04060211 CITY OF CUPER'I'INOP'°; '
BUILDING DIVISION PRRM CCINTRACTORINFORMA; N: '.
<, rd ^$'ss .�.. ...5 .,az,.tba. pestd ee
BUILDING ADDRESS: SHOWCASE KITCHENS INC PERMITN004060211
1735 COqWnPTW R1
'.R'S NAME: PERMIT LSSUEDATE
TATSUO & SEIKO ITOH 12333 SA
PHONE: SANITARYNO. CONTROL NO.
(408) 253-0412
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ties, LICENSED CONTRACTOR'S DECLARATION
0o jp�� b tri t o
>:Lag I hcaby INil 1 am Torted ander pmvisinns of Chapter v(commencing
6¢
with 5mtion7IXNXp&of Division ail tc Ousinexs�and Pmfcssinnx Cod fid myliccns is
a « inmurrLsderr� / =J S�(S KITCHEN REMODEL
p 2 LicenuCbeat Lie.p
n F 0 Da1C O//it rl Y CnnlractOr DEC�J ARCHITECTS DEC ATION (; C �� 1�U9
r_ti4occ,xumdnryp1m.ahaI1bc.m es "cards EC L
JyU
3 Licensed Profcssionel n
bar I am exempt fr DECLARATION
Conn ,. D 11 ll� D E
a 1 hmehy affirm tat 1 am exempt from the Cnmranor's License Law(or the U ,.
00 follmvmgreason.(Section 7031.5,Business and Pmftstiom Code:Any city or county ���\\\��
K m which requires a permit to continuer,alcor.improve,demolish.m repair any Structure f] �7 �Sy�
tu '^ prior to its i,meee.am m,,ire{the applicant for men permit to rile a signed Statement
that he is lice road pursuant to the previsions of the Comournor's License Law(Chap¢rY Sq.Ft. Floor Area Valuation
as IZ-$ (commencing with Section 7000)of Division 3 of to B usinces and Profcssim"Code)or
y _ Nal he is exempt therefrom and the bass for the alleged exception.Any violation of
Section 703 L5 by any apple n far a permit subjeces the applicant to.civil penalty of 35daWfOuffilerO 0 Occupancy Type
an,mon Nan five hundred dollars(5500).
❑1,summer drove p upeny.army employees wit wages u oten u1e companntom.
will do Ne work.and theswnart is not ntended or offered for made(Sec.7044,Business Required Inspections
and Profession"Code:The Cogentncto's License law does;net apply to an owner of q P
progeny who builds or improves thereon.and who does such work himself or through his
a5um employcu,provided Nm seen improvements arc not intended or offered for salt If,
however.the building or improvement is said within am year of completion,to owncr-
builder will larva the burden of proving that he did ml build at improve for purpose of
sde.).
❑h as owner of Jre propeny,am exclusively comparing with licetued conwetms to
consumer the project(See.7114,Business and Professions Cade:)The Conmmar's Li.
ve taw data not apply 1n an owner of propcny who builds or improves intent.and
who concocts for such prujccu wit a contnctortU licensed pursuant to du Conuactols
Lice.Law. '
❑1 am exempt nder Sec. .B&P C for this reason
tc Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declinations:
7C3�37'YIW""
1lave and will maintain a Cmtifiuk of Cmiscnl ai self-iosum for WorkcYsCompen-
n,es provided for by Section 3700 of to labor Code,for to performance of to
far which Nis Fenn it is issue(.
have and will maintain Wokers Compensation Insurance.u mquired by Section
of Ne Labor Code,for Ne performance of the work for which this permit is issued.
WorIt - C pensatio Insunn< ursicr and Polity nuOORI mr;
er�L«CERTIFICATE
E %--OF Ex Polity O '
CERTIFICATEOF COMPENSATION
NFROM WORKERS'
COMPENSATION INSURANCE
This section need not becompleed if the permit is forum,hundred dollars(SIM)
err lcsa)
I cmdfy that in Ne performance of the work for which this permit is issued,l shall not
employ any persan in any manner so u to become subject o the Workcts''Compensation
Laws of California.Da¢
Applicant
NOTICE TO APPLICANT:If.after making this Cenificae of Exemption.you should
become subject to the Worker's Compensation provisions of to Labor Code,you must
.,O forthwith comply wit such provisions or Nis permit shaltM dmmcd revoked.
z CONSTRUCTION LENDING AGENCY
(—'(A I hereby anrrm tat were is a construction lending agency for the perfonoance of
a> tc work(tar which tis permit is issued(See.3097.Civ.C.)
U] A Landers Name
Landcr's Address
V C) L amity that 1 have read this application and state Nat the above information is �\
lgy P comes 1 agree to comply with all city and county ordinances and slate laws slating to
0 building smswcrom,and hereby authorize reprearmardves of this city to corer upon the
r W shove-(We) and pmpeny for emnify an keepus. /a
(We)ague to save,indemnify end kith may
in
w City Of Cupertino against /
Uy in
judgments.do,sate"and expemuermit may in myway account against said City
V z consequence of tc granting of this permit.
r-+ APP CANT UNDERSTANDS AND WILL COMPLY WIT NON-POINT Issued by: Date
SOU REGU 'Z z
�LATIfjNs. tea.— / T /a/j Re-roofs
Sr r✓tus of Applica///CC�o,,optracct`o-r`''',1t/ (J J/Ddte 7�
(/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicnol or future building occupant store or handle haendous material
a defend by to Cupenina Munici aN
l Code.Cbmunr 9.12.and ,Health and Safety
�t'Section 255320. All roofs shall be inspected prior to an roofing material bei" installed.
El yes thNa P P Y g g
Will the applicant or future builVjn!«,apanl aw,gaipm,nl ardevmes wmrn If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as fined by to Bay Area Air Quality Management all new materials for inspection.
District? /
[D Yet, �No
I have mad to hazardous maenialsnyvimmcn"under Chapter 6.95 of the Calibb.
ma Heals&Safety Code S,cuons 25505.25533 and 25534.1 understand Na if tc Wilding
docs not cu emly van a enans,Nm it s my re Wp hility w notify tc meupanl of tc
• m inmo ehme,l�melrgllaiaaaanm em;ficawora,ypp Isy Signature of Applicant Date
All roof coverings to be Class "B"or better
sOq ed r auth.h,.cd agent
ATY OF CUPERTINO
cuP TYOF p PERMIT APPLICATION FORM
APN # Date:
SSG. 067
Buildin ldress: Mailing Address (if different from building address):
/73,- 62�� � �
Owner's Name: Phone #:
Contr ctor: License#:
Contac Phone: 2.57 -af17 Cupertino Business License#:
Fax: 2__-5-13.-ate//
Building Permit Info:
Bldg Elects Plumb Mech�T—
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: S/Sq.Ft.:
Cost of Project- 3I Occupancy Group:
Type of Construction: Q Please check this box if the project is a
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> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1of3 � � J � 33
'�� - RTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee 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 Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINI'ERCEP 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 Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent 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
BREMFDCT 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
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
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 Inspection 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
City of Cupertino
Cid Plan Check Transmittal
Permit# . 04060211 Control# 13351
Project KTCH REMODEL/CEILIN Plancheck# 1
Address 21735 FileDate 6/24/2004
COLLINGSWORTH
Owner SEIKOITOH
Description KTCH REMODEL
Plan Check Status (attach comments and return to Building with plan set)
Plan
Dept check# Date Due Date Staff Comment Date Approval?
Building 1 16/24/20041-'7/8/2004 1 POH 1 6/24/2004
Assessor 1 6/24/2004 7/8/2004 SENT 6/29/2004
:i
Additional Plan Check Fee ❑ Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount
r
CITY OF CUPERTINO
BUILDING DIVISION PERMIT .,CONTRACTORINFORMATION.•
BUILDINGADDRFSS: SHOWCASE KITCHENS INC PERMrr NQ 04060211
21735 CO
OWNER'S NAME: PERMIT ISSUE DATE
TATSUO & SEIKO ITCH 12333 SA
E:
SANITARY NO. CONTROL NO.
(408) 253-0412
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lap LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
G wim Section 7")of Division Sof the Bug apd Pmlccriusu Code.and my license is
71 In sun tnted5 aerre� , s�(3 KITCHEN REMODEL
pq� LicenseYl Li
t—p Dam e Commawr
II ��T ARCHITECTS EC ATION
v_YWndersunJ my plana shall he mud records
JyU
;off
Licensed Pmfcsaionel
S OWNER-BUILDER DE CLARATION S
^ I hereby
.(Sinn that 1 1. ,Bumps from thr Canvnmoh LiA n c Law for the
dpo following mason.(Section I ]031.5,Business and ere d eimla Coda:Any city or county
K m which mmuirm a pcnnit la mnswn,n@q improve,demolish,or repair any structure
m"^ prior In in issuanec,arm mquinv the applicant for such permit 10 file a signed statement
t£?'<
that be,is licensed pursuant to the provisions or the Canmactmrs Lang,Law(Chapter 9 Sq. Ft. Floor Area lel Valuation
raH$ (commencing with Section 7001 of Division 3 or Oc Business and Professions Code)or
y
that he u exempt mesefrom and dm bass for the alleged exemption.Any violation of '
lic
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of ,100 OccOancy Type
not more Nan fixe hundred dollen(550).
0 I,as owner of the pmpcny,or my employees with wages as their rale compensation.
will do the walk,and the swmum is not intended or.lboad farad.(See.7044,Business '
and Profesdom Cade:The Com gimmes License law docs not apply to an owner of Required Inspections
Property who builds or improves thereon,and who docs such work himself or through his
own employees,provided that such improvem,nta am not intended or offend formic.If.
however,the building or improvement is mid within ane year of complcdon,the owner.
builds will love the hu den of proving that he did not build or improve for purpose of
.]a I.
❑1,as owner of the property,am exclusively convecting with licensed contractors to
construct the projcn(See.704a.Business and Professions Code:)The Contractor'a Li-
came law does not apply to an owner of Imperil,who builds or improves themon,and.
who contracts for such projects with a contractor(s)licensed pursuanuo the Contractor's _
License law.
C]1 am Inchon under Sec, B&P C far Nis reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcirmy of perjury one of the following dalueuons:
7CI371
have and will maintain aCenirin¢of Consent to self-insure for Worker'sCompen-
n,as provided for by Section 370 of the labor Code,for the performance of the
k for which mil permit is issued.
haus and will maintain Worker's Compensation Insurance,as ma ined by Sccuon
of the labor Cade.for dr,performance of Ne work for which this permit is issued.Worker's Compenaatinn Insurers caricr end Policy num
es!�/ .v; oOF
A Policy >
CERTIFICATE EXEMPTION MOM WORKERS a C('
COMPENSATION INSURANCE
(Thu senior mod not he completed lithe permit is foram hundred dollars(SIM) -
m Imo)
1 canary mat in the performance of are work for which this permit is issued.I shall net
employ any person in any manner so as to become subject to the Workers'Compensmion
Laws or Cdif rria.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccrtifttm of Esau ion,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
,O forthwith comply with such provisions or Has pernil.hall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
{—'^ I hereby aRrm that there is a construction lending agency lot the performance of
a 7 dm work fur which this remain is issued(Sec.309],Civ.C.)
ALender's Name
z Lender's Address
U O I certify that I have read this application and sum that the above information is C
U. comma I agree to comply with all city and county oNinurtts and sum laws relating to
O V building construction.and hereby auNanto represcntamse of this city an enter upon the
Cil .hove-(We)a re property for impactionnifakeep ha.
,r G es ju agree to sive,indemnify and keep hay in m me City of againina idCtagainst
TA inconsequnce of the grarind ap.nseawhich mayin any way accrue against said City
U Z APPI,4 ANT of UNDERSTANDS
of this permit.
^ APP CANT UNDERSTANDS AND WILL COMPLY WI NON-POINT Issued by: Date
a ,-c/;
WOUSOU��+{}�§REGULATI S. /'
G 23/0 Re-roofs
ort of ApplicaMCanuaz�Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havardaus mamnal
as defned by the Captain.Monte Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
E3 Yu
Will the applicant or future lama -occupant m„quipment ar devicrs which
-If a roof is installed without first obtaining an inspection,I agree to remove
.mit hazardous air contaminanb a recd by the Bay Arta Air Qudity Management all new materials for inspection.
D'svio"
❑yes in No
1 have mart Ne bava d ogar mrialsrquirements underChapmr6.95 ofd,Califon
nia Health&Sdcty Co .Sa6ons25505.25533and2534,1undcrsumd Nazi!the building
docs not res any bove a Mort that it is my rcaponsihllity to unity the occupant of me
ireme ich mug to met toissuma a cNTmam of acup . Signature of Applicant Date
- 3 All roof coverings to be Class"B" or better
O r surmised agent a
1. 2y1a CJs �-0 2F�"q?Ar.
4x10 Header
' 0005,7 e
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r 90 Deg.
- - - - i Head And Track
i - Must Be level /
- /R S;-,4 14 To P c F gp�fjJM IC rLuSN 6 And Straight
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1—Shim And WJ/Screw Typ-
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APPROVED cm OF
µ1 ACCORDANCE W"M
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CUPERTI
r le el B ^
_ •� i ase DATE
L - --- SIGNED s MUST be
This set �d wand R is unlavAul `
Pocket DoorFrame Set kepi q� 1he a r eons On same n� Igo
makedova at am
fro
r 09 Building
r J — D PO t'COY Ot Cup ypecificatwns
1The 1ANT n9 of this planor m be an
SHAu N07 be bald 10 Provisions of
*wwr JaPPD%W 01 m a State law.
any CAY
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_ KLTCIEKS 12333 awwway�_5u�ylmk Rd.. Servte9e CA 95070
CNeM: ITOH
/[J / t12 MFB: Cry"
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p , Phots: Vkw: Plan
y �� p _ S ZS A COMPVrER Daar Sfylt: Cants Clank fa XL-COE
_ ONLY. Stale: Scale—h-fM
P OJTMMD TO BE AN EXACT OEPICrZON. LmauW: ZTOH-REV15MROM I A:O: Naw
JOHN SWARTL
BWlder: TORN SWARTZ 1 -
s�— E