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03080032 CITY OF CUPERTINO ' '' ""`` BUILDING mvlsloN PERMIT t CONTRACTQ�R INFORMAIIO,a " BUILDING ADDRESS: KALLIO CONSTRUCTION PERMIT N003080032 21447 KRZICT4 PL OWNER'S NAME: 1492 WALBROOK DR PEWIT 35UE DATE HO STIMSON F AND HELEN Y 08/08/2003 E: (408) 873-9777 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 j0 LICENSED CONTRACTOR'S DECLARATION Job Description F 1 hereby affirm that 1 am licensed under movixions of Chapter 9(commencing U tui th Section70M)of Division Sof the Bratimmand Professions Code.and my license is N ire mu force and effort. KITCHEN REMODEL Z License Class Lic.M �(V o Doe cimanctor a' ARCHITECT'S DECLARATION I aI understand my plans shall be used as p.hire rccards A V�� U ty Licensed professional ®�� OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the ,0 rallawing reason.(Section 7031.5,Business and Professions Code:Any city Or county I which reyuir a renuit,.construct,alter.improve,demolish.or repair any structure _y, prions its issuance.also requires the applicant for such permit to file Stopped statement E0 Nathcislicensedpursuant tothe pmvrsionanfdWCommcmr'sLieur.Law(Charter 9 Sq.Ft. Floor Area Valuation (dommeneipg with section 7obalk or Division 3 of BUinea and Praressiant cape)ur 36205040 . 00 n that he is exempt decmfrom and the basis for me alleged exemption.Any=uI Section 7031.5 by any applicant for a permit subjects the applieurt to a civil penalty or APN Number Occupancy Type a not are Nan five bandied dollars($500). D 1,at owner of the property,or my employees with wages as their sole compensation, Will do the work,and Ne swcwm is not intended or offered for sale(Sec.704,Business land Professions Code:The Contractor License Law does at apply 10 an owner of 10 2 - PIERS d Inspections property who builds or improves thereon,and who does such work himself or through his own employees provided that such Improvements an not mended or offered for Sale.If. 103 — UFER however,me building or improvement is sold within one year of completion,me owner. builder will have the burden of proving that he did not build of improve for purpose of 104 — REBAR tale.). 105 — ANCHOR BOLTS D 1,as owner of the property.am exclusively contracting wide licensed comma ors,. 106 - SEWER & WATER comm ct the project(See.704,Business and Professions Code:)The Contractor's Li wheLa.does a.,apply 1. aownerofpfmpenyWho builds orlmprovea thereon,and, 202 - UNDERFLOOR PLUMBING o contracts for such projects with a contractot(s)licensed pursuant to Ne Contractors Lieemxe L.w. 203 — UNDERFLOOR MECHANICAL Dl am exempt under see. .B&P C far mit reatmm 204 — UNDERFLOOR FRAME Owner Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION Ihereby aMO.under pepabyofperjaryarm orthe following Unismationt: 301 — ROUGH PLUMBING . have aadWill mmrtair.cemre.toafConsent 1.self-maumfur Worker',ComPcm 302 — TUB & OR SHOWER shrimp,as provided for by Section 37M of he tabor Code,for thperfu e memere of the 3 03 — ROUGH MECHANICAL Work I.,wmehwspermirisissued. 304 — ROUGH ELECTRICAL D 1 have and will maintain Worker's Compensation Insurance,U required by Section 3 0 5 - FRAME 370D.17 the Labor Code,for dee performance of the work farwblch this repair is issued. My Worker's Compensation Insurance carrier and Policy number aur 306 — HOLDOWNS Carrier: Policy No.: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK ('Itis section need nut be complerd if the permit it rmrmnm hundred OWN.(SIM) 309 — EXTERIOR LATH arms') 310 — INTERIOR LATH 1 certify Not in the performance of the work for which this permit is Used,I shall net 311 - SCRATCH COAT employ any person in any manner so as m become subject,.the Workers Compensation Laws of California.Data 313 - ROOF NAIL �,pplieant became afterperso misGision,1IofExemption.you M.mshould 501 - FINAL ELECTRICAL ENERGY becomesubject,. it Worker's Compemmion previsions of thefarmCodeavake you mon Z mnbwbhcomply wimstrehprnvuimrsnnhispermdabaubedccmcdmvmkcd, SO2 — FINAL PLUMBING ENERGY .�. CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby aifrm dear mem is a conswction lending agency for the performance of 504 - FINAL BUILDING ENERGY 7 the Work far Which this parent isIssued(Ses.30D,Co,C.) 505 - FINAL ELECTRICAL A Lender's N.M. z LibdertAdd.x, 506 - GAS TEST C 1 ccnify that I have read this application and SUM that the above information is 507 - FINAL PLUMBING F conch 1 agree to Comply with all city and county ordinances and state laws relating to U buildingconswctian,antlM1erchyamhorimmprescmatirosufNisci menter upn^NO JINMECHAN CAL W .hove-momimied pmpcny for hambetlon proposes. 09(We)agree to ears,indemnify and keep harmless the City of Cupertino againstliabilities,judgments•costs and expenses which may in any way same against mid City 5 NGZ in consequence of the grant,,Of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date SOURCE REGULATIONS. Re-roofs Signature Of ApplieanUComraMOT Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hawrduus material as darned by the Cupertino Municipal Coda.Chapter 9.12,and the Health and Safety Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes C]NO Will the applicant or future building Occupant esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ha'mmous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? DYes DNO I have read me hnaNmus materials reyuimments under Chapter 695 of the Califon ria Health&Safety Cede,Sections 75515.25533 and 25534.1 undenmnd Be,if the building does not currently have a tenant mat it is my responsi hil ity to redly the uecupvm of the requirements which Must or Met Poor aissuanceOf.ardfaateoraaparcy. Signature of Applicant Date Owner or antlarind age.( Date All roof coverings to be Class"B" or better 'SmC i�-T^Y OF CUPERTINO CU CITY OF No PERMIT APPLICATION FORM 0,f 0 '53a - APN # 3 to Date: D Building Address: Mailing Address (if different from building address): 'P- 1 2 4Ow er's Name: Phone Y rJ ontractor: U License#: 53r 5 Contact: Phone: Cupertino Business License#: E L L�[) Fax: Building Permit Info: Bld�. Elect Plumb ' Mech .25 Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: �66 $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ 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> IM 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 Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING lof3 ( '� CITY OF CUPERTINO I '100 CUP TYOf O PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL / BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2of3 z(Q CITY OF CUPERTIl`�O CUPEFT OF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 his ection BUILDING BSWIM 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 Elec 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 3 of 3 Kapio Construction GA 1482 Walbrook Drive On 1 tZF�GTO R. a San Jose, CA 95129 i l (408) 873-9777 - B HIC 554785 s tl tl 1 Pro( c wner Itit� o oMrs I< cuP>zr�lvt0 �� (0 873 - 14) -5 t v.s�-o.a Yaw Cad c�S q D U,t A 2 O�v U p c�A CAZC.+r t Cc Q, Y o z 0 D cG Btl�� s o2 + fro=..." s w,Gtct»+u "- APPROVED PI u"::A uG WDESmoDOR 44M j, IN S`1`►� L.C. o2w � cualt m canes r�ostD� � 1 )a DATE ^03 SIGNED_.._._ 6 `UA'^-ffY.'-." • �iE'�.w �'vr a L 01 Pus s: sl p ana ;rd prct`cstmra`t.'UST to kept u.U+;ob a,a tmms,r�d it Is un%r,(,U to :S . make Trod chrulgza cr a!!9=Ana on Sean _ without v.- ts.-i peanw_,—% tram t)n �e8 hepL,•'Ilr;Ot cupah;nm V The r•amt. .ra o4 the p'1 ms epadneattrap SHALL SCOT bs M".d to pamM or to ba en pproval or the ma,,w of any xwgm AUG 8 2003 S ny ay Om'rwce or State LM b"`n