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03040108 (2)CITY OF CUPERTINO + '•-* to '�' '"^ +7• BUILDING DIVISION PERMIT -fCONTRACT0R4NF0RMATIO , elji�ullt DR 9s: FOOTHILL BLVD # B KALLIO CONSTRUCTION PERMIT ND.03040108 Gi�glff`PI PATRICIA M 1492 WALBROOK DR 7" 3Z722/2003 E: (408) 873-9777 SANITARY NO. CONTROL NO. ARCHITECrIENGiNEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSES.ImOrdi1cCONTRACTOR'S DECLARATION 1 Mmby affirm Nn I am liamed a tier pbvbions of Chaper 9 (commencing Job Description p ion Section ]0110) of Division 5 of Ne, BuNneu tab Proressiuns Code,, slid my Ikene is in full forte�pB c ✓/–' 2 BATHRMS REM L/UPGRADE Dabnf` ARCFiITECTSLARATION i undersand my plans shall M1c rued u public mc.rds e/ r Licensed Pineal OWNER -BUILDER DECLARATION V I hemby affirm that 1 am exempt from the Conlncmfs License Law for the rollnwing mason, (Suction 703 1.5. Business and Pmfeadons Code: Any city or county which pernms a pool t. anmucL alu:r, improve, demolish, lir repair any wecone poor In its issuance. she, requires the applicant for such permit in rile a Signed statement hoc -he u licensed pursuant b the provisions lir the Conlsitiess U.. law(Chaour 9 (communing Section Sq. Ft. Floor Area 2��ion with 7000) of Division 3 Or the Business and Professions Cade) or that he b aunpt demfmm and the basis for th, alleged exemption. Any violation of LE Section 7071.5 by any applicant for a permit subjects the applicant to a civil penally of not more than rive hundred d.lWas (ssod). 3611ft i908�[ 0 O Occupancy Type t]^I, at owner or the property, or my employees with wage as their sole compensation, ' will do the work, and the swcturt is not intended eraffeud purism (See. 7814, Business and Professions Code: The Contractor's Liam, taw equal trot apply b an Owner of 101 – UND7 '�L Inspections properly, who builds.,improve, them.nand who doessuch work himself., through his 102 – PIERS own employees, provided that such improvements am not intended oroffcied for sal, If. however, the building or improvement is sold within one year of completion, the owner. 103 – UFER bund,, will haw the burden or proving that he did not build or improve for purpose or 10 4 - REBAR ale) ❑ 1. a awncr of thero ivcly concting with licensed contractors; m ppenexclusively amexclusivelyve r 105 - ANCHOR BOLTS construct the project fSee. 7044, Business and R.fessimts Code:) The CO.&.,.,. L;. 106 – SEWER & WATER cense law docs not apply no in.wnrs of properly who builds or improves thereon. and who contracts for such projects with a contragoris) licensed pursuant b the Convectors' 202 — UNDERFLOOR PLUMBING License ❑lam uemq under Sec. ,B&PCfor onto meson 203 - UNDERFLOOR MECHANICAL Owner Dau 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following dwlartions: 301 – ROUGH PLUMBING sw and will maintain aCenieab of Cement to selFinsore for worker's Compen. 302 — TUB & OR SHOWER . as provided for by section 7700.( the labor Code, for use pert.m,mtte of the work for which on, permit u isme0. 303 — ROUGH MECHANICAL ❑ I haw and will maintain Workers Compemalian Inwrance.. required by Setti.n 304 - ROUGH ELECTRICAL 77Morlive liber Codes for the performance crib, work forwhieh this permit is issued. 5 305 – FRAME FRAMEHOLDO My W.rk,fs m wmm msursmje artier and Policy number am: Curti �,Le.�� Fillecyy,,�gE4..2SO -3oo �� 306 - NS CERTINCATEOF ER EMPNLRWROMWORKERSI 307 – INSULATION COMPENSATION INSURANCE 308 - SHEETROCK trlesa)�bmnims need net memnpmmd if be lermllbmruxe h..aw donms(slm7 309 — EXTERIOR LATH I OcITY that I. the life—. of he work for which this permil b issued, I Nall nut 310 - INTERIOR LATH employ w, any pcnonin any manner as u le becnmc subject to the Workers Compensation Laor Califroro v Dab 311 – SCRATCH COAT &-Isl"ant T. If. NOTICE TOAPPLICANi:lf.afermaking thisolisim. of Exemption youshould501 mination 313 - ROOF NAIL become subject b the W Com of proHmons .f the labor code, you mum - FINAL ELECTRICAL ENERGY mrthwith comply with such provisiomarm,ermhshall be, numerous rm.ked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY Thor whichpho tdsem;u cemlmcti30 len ding agcmy f.nhc performmce of 503 - FINAL MECHANICAL ENERGY the wish for which Nu permit u issued (Sec. 7097, Civ, C.) 504 - FINAL BUILDING ENERGY Lender's Name 505 - FINAL ELECTRICAL Lender's Address I ceNfY list I have read lis Mplicati.r and roam that the above mfornation b 506 – GAS TEST cmmtt l qme to comply with all city and county oninanas and silk laws mixing re building convection, and hereby author mprcxnudyes or this city an 507 - FINAL PLUMBING corer upon the ah.w.m,.tiomd pmpelly for inspection hoprona — FIN L MEC ICAL (We,) agree to saw. indemnify and keep harmicss the City or Cupenino against liabiliden, 0 – F I judgments. costs and csponsu which may in MY way amus against said City in consequence of the granting of Nis permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT 5 – NG Issued by: SOUR R ULA OS 4 - C WORKSDate J L p� 'i2e-roofs Ss xormof ApplscanVContracl.r am HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building occupant more or handle hoonesta material ss defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety code, Sectio. 25532(a)? ❑Yu OOTra All roofs shall be inspected prior to any roofing material being installed. tae applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove 6Wits mardnus aif contaminants as defined by the Bay Area Air Quality Managcmcnl I? all new materials for inspection. ❑Yea I -FN. 1 have mad the hmafdous mmcrie s requirements under Chapter 6.95.1'one Cillifm. nu Fiction 6: SafulYCudc, Sectiw 25505, 25577mu125574. 1 understood thmif the Wilding does not cursorily hide a bran, the, it u my rrsponsibihty b dry the occupant of tae requirenscpta'vfm:T met issuance, ora CerdrmateQ panty, 7(.� Signature of Applicant —(�(e �Oorw 8 Date All roof enverinoc in hP (ince "A" - 6... a_�ner Or authorned agent n... ... wtwt • -d � c° n fi F� O QrPSsuRE r3Rl AIRF_?? vpLvC- �f 0 4T10-1fib 4 U W d3s: � Zb yC�41 �p L) cut,TQA c,rc,{,o Kanto Construixlon 1492 Walbrook Drive San Jose, CA 9512'9 (408) 873-9777 1 13 HIC 554785 lL>.2r� :> F an7idLc 1. �l[ W`"t! f w"nti., f �)(-._.V'E rc)Lor,/I L� SGc9P& OP unoP V C la-aQ:� w, aura c C CL nc;. R V, I`°I m bz to CITYOFOF CUPERJINO Alk CITY OF CUPERTINO PERMIT APPLICATION FORM OJo�eOl"? 1 of 3 9�-s7?. z1 N # r 0 Z Date: Building Address: t Owner's N r Phone #: q 7 CoPtr� low D CLI�t License #: Cohn l: L"L4 v Cupertino Business License#: Building en -nit Info: 'Bl Elec lum Mee Job ription: sidential ❑ Z Con mer al Sq.Ft. Floor Area: S/ q.Ft.: Cost of Project: J Occupancy Gro Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co nstax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Flee Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 9�-s7?. z1 CE`- CITY OF CUPERTINO • C1N OF CUPEf�TTINO PERMIT APPLICATION FORM 2 of 3 Quantity Fee ID Fee Descri tion Fee Group BMITIGATR Res. Housin Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL' BNEWMULTI ::_Rultifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping S stem Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREPPlan CheckRe eat Fee BUILDING - BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING . BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT -Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li hting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 15-K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Kern Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 S."7mv.,' CITY OF CUPEkTINO 0 • CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIN4 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elee Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 0 3 of 3