the afforrome of the work far which this permit is issued.)shill not 311 — SCRATCH COAT employ any person in any manner m as m subject rke become subjeco the Wors'Compcnuian Laws.(California.Date 313 — ROOF NAIL plicant NPOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY become subject to the Workers Compensation previsions nthe Labor Code.YOU mnat 502 — FINAL PLUMBING ENERGY OZ forthwith comply with such provisions or this permit shall be deemed revoked. ?C. CONSRUCf10NLENDING AGENCY 503 — FINAL MECHANICAL ENERGY F•^ 1 hereby affirm that from is a construction lending agency[or the Performance of 504 — FINAL BUILDING ENERGY W > she work for which this permit islssucd(See. 007,Co.C.) 505 — FINAL ELECTRICAL W Q Lenders Name .:) Z CLI I`odcrf A°°"" 506 — GAS TEST U p 1 cenify that 1 have mad this application and suite that the abbe information is 507 — FINAL PLUMBING W f-' comet.I agree to comply with all city and county ordinances and state laws relating to 7 O U building construction.and hemby authodm representatives of this city to enter upon the 5 FINAL MECHANICAL 1 t" 9. aMvc(We)agree to property emnifmUcy an keep ca. O9 FIN E s\ ► 0. (We)agree to save,indemnify and keep bartnlev the City of Cupertino against 5 N G O/(^` /L/—y (q liabilitics,judgmcnts.costs and capcnacs which may in any way accrue against said City U Z in consequence of the gmating of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by51 — WORKS Date Re-roofs ;District' gnature of Applicart Crommalnr Dat HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant ar fmure building ocapam stem nr M1andle hvallous material defined by the Cupertino Municipal Cuda Chapter 9,11,and the Health and Safety Code. Oyer z553xar. � All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant m future building occupant nuc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haaardous air conuminnts as depncd by the Bay Area Air Quality Management all new materials for inspection. ❑Yes 1 have read the harallous materials requirements under Chapter 695 of the Califon nia I icalth&Safety Crate,Sections 25505.25533 and 25534.1 understand mat ifilre building docs not cumntly have a mvnt,that it is my rearanwhility I" 'MIB tM occuPant of the requi I h cup e. Signature of Applicant Date e, CIO_ 6Z, or agent 1 am O All roof coverings to be Class "B" or better tl�S�© 3 cr� � ex f s p � 4' 2 1 X03 �+ o , vsvu cb IFF key � ,2� ViJ �U >KUll� Iulluln II 1 IU-e-w p�PPROlIIED: `' Aw�WAN E WITH THE ` 1 � iPEfn,N E N 0 DATE. SIGNED-- ecifications MUS ' O Th'i's set of DI at e11 times and it is u i bd keit bn lb t nes or alteratio s IaWfkil [o a any -. B WitHa�t Wglttan r par il. must on frr m ln@ byHomd Iw:. ications 1i�3 �gti�gl litia plan end specif ��t to permit or to be an wkt r,P 4�ll Rif�VAP.pAum of any Drovisions anY �ItGI Oidlnaw o,or State law. Seru CITY OF CUPERTINO o311 ' 160 CITYOF PERMIT APPLICATION FORM • CU PERTINO APN# Date: V l Building Address: a� Owner's Name-i pp Phone#: l 1�C, lGc l Cotractor:j License#: �L ( U � SSS{- Contact: Phone#: 7 ' _ Applicant/Contractor: Fax#: Building Permit Info• Bldg lec Plumb Mech Job Description: t Residential: Commercial: Sq.Ft.Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: ype of Construction: Occupancy roup: r Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=260A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BE%VESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-familyRes ELECTRICAL BNUCOMME New Conon Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 320