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03080038OF CUPER,rINO '� • ^ * •Z % BUILDING DIVISION PERMIT �CONTRAGTOR�INFO�RMATION ECITY DING ADDRESS: 99 LTLAr WY SHOWCASE KITCHENS INC PERMIT N003080038 NAME: 12333 SARATOGA—SUNNYVALE R PERMITISSUEDATE OBINSON KENNETH rS (408) 253-0412 SANITARY NO. CONTROL NO. ARCHOECI'/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMBMECH 0 LICENSED CONTRACTOR'S DECLARATION I Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commcncing p with Section 7000) Ofense Division 3 or Ne Businexs and Professions Code, and my license is inr`olllort andefRcp %per P —. KITCHEN REMODEL �1NAL,EV' L;e,a Dale/� Contra tun mlinypi.m.hal Muscdsss, licrcearrth NOV 0 3 2003 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby nfrim that 1 am exempt from the Contractor's License Law for the BUILDING Code: Any city or county following reason. (Section 7031.5, Business and ProfessionsBUILDING which requires a permit to construct, alley, improve, demolish, or repair any structure p im to its couancc, also mquims the applicant for such permit to Glc a signed statement that he is licensed Pursuant to the PerviShresr(hhc Conwcmr's license Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 Or the Business and Professions Cala) or 35904011.00 that he is exempt therefrom and the basis for the alleged exemption. Any violation Of APN Number - Occupancy Type P y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not more than five hundred doRars(SSW). I, as owner,!the pmperty. or my employees with wages sm their sole compenutlon, will do the work, and the suuclum is not intended or offered for Sale (Sm. 7044. Business— and Professions Code: The Contractor's License Law does The d Inspections not apply to an owner of 102 — PIERS IERS pmMny who builds or Wtnoor and who docuuch .,it himself or thmugh his own employees, provided that such improvements are not intended or offered for sale. If. 103 — UFER however, the building or improvement is sold within one year of completion, be owner. builder will have the burden of proving that be did not build or improve for purpose of 104 — REBAR al`')' 105 — ANCHOR BOLTS L as ,thea of exclusively confessions with to SEWER :) The Cconvenors conamn the Project (Sec. 7044, Business and Professions Code:? The Contractors Ll. ct Sec.property, , B 106 — & WATER Corona Law does not apply toanOwner ofpmpenywho Wild&OFimproves daemon, and, 202 — UNDERFLOOR PLUMBING who contracts for such projects pursuant with a contractos(s) licensed pursuano the Contactor'. License taw. 203 — UNDERFLOOR MECHANICAL ❑ Iame.emplunder Sea. ,B&PCI.r,daremon 204 - UNDERFLOOR FRAME Dat` 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decWations: 301 — ROUGH PLUMBING I have and will maintain a Ecnificale of Consent to self -Insure for Workers COmpan- 302 — TUB & OR SHOWER ration. sa pmvidcd for by Section 3700,( the Labor Coda, for the Performance of the 303 — ROUGH MECHANICAL work for whim thisparmnisissued. 304 — ROUGH ELECTRICAL ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 Criticlabor C,do. for the Performance or the work for which this pend is issued. 305 — FRAME My WorkerE Pam or ecce. 'wand Pnhayromixt Me � 306 — HOLDOWNS Pa°`y 307 — INSULATION CERTIFICATE OFEXEMPf10 MWORKERS' 1, COMPENSATION INSURANCE 308 — SHEETROCK (rd.ace,inn need not ho completed ifthe permit is (atone hundmddollaa($1fs) 309 — EXTERIOR LATH or 310 — INTERIOR LATH I certify Not in thein any mann Of the work for which t to Permit is isavedJ well not employ any in any menncrmulo become subject the workeri Compensation 311 — SCRATCH COAT Law,oanypen,n Lawscant rma.Da" Applicant 313 501 — ROOF NAIL — FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: IL after making this Ccnilicte of Exemption, you shod ld become subject to the Workers Compensation previsions of to labor Code, you must forthwith comply with such provisions or this Permit shall he doomed revoked. 502 — FINAL PLUMBING'•ENERGY CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm that Here is a Construction lending agency for the Performance of 504 — FINAL BUILDING ENERGY thework fur which thus prmWoodei, is Wood (see 3U97, Civ. G.) the w Under's Name 505 506 — FINAL ELECTRICAL — GAS TEST Lcndar'. Address 1 cenify this 1 have read this application and stale that the above informatiun is 5 0 7 — FINAL PLUMBING coral, I agree to comply with all city and county ordinances and sbte laws relating m building construction, and hereby autborire mprescntativesof this city to enter upon the FIN MEC CAL above-mentioned property for inspection purposes Indemnify O9 FI (We) agree 1, save, and keep harmless IM City or Guperlln, regal nsl liabilities, judgments, cost ad ..per. which may in any they act. against said City 5 NG in conscqucnco Of the gond ng of this permiL AP ]CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 C WORKS Date SO CEREGULATIONS Re -roofs Type of Roof tort of Applicant C,ntmotar C/ milt HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant.tom or handle hisard,us muedal as defined by the Copan no Municipal Code, Chapter 9, 12, and the Health and Safety C.Section 25532(.)? ❑Ycs Nu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which R h.11mous air cadaminents u fined by on, Bay Area Air Quality Management all new materials for inspection. iatricR ❑Yea u I have mai the haraedtms materials requirements under Chapu:r695 of the Califo> ma Health & Safely Cale, S.Cumw 25505, 25533 and 25534,1 undcawd that if the building docs not Coot tl, hese a Conal. that it is in, responsibility in maul, the atopen, of the ryfliucourtua which in met Pro MCC or a c"ca@ or .nay. Signature of Applicant Date �' ° All roof coverings to be Class "B" or better net or Mackircd .gem am loo .7 QWN a�J >yU OC `emff u—v _Z> e�C OF CUPERTINO � �Me ' &"' bay '^"-,"'�a lays 1•-'p )NTRACT0R INTORMATIC,,:� p BUILDING DIVISION PERMIT PCITY BuaglNcnoOaess:SHOWCASE KITCHENS INC PERMIT N003080038 799 LILAC WY 'NER'S NAME: 12333 SAP ATOGA —SUNNYVALE R PERM"ISSUEDATE ROBINSON KENNETH W AND LIND] ns/ii/2003 PHONE: (408)253-0412 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION eSCrlptlon 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing wish Section 70M).[Division 3 orthe Bueinexs end Professions Code. end my license isIV 0 a full fort and cffec �pe� •• KITCHEN REMODEL `eD License a`Lie.a DVM Curd" NOV ��,,t•_/�/a�L, tic O 32UO3 2 03 1 un3EFslend my plans shot he udDisp rccnOd Licensed Pmfessimml OW NER-BUILm DER DECLARATION 81J�l.DING I herchy aMrm that 1 aept from she Contmewr'A License Law for the xem " following reason. (Section 7031.5, Business and Professions Code: Any city or county which mquira a pcmtit m construn. Alco% improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed positions to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section HIM) of Division 3 of the Business and Professions Code) or 35904011.00 that he is exempt themfmm and the basis for she alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicants for a permit subjects she applicant o a civil penalty of not more Nan Five hundred dollen (5500). 1, a owner of the property, or my employees with wages m their sole compensation, iui — d Inspections will do the work, and she swctum is not intended or offered for sele(See. 7W. Business and Possessions Code: The Contractor's License Law dos not apply to an owner of 102 - ----- I ERS property who builds or improves hereon, and who dassuch work himself or Hough his own employees, provided that such mpmvemente am not intended or offered for sale. It. 103 — UFER however, she building or Improvement is told within one year of completion, she ownco- builder will have she burden of proving Nm he did not build or improve for purpose of 104 — REBAR 105 — ANCHOR BOLTS O L as owner of the property, am exclusively contracting wish licensed Curio ors to 106 — SEWER & WATER initiates she project (Sec. 7044, Business and RafessionsCutCuThe Canuacwr's Li arse Law does not apply to an owner of property who builds or import demon, and, 202 — UNDERFLOOR PLUMBING who surface for such post wish aeontncmr(A) licensed pursuant t. the Contrectofa 203 — UNDERFLOOR MECHANICAL LiarxeLaw. O l for exempt under Sea .B& P C for this naso^ 204 — UNDERFLOOR FRAME Da" 205 — UNDERFLOOR INSULATION — ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION I hereby salon under Penalty of perjury one of the following doctors301 302 — TUB & OR SHOWER 0 l have and will maintain a Certifies of Consent to self -insure for Workers Compete aatim, as provided for by Section 3700 of she Labor Code, for the performn¢e of he 303 — ROUGH MECHANICAL work for which this permms issued. 304 — ROUGH ELECTRICAL 0 1 haw and will maintain Workers Compensation Insurance, as mquimd by Section 305 — FRAME 3700.fthe Labor Coda for the performance ofthe work for whim his permit is issued. My Work!er's��y peri lion 1 mcca 'ser and Policy nudist 306 — HOLDOWNS en C ,vas � P11 : o�QQg 307 — INSULATION WORKE CERfIFI OF N7INSURAANCEORKERS� I COMPENSATIOATE 308 — SHEETROCK (Th4scolonnced natMcompletcdifhe, Permit is foranehundird unit= (SIM) 309 — EXTERIOR LATH orlas.) 310 — INTERIOR LATH 1 ccnify that In the perrmmence or he work for which this permit is issued, 1 shall not employ any astaxon in mu y manner an to become subject to the Workers' Compcnsailon 311 — SCRATCH COAT Laws afCarfarnia.Dow Applicant 313 501 — ROOF NAIL — FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the LOW, Code, you must fpnhwith comply with such provisions or this permit shall he deemed moms 502 — FINAL PLUMBING ENERGY 503 — FINAL MECHANICAL ENERGY CONSTRUCm ONLtioni AGENCY IMr shay therein eomSec.1097.Cing agency for the perfurmancc^f 504 — FINAL BUILDING ENERGY which this ' did, workUnit for whichthlspermitlsivucd(Scc.3o97,Civ.CJ Lenders theme 505 506 — FINAL ELECTRICAL — GAS TEST LcndersAddreaa j I unify has 1 have mad this apprati^n and mm that the above information is 507 - — FINAL PLUMBING comes. 1 Agree to comply with all city and county ordinances and sate laws Missing 10 building consuuclion, and hereby auhanm mprescou s of this city to enter upon he FINET. MECHAN CAL a ah^va-menti.nedproperty for lnspechimInirposeta Us09 FI (We) agree to Bove, indicmm fy and keep harmless the City of Cupertino age our liabilities, judgments, costs and expenses which may in any way acme against said City 5 NG // in consequence of the granting of this permit. AP IC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 C WORKS Date 1 SO CE REGULATIONS Re -roofs Type of Roof ' i . tore of ApplicanVContncmr 7um 061/ HAZARDOUS MATERIALS DISCLOSURE Will he applicant of future building Occupant atom or handle hawses material az dcfmcd by the Cupertino Municipal, Cut Chapter 9.12, and the Health and Safety Code, Section 25532(4)?Nu ❑Yes All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Weupanl use equipment of devices which cath mown as air conmminaru u d Cited by he Bay Arca Air Quality Management all new materials for inspection. District'DYes u 1 have mad he W vardnus materials wymiremenu motor Chaper 6.95 of the Cali for ria Health & Safety Code, Sccuuns 25515.25533 and 25534.1 understand thin if the building Ices nss currently have a tenant Ores it is my responsibility I. and, the Occupant of he iremcnktwhicnacodifiamof paney. Signature of Applicant Date 3 4 All roof coverings to be Class "B" or better ner or amthoixed agent ate • • N m N P m i x N 3 3 w� n m Kw m F O vxi i p D yl LL y-� <J�./ sS IN ACCORD `NCE TIAE C►TY Of ^"ID ORDINAEIm COPERTr' r f E` LIE on , IrIL I'.! r; x IQ. I i.1m,, S to 19 oulanco u 0 N N � P h ILIUJI�j j Il m N Itl P V_ Q N vl m m C. � LL yy x N P x P °D N O N m N P m CRY OF • CUPEkTINO C*Y OF CUPERTINO 0 PERMIT APPLICATION FORM APN # � 6 � Date: Building Addres : Mailing Address (if different from building address): e/c/ G/ 411W G Owner's Name: Phone #: 2oa r 2S -r - Contractor: License #: Boiler <= 100,000 Btu MECHANICAL Contact: / Phone: =.f3- oSF�2 Cupertino Business License#: ---�D �'� .gni Fax: BBOILER3 Building Permit Info: B I dg Zl— Elect Plumb Mech Job Description: p� Residential JP' e/� ip � Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: /SZ� o2fJ d ' Cost of Project: 4�G, �fl Occupancy Group• Type of Construction: Please check t i the project is a BCONSTAX second -story addition: ❑ U 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/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 BMITIGATC Comm. HousingMit. Fee BUILDING L1 1 ot's d� C*Y OF CUPERTINO 10 CITY OF PERMIT APPLICATION FORM CUPEI,TINO Quantity 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 BNUCOMN E 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 BPINfERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Cbeck 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 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENU URN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I 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/Aaratus ELECTRICAL I 2of3 Sov, CITY OF CUPEkTINO 0 CITY OF CUPERTUO PERMIT APPLICATION FORM ti 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING n LJ 3 of 3