05040001 (4) CITY OF CUPERTINO
BUILDING DIVISION PE T 4COT,T£RAyCTQit IFI U,I�'aQ1V :
BUILDING ADDRESS: PERMIT ND.
KALLIO CONSTRUCTION • 05040001
OWNER'S NAME: PERMIT ISSUE DATE
PHONE: SANITARY OL NO.
HITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
40,zLICENSED CONTRACTOR'S DECLARATION Job Descrition
C 1 h m by arrom that I sm licensed under provislom of Chapter 9(commencing P
�9. with Scam.7M0)of Division 3ofthe Business eM Proksaunt Code.and my liunm is
o in full farce and eH 7 s
nQ D�� ,l c,azt^r'i4: KITCHEN REMODEL
ARCHRECTS DECLARATION
I understand my plats shill W used as public records
3 0 Licensed Profesaknal
3 Oat I am exempt
from
DECe Conu ON
I hereby.(Sere that 1 em eacmpt Tetin Ne Cationic License Lew for the
S:
pe O following mama.(Sudan IID str B.slus. and improve.
de oli Code:Any city m county
y 9 which tequiru•Permit to ul.i t,alms improv.demolish.Of¢pair my atramm
FZa
Prior is licensed
immum(l.the lhmappliunlto,W Con Permit LimleasLaw(catement VaIU t100
< (commencing cdpu ction7othepmvivismofd¢Commnessaianrclsw(Chapsr9 Sq.Ft. Floor Area
yF$ (cat he
(commencing iNSection70n0)ofddo Division n3 do be ted Business MY
Code)or .
that h u exempt thcrtfrom and Ne basis for the elkgcd exemption.My violation of
SeNon 7031.5 by my applicant for a permit subjects the applicant In a civil penalty Of 3 94NEt�er0 0 Occupancy Type
not mom than five hundred dollars(5500). _
❑I,as owner of the properly,mmy employees with wages u their role compensation,
.ill do the work and the structure is our intended or offered fmsale(Sec.7041.Business Required Inspections
and Professions Code:The Contra to's License Law does not apply do an owner of q P
property who builds m improves tharem.and who does sac h work himself.,through his
own employees,provided that such Impmwmenu me not intended proffered forsale.if.
however,Ne building or improvement le mid within ane yearof completion.the owner. .
builder will have the burden of proving that he did our build m Improve fm purpose of j
sale.).
❑I.a owner of cl property,,Business velyand conduProfessi n,with:)shed cantrmmn to 6/
comwd Ne project pply too4.wnrofand Profession,Wilds
Code:)The Contractor's d
cense Law tloca not apply m ts owner of properly who Wilda ter Improves themnt,end,
whoLacca for such projects with a contnemr(q licensed pursuant m die Conmemes C7/
License
nm Law. Ts
❑1 em exempt under Sec. .B @ P C for this moon
Owner Dem V
WORKER'S COMPENSATION DECLARATION
I hemhy affirm under penalty of perjury one of the following declarations:
❑I have and will maintain aCe tificam of Consenuo ael6iosure for Wmker'e Compere
motor.as provided for by Senior 37M of the Labor Code,for Ne Performance of the
rk for which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
00 of the labor Code.for the performance of the work for which this permit is IsemA.
My Wmisces Conformation Immosnee cartler and Policy number a.L:
Cann., rirj+T& PUIV9 Policy NO: 7J��7 7Cb
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If the permit Is forone hundred dollen(SIM)
or lea)
I unify that in the performance of the work for which this permit la issued.I shell nm
employ any person in any manner m is In become Whim'to the Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Ccnifmrc of Exemption,you should
become subject an the Workees Compensation provisions or the LeWr Code,you most
Oforthwith mmply with such provision of this permit shall he doemed revoked.
Z CONSTRUCTION LENDING AGENCY
El hereby up.that tomeisaconuathm lending agency for the Performance 4 e
tithe work for which this permit is under!(Sec.3097.Civ.C.)
gQA Lentler's Name
0.Z Lattices Add.
U Q I mnify that I have mad Nis application and stem that the above infomwiun is
LL Pcoma 1 agree to comply with all city and county ordinances and auk laws relning to
O tJ Wilding construction.and bomb,euthorire mpmsenuoives of this city m ender uPtn the
[A above-mentioned property fm its'aion putrmses.
(We)agree to save,indemnify and keep batmless the City of Cupertino against
„+,AA Iiabilitiu,judgormu,eosumdexpenses which may mmy wayauroeagam,said City
in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS jkND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOyy ERECULA IONS. `jj'/
7L K«Qe , -I Re-roofs
Signature of Applicam/Contractor Bain
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or hand).herudoue material
as deliocd by the Cupenino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Smdub 25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
El Yes No
Will the applicant or future building omupam use equipment or dervims which If a roof 15 installed without first obtaining an inspection,I agree to remove
emit ha'urdom air contaminants as de0ned by the Bay Arca Air Quality Mmagemcm all new materials for inspection. _
Dix0in7
❑Yea TO
I have mad the hurardmus materials mquimmcros under Chapter 6.95 of the Califon
nia Health @ Safety Cade,Secuonsa5505,25533 and 25534.1 understand that lithe Wilding
does not cunemly how a Imam,that It's my responsibility to nod I the occupant of Ne
requirc�menuwhicgtntatWmnpdor to iamance ora ccmEeem or mpmey. Signature of Applicant Date
;E:: K°��Q `1MC5 All roof coverings to be Class"B"or better
Owner or authorbed a gent t D.I.
'
aw
CITY OF CUPERTINO
CUPEkTINO
PERMIT APPLICATION FORM
f0APN# — � o Date:
lding Address: Mailing Addr sif different from building address):
ner'sN e: Phone a7s
C`
Contractor: License#:
6E Co —V .5_
Contact: Phone: fOe 3 V-5-1 fY Cupertino Business License#:
C— «LL J p Fax: —
Building Permit Info:
Bldg Elect Plumb Mech ❑
Job Description: �
Residential t+cuv, , Commercial ❑
.Sq.t. to r ea: $/Sq.Ft.:
Cost of Project: I vOccupancy Group:
Type of Co structi Please check this box if the project is a
K p second-story addition: ❑
Project Size: Standard Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> lM 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 <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 31
0 CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb 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 rinklerBackflo PLUMBING
BPSTORM Stonn/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 din MECHANICAL
BREN AIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFD{T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Ap Hance ELECTRICAL
• 2 of 3
OTY OF CUPERTINO
CUPER,TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
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 Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
)1-13 ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
3 MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Plannin Lon Range Residential PLANNING
ZADDCHG Address Chane I BUILDING
3 of 3 •
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CUPEKTINO _.3
Assessor's Parcel Number: _ D3 2—
Name of owner. co VIq,V
Project address. 10 '2;' �-OL al hM Q YT-IV 42-
Contact person. ERI C- KA Li-1 0 Phone. luoe
Fax. �OQ, R7.3 977
Net square footage of lot.
Existin PP�ro�po-s"ed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done?
Brief description of work. /��J C/fes/✓ JZ�/rtO
Code editions:2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y-N)
2001 CPC (Y - N)2001 NEC (Y -N)
Effective 11/1/02
OFFICECUP APR 12005
Plan Review Process Work Book - Page-8-Revised 4/28/04