03020108 CITY OF CUPERTINO r> �a* md5=r ',rF" ,v«s - =
BUILDING DIVISION PERMIT ' CONTRACT00AMRMATIONX
BUILDING ADDRESS: KALLIO CONSTRUCTION - PERMITNO.
10311 PALO VISTA RD 03020108
'S NAME: 1492 WALBROOK DR PERMITISSUEDAT'BB
ARMSTRONG MURTAGH 02/26/2003
PHONE: (408) 873-9777 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BILDIGO a= PLUMB O
�o Zp LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am Ilmnmd under Msiona of Chapter 9(commencing - p .
wish Smdn700I) fDlvWon3o:r:Busi,.,, . of Ions Code,mdmylicesseh n m��'����
:5N
1.1. � � BATHRM REMODEL (TII�{spI�TDOW)
j J 3 Licenm Clss Lk.g
p Dam Con un
ro CHrTErSDE AI N APR 2 2 2003
uq(T
n Immand my plana shall M used l tic record&
jo Licensed Peer..local
OWNER-BUILDER DECLARATION
I hereby aMm that 1 am exempt from the COntraerefs Lacnm Law for the BUILDING
O O following moon.(Section 7031.5.Business and Professions Code:Any city or county
g which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires ft applicant for such permit rile a signed comment
ggg���
that he is licensed pursuant to the provisions of the Commcmb License law(ChaPter9 Sq.Ft.Floor Area - MUiRion
(commencing with Section 7010)of Division 3 of the Business and Professions Code)or
that he ts exempt therefrom and the basis for the tlmged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
not more Nan live hundred dollars($500). r Occupancy Type
0 1,As owner of the property,Or my employees with wages As their sole compensation,
will do the work,and the structure is notlnus ded muttered for ssld(Sec.7044,Business 4:09: F71
and Profession'Code:The Com melm's License Law does not apply a an owner of 102 - P I ERS equlred Inspections
property he buildserimprows thereon,and who dmuuch such himmiferduough his
Own employer',provided that such improvements vent Intended or offered for Asks.If. 103- — UFER
hewever,the building orimprovement issold within one yev o(mmpledon.the Owner. 104 — REBAR .
builder will have the burden of proving that M did not build m purpose Improve for puose of
am.)', 105 2 ANCHOR BOLTS
0 1.as Owner of the property,am exclusively contracting with licensed conmumm to 106 - SEWER & WATER
construct the project(Sec.7044,Business and Profession Code:)The Comecon Li.
move Law does not apply to an Owner of property who Wilds or Improve,themen.and. 202 - UNDERFLOOR PLUMBING
who contracts for such Projects with a cwuecar(O licensed pursuant to the Convactols 2O3 - UNDERFLOOR MECHANICAL
License Law. -
0lamexemptunderSee. Bk P C for this own 204 - UNDERFLOOR FRAME -
Dam 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby aRlnn under penalty of perjury one Of the fallowing deemadon: 302 - TUB & OR SHOWER'
0 l have and will maintain a Caniricam of Consent o mlbbnsud for Wmsm.Compen- 3O3 — ROUGH MECHANICAL
sailor,u pwvldcd for by Section 3700 of the Labor Code,for the performance of the
..,it for which this permit is based. 304 ROUGH ELECTRICAL '
0 1 haw and will maintain worker's compensation Insurance,as required by Section 305 - FRAME -
3700ofthe Labor Code,for dm performance of lhewmk for hichthupermitHiumd. -
MyWmkraCompensationlnaussmacaniesandPa 'brace: 306 - HOLDOWNS
ap� TE FUKJ 1� PoIIryNoc6N7-2,00307 INSULATION
SG
CERTIFICATE
COMPENSATION INSURANCE EMPTION FROM WORKERS' 308 — SHEETROCK
(Thbeem.need rat lmcomptead rdsa Permit I,(Ore.humn•A dollan(f100 309 - EXTERIOR LATH
eflC3s.) 310 - INTERIOR LATH
1 ren fy that in me performance Of rim work for which this permit is based.I shall not 311 - SCRATCH COAT
employ any person In any mancren u to become aubjmuo the Worbcts'COmpematien
Laws of California.Dam - 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:IL after ending thU CcNRcate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY .
become object to the Worker's Compensation provisions of um[AM,Code,you must 502 - FINAL PLUMBING ENERGY
DOforthwith comply with such provisions or this Permit shall W deemed revoked.
n
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(-a
I hcmhY Affirm thut them is A construction lendinj.pancy for the performance or 504FINAL BUILDING ENERGY
the work for which this permBlawued(Sm.3W7.Clv.C.)
Lander',Name 505 - FINAL ELECTRICAL
w Ca
�Z Lcn&esAEdmas 506 - GAS TEST
U O I candfy that I haw rod this application and ma that the above information is 507 - FINAL PLUMBING,'
lg,F correct.I afree to comply with all city and county ordinances and nate laws relating a 8 -, FINAL MECHANICAL
O building construction,and hereby authorim representatives of this city to enter upon the
W8
propcny for inspection purpose& 50 - FI L RADE
(We)ju agree to caw,Indemnify and hop harmless the City ru Cupertino id City
Usti incoliabilnse&judgmenuecorningOftis expenses ch may In anyvnyamue&[&lost said City I NG
U 7 In eamequenm of the granting Of this Pcnnbt.
r7 APPLI ANT UNDERSTANDS AND WILL COMPLY WITHAL ON- INT Issued by; 5 C WORKSDa[e
S U °�ULATIO a
Re-roofs
nuurc of Appllc HAZAtractor Dim
RDOUS MATERIALS DISCLOSURE - Type of Roof
Will ua apPllant or forum Wilding occupant ams or handle hvudous material
Brad by the Cupertino Municipal Code.Chapter 9.17,and da Health and Safety
Section 75337(e)1❑Yes gat N��O All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaNOus air comorinm"As defined by the Bay Area Air Quality Management all new materials for inspection.
Muriel?
Oyes
Ihave rend the has uamamrials requimments under Chapmr G95 ofthe Oliror.
niaHealffi&SefctyCd,5.d.Z5O5.75533and75534.Iundcrs dial ifdm Milding
J tly have a ananc Net It Is my rcaponslhility,a and mess t of um
rpm m rarch m ay��m t er i m.1.17acerilld.asloe Signature of Applicant Date
��-LSCS((7 r l� �
Ownerunwhorized agent ppm — All roof coverings to be Class"B"or better