03040108CITY OF CUPERTINO
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BUILDING DIVISION- PFRMIT'CONTRACTOR
INFORMATION`
Bil�2)"i°Rss'FOOTHILL BLVD # B
KALLIO CONSTRUCTION•
PERMIT NO. 03040108
D"Yfff9''TPI PATRICIA M
1492 WALBROOK
DR
pr`h "$" W722/2003
(408) 873-9777
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Q 0
LICENSED CONTRACTOR'S DECLARATION
1 hemby affirm ,hat 1 am lite ad u der provisions of Chapter 9 (commencing
with Section 7003) of Division3of Ne ext. od Professions Code.and my license is
Job Description
p
in full framc t
l2B Limit g-795-
2 BATHRMS
REMODEL/UPGRADEL^n 8
Dam n'r C
ARCHITECT LARATIN
I understand my plans shall be used as public records
AUG 14 2��3
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
i following team, (Section ]1131.5. Business and Pmfcssinns Code: Any city Or county
BUILDING p�/±
B UI LDI TVG
which requires a permit to construe,, alter, improve, demolish, or repair any structure
! PH., to its ism.m.,alw mquisesth.,licanl for such permit to file. sigriedsmmmem
1 that he is licensed pursuantmthe mvisionsofthe Contractor's License Law (Chapter 9
Sq. Ft. Floor Area io❑
1 (commencing with Section]Pi0(p of Division 3 of the B usiness and Professions Codd) or
$2��
. that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjecu the applicant to a civil Penalty of
36PM Nq5l3!K O O
Occupancy Type
no, mom than five hundred dollars FSk
0 h as owner of the property, or in, employees with wages u their sole compensation,
tended offered for talc Business
will do duewiou ands:
FOUNDIkT
The Contractor's License Law dao ore apply lf an owner of
Floor
and Professions Code: The Conmcton,
Inspections
rad who dm esuchwmkhimmlforthroughhis
102
- PIERS
oProperty wn crowyeet, providedthawschimpmandwho
tbmwernt suchemprowmentsam for rule. If.
own employees,ping
103
UFER
llrcmd
or
however. the building or impressment is sold within arm yeti of complcuan, Ne owner
u, year of
—
builder will have the burden of proving that he did not build of improve for purpom of
104
- REBAR
sale.).
❑ 1. as owner of Be propeny, am exclusively contracting with licensed contractors to
105
— ANCHOR BOLTS
construct the pmject(See.]Wa, Business and Professions Code:) no Contractor's Li-
106
— SEWER & WATER
come Law docs not apply in an owner of propeny who builds or improves Berton, and
who contracts for such projects with a contractor(.) licensed pursuant to the Contractors'
202
— UNDERFLOOR PLUMBING
License Low.
I aro exempt under Sec. , B h P C for this mason
203
- UNDERFLOOR MECHANICAL
204
- UNDERFLOOR FRAME
Owner Date
205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby.fnrmander penanyof perjyry oneor the muawing dectisaumts:
301
- ROUGH PLUMBING
L3 tb.wural will maintain.CemfinmofCoruermt be self-insum for workers Compcm
302
— TUB & OR SHOWER
sa,ion, ex provided for by Section 3900 of the Labor Cade, for W pe forman d of ,he
work for which this peri, is issued.
303
- ROUGH MECHANICAL
❑ I baro and will maintain worker's Compcns.tian Insurance. a required by Section
304
- ROUGH ELECTRICAL
3900 of the Label Code. for me x fmrm;m, of the work fm which this permit is issued.
305
— FRAME
My workers nm ens.dontniemnce cammr and Policy numhcr are:
came -,900 z
306
- HOEDOWNS
P.b u.:WOO
CERTIFICATEOF EM OM WORKERS'
307
— INSULATION
COMPENSATION INSURANCE
3 0 8
- SHEETROCK
nrlessJ(Tnrs section need not hecomplemd if the permBisfmonehundmd dollars (gimp)
309
- EXTERIOR LATH
1 certify that in the perfnrmec of the work for which this peril is issued. 1 shallnot
3 10
— INTERIOR LATH
employ any person in any manner so a In become subject to the workers'Compensa,ion
311
— SCRATCH COAT
Laws of California. Da¢
ApPhcam
313
- ROOF NAIL
.TO A m ICworker. Compensation is C ns of Of Exemption.
becomeNOOK should
NOTICE TOAPPLICANTOr Worker Compensationer moil,ma provisions of of ELaborxemption,. on
CMe, you mud
501
- FINAL ELECTRICAL ENERGY
forthwith comply with such Provisions or this Perls shall M deemed mvoked,
502
- FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
that them i.acd(Sec. n lending097.0. agency for the Performance of
Thur hy which
e work fur which Bis permit is issued (Sec. 709], Civ. C.)
504
- FINAL BUILDING ENERGY
L
Lender's Name
505
- FINAL ELECTRICAL
Lender's Address
1 cenify that I have read this application and state Flux, due above information it
506
— GAS TEST
correct. I agree to comply with all city and county meirnees and state lawsrtlating,o
507
- FINAL PLUMBING
building conswpres
etion, and hereby authertre mentatives or this city to enter upon the
almve- mcntio and pmpcny for mi ccuon purposes
— FIN L MEC ICAL
(We) agree ,o saw, indemnify and keep harlces dm City of Cupcnimi against
0
- F I
liabi li,ies, judgments, costs and expenses which may in any way acerae against mid City
in consequence of the granting afthis Permit.5
- NG
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
_
Issued b yt 4
- C WORKSDate
SORq�R�uLATDI�s.
ate -roofs
sJgoammOFApphcanuconrctor 7v&,_22-
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will dm applicant w future building occupant store or handle hazardous material
as defined by ,he Cuper inn Municipal Code, Chapter 9.12. and the Health and Safety
Code. Section 25532(a)?
❑Vci dJ No
All roofs shall be
inspected prior to any roofing material being installed.
Will me applicant or mwre bwming occupant um equ;pmcn, aro devmes wnieM1
If a roof is installed
without first obtaining an inspection, I agree to remove
M1ar�rdnus air contaminants az Jcfincd by dmc Bay Arca Air Quality Management
Dinrictp
all new materials
for inspection.
❑Yea
I have read our hasaNnus materials myu;mmenu under Charm, 6.95 of the Califor-
nia Health Si Safety Cured. Sections 255115, 25533 and 25536.1 undemmnd thm if the building
data not currently have a tenant. that it is my mmientibiloy in illy the m�acupant of the
H, rent j�h must no I P60Tto issuance of a CCNGcam Gcc panty,
Signature of Applicant Date
22--t9
roof coverings to be Class "B" or better
O No, au(NOiredapem Date IAll