03060160CITY OF CUPEWFINO
CONTRACTOR INFORMATION
'
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
KALLIO CONSTRUCTION
PERMITND03060160
OWNER'S NAME:
1492 WALBROOK DR
PERMR LSSUE DATE
NE:
(408)873-9777
SANITARY NO. CONTROL NO.
ARCHITECTIENCINEER:
BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1 hereby 1 licensed Chapter 9
Job Description
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(cram that am under provisions of (commencing
with Section 7M))Of Division 5 or doe Busing and Professions Colle.ind my him.. is
n
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err t.
in fall Class Lit. p
LicenClua
se
HEATER & A/C W/DUCTS FONA F93
e F, O
Dam Contractor
ARCHITECTS DECLARATION
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l understand my plans shall he used as public records
q s) 2p 'S
JUL 2 003
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Licensed Pmfessinnal
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OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Conmactors License Law for the
BUILDING
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following reason. (Section 7(1]1.5, Business and Professions Code: Any city or county
which amerus a permit to construct, afmr. improve, demolish, or Occur any slrucmm
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prior to its imuance.alxu nmuims the applicant rersuch permitto rile axigned statement
that he is licensed pursuant o the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area Valuation
at-
i
(commencing with Section 7000)nf Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for me alleged exemption. Any viplauon of
35703053.00
Section 7071.5 by any applicant for a permit subjects the applicant o a civil penalty of
APN Number
Occu ane Type-
net mom man fin hundred della,a(S500).
p y
❑ I. as owner of the property, or my employees with wages u their sole compensation,
will do the work. and the somehow is not intended or offered for sale (Sec. 701x, Business
3 01 _ ROUGH IijTT�T77sy�ttg�2ja
and Pmressions Code: The Como cur's Lic ns, law docs not apply to an owner of
tl7Tel�' it}3 Ct100S
property who builds or improver thereon, and who does such work himselfor through his
303 - ROUGH M CHANT AL
own employees. provided that such impmvemenu are not hoarded or offered for sale. If.
304 — ROUGH ELECTRICAL
however, he building or improvement is sold within one year of completion. Ne owner-
builder will have the burden of proving that he did not Wild or improve fur purpose of
501 - FINAL ELECTRICAL ENERGY
sale.).
502 - FINAL PLUMBING ENERGY
I, as Owner of the propcny, am exclusively contracting with licensed contractors to
connmct the project(Sec. 7044. Business and Pmfcuiam code:) The Contractors u.
503 — FINAL MECHANICAL ENERGY
for such plymmowneorpmpeny thewogmd,
or ant
who
505 FINAL
icOsedpurulds tovo
contracts projects with a contranor(s) licensed pursuant to ole COnuacmh
— ELECTRICAL
law.
507 - FINAL PLUMBING
❑l
Fit BmPCfortsoo.
^uaerSe.
n WAW e, I AbUfoe h Date � /fl
508 - FINAL MECHANICAL
WORKER'S COMPENSATIV4 DECLARATIO
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I low and will maintain a Certificate of Cometh melt-insure for Worker'sCompcn-
ration, u pmvidrd for by Section 37M of the labor Code, for the perfmsnance, of the
work for which this permit is issued.
❑ 1 hats and will maintain Worker's Compensation Insurance, as myuired by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Workers Compensation Insurance canner and Policy number am:
Carom'. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GTu section need not he completed if the Permit is fnronc hundred dollars ($1,1(1)
or It..)
1 certify that in to performance of the work for which this permit is issued, I shall not
employ any person in any manncrao as art become subject o the Workers Compensation
Laws of California. Dal,
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
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become subject to the Workers Compionsib n provisions Of the labor Code, you must
hodwith comply with such or this shall he deemed
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prevision permit invoked.
22
CONSTRUCTION LENDING AGENCY
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I hereby affirm that then is a construction lending agency for perrurman¢uf
i
me work for which this permit is issued (Sec. 3097, Co, C.)
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Lender's Name
IL
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Lender's Address
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1 cenify that I have read this application and state that me above information is
I agree to comply with all city and county ordinances and rete laws mitring m
pUcorrect.
building construction, and hereby authmore r,preaentadws Of this city to enter upon the
above.mcnudgar propertyest for inspection
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curcuma.
(We) agree to save, indemnify and keep harmless dte City of Cupertino against
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expenses which they in any wayaceiuc egging said City
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in conseywncc of me Framing of this permit.
incoitica.judg of timcramindof this
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-P INT
Issued by:
50 �R[� LpTuCombr1
Date
' Gr 02
Re-roofs
SI fApplwam7ConuactII Data
HAZARDOUS MATE ALS DISCLOSURE
Type of Roof
Will the applicant or future building Occupant store or handle haradous material
u defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Alikode,
Section 25512(a)?
❑ Yes KR.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or dcvicus which
If a roof is installed without first obtaining an inspection, I agree to remove
it hvaf lour air contaminants m defined by the Bay Area Air Quality Management
all new materials for inspection.
strict?
❑Yese
7d,.a
I have real the ha.rmms mamriaB requiwm,na book, Chant, 6.95 of the Califon
Health sk Safety Cote, Sermons 25XI5.255A and 25534.1 undersand that if the building
net cunemly haw a most, that it is my rcapra ihib y to so do
Ile rcc ant of de
uirt mmmf,lcm,lp amepr.cerealamr a y.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner or luborfind agent ,m
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CITY OF
CUPERTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
69.3C)Go40
APN #
Energy
Building Address:
BREMFURN
Owner's Name:
ff % IG'i Ci I
Phone #:
y-3o54
Contractor: F1 Phone:
kaQGo "-1aa -37a
License #:
7/6 af3
Contact: Phone:
1
Cupertino Business License #:
Building Permit Info: _
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BldgElbi" ect LJ lum)S
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Job Description:
NeW /9G C fill i
KQ.t,J �( $
Residential K Commercial ❑
BUILDING
For Residential Installations:
Attic ® Is'floor ❑ 2nd floor ❑
Elec Permit Issuance
Adhere to min set back requirement ❑
MPERMTTFEE
For Commercial Installations:
MECHANICAL
Replacement same weight ❑ Additional weight (structural talcs) ❑
Plumbing Permit Issue
Structural Calculatio quired for new installation
BPERMFEE
New installatio anning A rov Required ❑
BUILDING
Cost of Pr 'ect:5, e,_ Type of Construction:
6so ,
Occupancy gro
Strapped On Platfo Bonded ❑
Sq.Ft. Floor Area:
New Location Replacement ❑
BUILDING
Qty. if
ADDHAable
FPP M
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BENERGY
Energy
BREMFURN
Relocation of Furnace
AL
BREMACOVER
A/C Unit > 10,000 cfm
AL
BREMAIRHAN
A/C Units <= 10, 000 cfm
AL
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BREMRECEPT
Rec tl, Switch & Outlets
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BSEISMICRE
Seismic Fee Res
BUILDING
EPERMTTFEE
Elec Permit Issuance
ELECTRICAL
MPERMTTFEE
Mech Permit Issuance
MECHANICAL
PPERMTTFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
\ BUSL C
Business Li ense
BUILDING
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