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BUILDING DIVISION PERMI
lvVy4\°A
KALLIO CONSTRUCTION
PERMIT NO.
BUILDING ADDRESS:
OWNER'S NAME:
1492 WALBROOK DR
PERMIT Lu E A
HI
E:
(408) 873-9777
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLOG ELECTPLUMB MSCH
LICENSED CONTRACTOR'S DECLARATION
1 herby that l am Iicenud undo provisions of CMpser 9 (wmmcr¢Ing
Job Description
WNxSton yof0ivialon3orlh^' ineaSApd Profcuiortr Code. end mylicenscii
,o
mm�ro«r-•.• `
Q nse l S '
m
BATHRM REMODEL t� /�1I
E
G1o� tt—BNiP'UiS
R HBECrSD RATION
understand undernd my plans shall be treed as public recmda
MAY 1 6 2003
Licensed PmI
Propose
OWNER-BUILDER DECLARATION
1 herchyonste air,. Inn 1 exempt from the Contractor'. Lew for the
following Ieaaoa SCe 1. e: Ansi
703 1.5, Code: Any tiny pr county
sher. end Prove.
BUILDING
canto o construct, dcomli
which aquina n Permit re,ureaealcor, impale. h Permit t m mash any tuement
prior In its iuuaxc, also enquire nhc applicant for such permit b f Ic a signed statement
that he is licensed punuam M dm provision orNC Contractors License Law (Chapter 9
Sq. Ft. Floor Area
y@j"ion
(commcnclog with Section 70M) of Division 3 of the Business and Proredons Code)or
that he is escrepl therefrom and the basis for the allcgcd ..pd. Any violation of
Section ]031.5 bymare Nany epPliunt for a permit subjects Ne applicant m a civil penally of
met an five hundred dollars (5500).
3AFTSMMIleroo Occupancy 1YPe
❑ i.0 ownu of Can property, x my employees with wages as their In compensation.
will du NCwOrk,NdNsa slum Is WtinVMCdaraffer ror,.IL(SLc.]O4I,BOaIMai
and Profession Code: The Contractor's License Law Causes nt a oapply an owns of
UNDP �jId Inspections
pmpetywho Wildandmproses lherenn,and whodxs¢uch werkhimselforNrough Ms
102 - PIERS
own employee, provided Nalsochimprovements arenm intended ororterW tensile. if,
however, Ne building or Improvemento
(! sold within one year of completion. fee wner.
103 — UFER
bmlew w;u neve the burden of paving the he did not build er improve for purpose of
104 - REBAR
ialea.
01, as ounce of the propeny, am exclusively convecting with licensed contractors; to
105 - ANCHOR BOLTS
contact the paiccl(Sec.70". Business and l'royfesslne Code:) The ConVsa,ces U.
106 - SEWER & WATER
cease Law dons not apply lom with omnallorly who sedpurlds rimpro the thereon, add
for iYLh pafeCLS wIN a COnVaL101(a) IICCnYd pYI6Yenl I0 NC enhlVaelort
wile ea,
202 — UNDERFLOOR PLUMBING
Law,
Uc1 won law.
❑Lem exempt under See ,BkPCfor this recon
203 - UNDERFLOOR MECHANICAL
OwwDale
204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
Ihereby efordorder pemetyofperjury one orthe following dxlaratons:
301 - ROUGH PLUMBING
have and will druduin• CeNfcen of Cement to self -intra rut Workers Compeo-
302 - TUB & OR SHOWER
sabot, as provided for by Section 3700 or the labor Code, fur to performable of the
wor
work for which NI. permit is issued.
3 0 3 - ROUGH MECHANICAL
p l have and will maintain Worker[ Compensation Insurance, as a Arad by Senior
304 — ROUGH ELECTRICAL
37110or the Labor Code, for Nc puformanm of the wort forwhich this pCmi, is issued.
30rj _ FRAME
FRAME
My Work aCmorenvdon Inlamhlx mer and olieynumberaa:
C.
PON
305 —
HOLDONS
(.ERTIFICATEOP EXrM FROM WORKERS'
307 - INSULATION
COMPENSATION INSURANCE
308 - SHEETROCK
ICCIIOn bond not 6C ComplClCd lfllle Permit Is rM 00eM1v0daddollN(SIIXI)
calm)
309
309 - EXTERIOR LATH
I eudfy Nar in the perfnrmarhce or the work for which this permit U issued. I he, non
310 - INTERIOR LATH
employeny Pcnon in any menblrso u W biome mb*t to the Workers' Compensation
Laws or Ce lfomia. Dace
311 — SCRATCH COAT
A,11cern
313 - ROOF NAIL
NOTICE TOAPPLICANT: If, ftr nudclo, this CcniOcadteorExemption, should
become Aro W Compensationprovision a IoM Code. youmust
501 - FINAL ELECTRICAL ENERGY
forthwith Comply with such provision or this Permit shall be doemed awked.
502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
I Nel Nerc iso Construction tending agexyfor lM PerhxmaxehJ
503 - FINAL MECHANICAL ENERGY
for which this
Use work for which Nu pertnil i¢ issued (Sec. Jtyi], Civ. C.)
504 - FINAL BUILDING ENERGY
Lender's Name505
- FINAL ELECTRICAL
LetveraAddm.. Add
I =try that 1 have reed thli application and [tale Nn the show Information is
506 - GAS TEST
cmmCl. l agree on comply with ell city and county ordinances and state laws totaling no
building construction, and hereby euthoria apnscoleiws of this city to
507 - FINAL PLUMBING
enter upon to
papery tot InPecton Pugwea
FIN
(We) agree to save, indemnify and kccp hamnless the City of Cupertino against
nose, and expense which may in any way tare again[,
0 9 F Iliabilitie,Judgmene,,
said City/in emuequeneeor Ne grnting of this Permit.
&MECFLWCALaMve.mcntiunrA
5 IG
UNDERSTANDS AND WILL COMPLY WITH ALL NON -POI
SOURC
Y//APPLICANT
Issued by:5 Date
WORKS
M�uATIONS.
�%Z-r .`.DOLrRe
-roofs
oh l[IFumas AppncahC.n.cbor 1 ate
V
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
W01 the applicant or future building eecupat nae orbandlc hnmdous mannual
as defined by the Cupertino Municipal Codc, Chapter 9.12, and the HxIN and Safety
Code, Sidon 25532(e)?
❑Ye (`ZIN'
All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant orfuturebuilding Occupant use equipment or devices; which
If a roof is installed without first obtaining an inspection, I agree to remove
h ramous air C -Ma ed -an s as defined by the Bay Arca Air Quality Management
Diorite v
all new materials for inspection.
Oyer; /( u
I have read the haramtms mannans teqm
uiaen¢ undo Clupter6.95 of Ne Caliroo-
nu Helthh SafmyCode, Seenon25505,25533 and25534. I undcnl LMW tf1hc building
dOCa 1101 eera0l y MYC a nYham, that It Is my aap0nslbll ley
m notify Coram or NC
qtr Bwhich nthemet 'or missuance ora Ccrtifaea or ry.
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Owner tar euNorivcd egcnl Date
47Y0
•CUPERTINO
(�WY OF CUPERTINO
PERMIT APPLICATION FORM
03 o3 U c/o
APN #
Date:
/ '
BAPPLOTHER
B A d.21 re s•
dOn
Ow is Ne:
Phone #: ,
BUILDING
SL
ContractorL&16 �Q
Licen
Y
Contac :
Cupertino Business License#:
G �L
1
BBOILER3
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area:
$/Sq.Ft.:
Cost of Project: oDU
Occupancy Group: r.i
Type of Construction:
BCONSTAX
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances .
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to 1M 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/ uasi
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 <= 200A
ELECTRICAL
BENERGYEner
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1 of 3C7 (? 7�
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CUPERTINO
ItITY OF CUPERTINO •
PERMIT APPLICATION FORM
2 of 3
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