04060166 CITY OF COPERTINO
BUILDING DIVISION PERMIT CO�'TRAG' 'cRxrrT 'o 011T
BUILDING ADDRESS: SHOWCASE KITCHENS INC PERMITNOO4060166
7571 LOCKFORD
PERMIT ISSUE DATE
NER'S NAME:
RONALD CLEMENT 12333 SARATOGA-
SANITARY NO. CONTROL NO.
PHONE:
(408) 253-0412
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MEOCH
�a0o LICENSED CONTRACTOR'S DECLARATION lob Descriptio
F 1 hereby affirm Net 1 am licensed under pr visions of Chapter 9(commencing
with5 tion 70(10).(Di1mkm3af dm Beat. rufcssions Cram-mJmylicemeis
NIU
zi In fall aadOffc 5�3 KITCHEN REMODEL/SKYLIGHT UPGRADE
n Z Data laza C..p 1 00] O 9nV
b 1� (i J1,
pace Contractor
W❑ an CTSD ION
1 trade end my plans shell.111boW usml es p c records
6U ®31VNI3
34 Licensed Professional
.�Og OWNER-BUILDER DECLARATION
<f 1 hereby.(firm that I am exempt from the Contractor's License Law for the
p D following mason.(Section 7031.5,Business and Professions Code:Any city or county ,2
which requires a permit us construct.alter,improve,demolish,or repair any structure
9975
prior m its issuance,also requires the applicant for such permit m File a signed statement Valuation
Ihathe is licensed pursuant to the provisions of the Comment"License Law(Chapter 9 Sq.Ft. Floor Area
(commencing with Section 7")of Division 3 of the Business and Professions Code)or
Out W is exempt therefrom and the basis for On alleged exemption.Any violation of
Section 7031.5 by any appliomtt for,a permit subjects On applicant to a civil penalty of f5r Occupancy Type
not mom than Bva hundred dollars(SSW).
0 1,es owner of the proper,or my employees with wages as their sale cempcausur n,
will do the weak end the measure is not Intended ar offered fosmc(So,.7W,Business Required Inspects 5
and Profession Cone de:The Convectors License Law doat apply m an owner of 9
property who build;or improves thereon.and who does such work himself at through his `
own cmplaycrs,purvided that such improvements amnm intended oroRaced fersek.IL sNraA sa004
however,the building or improvement is sold within one rev of completion.the owner- SEP O `
builder will have the Wrden of proving that he did Out Wild or improve for purpose of
sale).�
❑Lai owner JCCL property,nm exclusively contracting with:)TheeCon ntmoom i. BUILDING
came La Ne project(Sec.o an Business and rywh000 Cade:)TheConnector'sdomed, n
carve Law docs not apply je an owner of proper(who sed p or s improves Contra,and
who contracts for such projects with a conlrecmrp)licensed pursuant to the Convanoh
License Law.
0 l And exempt under Sec. ,B&P C for this moon
caner Data
WORKER'S COMPENSATION DECLARATION
1 hereby ante under penally of perjury one of the fallowing declarations:
0 I have and will maintain a Certificate of Consent to self-Insure for Wmkcr's Compen-
sation,as provided for by Section 3700 of the Labor Code.for the performance of Nc
work for which this permit is issued. ,
0 I have and will maintain Worker's Compensation Insurance,o required by Section
3700 of be Labor Code,for the performance of the weak far which this Permit is issued.
My Workur'a Co pens tion lns�ntt cavi end Policy numbcrart: //'',/
Cartier: Policy No.: 0 Q l vV� '
CE PICA73e OF E%EMPI'IOMFIGM WORKERS' I
COMPENSATION IN URANCE
(ThH section need nothecompleted if the permit ice for one hundred dollars($1 00)
or less.)
I ecrdfy Not in are performance of the work for which this Permit is issued.)shell not
employ any Person in any manderve As to become subject to the Workers'Compensation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or Nis permit shall W deemed revoked.
Z
y CONSTRUCTION LENDING AGENCY
[-i I hereby affirm that Nerd is a construction lending agency for the performance of
rli> the work fur which this permit is issued(Sec.3097,Cih,C.)
W Q Lender's Name
Lender's Address
V C I conify Out 1 have read this application and sate Net the above Woodman is
4A N cmrecL I agree m comply with all city and county ordinances and mate laws relating td
as
pr upon the
U buildingconstruction,
ageetoand w,indeyauthand repr homlesste Nis city mcnano Agaist
W above-mentioned property for iopecdon Purposes
. ea
v
G (Wu)agree to save,indemnify and keep harmless the City of against s against y liebiliticquence fWecmaeng ofthisomit. may in any way accre agunstsvd City
Acan`ANT of Nc RSTAN of Ibis pmmit.APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL SON-POINT Issued by:
SOU E GULATIONS.
-,'--2 • 0- Re-roofs
re of Applic.d9Commcm, Dam of Roof
HAZARDOUS MATE IALS DISCLOSURE Type
Will the applicant or future Wilding occupentstomor he charardmu nmilrmi
o defnted by the Cupertino Municipal Code.Chapter 9.11,and dm H"IN and Safety
C.d.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
EYcs 14FNa
Will the applicant or future building occupart use equipment or ddvimm whim If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
OYcs
I have mad On harardausnaminalsmquimmcmis under Chapwr&95 of the Califor-
nia Health&SafetyCude,Sections 25505,25533 and 25534.1 undersand Nalif the Wilding
Jel cumcmly haves to Net it Nit is m
y responsibility to natty the occupant of he
rc mem I,which most bc prior In is.an neclifie�ateefaapP Signature of Applicant Date
vyr �!' ��� All roof coverings to be Class"B" or better
•
CITY OF CUPERTINO
0 e 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN 36226042 . 00
DATE ISSUED. . . . . . . : 06/18/2004
RECEIPT # . . . . . . . . . : 25980
REFERENCE ID # . . . : 04060166
SITE ADDRESS . . . . . : 7571 LOCKFORD CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : RONALD CLEMENT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5047
RECEIVED FROM . . . . : SHOWCASE KITCHENS
CONTRACTOR . . . . . . . : JOHN SWARTZ LIC # 23049
COMPANY . . . . . . . . . . : SHOWCASE KITCHENS INC
ADDRESS . . . . . . . . . . : 12333 SARATOGA-SUNNYVALE RD
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
TELEPHONE . . . . . . . . : (408) 253-0412
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 340 . 00 102 . 00 0 . 00 102 . 00 0 . 00
BPBACKFLOW BREAKERS 1 . 00 9 . 99 0 . 00 9 . 99 0 . 00
BPERMFEE VALUATION 29, 975 . 00 340 . 00 0 . 00 340 . 00 0 . 00
BPFIXTURE UNITS 3 . 00 24 . 99 0 . 00 24 . 99 0 . 00
BPGAS OULETS 1 . 00 5 . 00 0 . 00 5 . 00 0 . 00
BPLANCHK PERMIT FEE 340 . 00 289 . 00 0 . 00 289 . 00 0 . 00
BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00
BPWATER UNIT 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00
BPWHEATER PER HEATER 1 . 00 9 . 99 0 . 00 9 . 99 0 . 00
PRERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BREMAPPLI NO OFAPPLIANC 3 . 00 19 . 50 0 . 00 19 . 50 0 . 00
BREMINHOOD NO UNITS 1 . 00 9 . 50 0 . 00 9 . 50 0 . 00
BREMPOWER POWER UNITS 2 . 00 61 . 05 0 . 00 61 . 05 0 . 00
BREMVENFAN NO UNITS 1 . 00 42 . 02 0 . 00 42 . 02 0 . 00
BREMVENSYS NO UNITS 1 . 00 9 . 50 0 . 00 9 . 50 0 . 00
BSEISMICRE VALUATION 29, 975 . 00 3 . 00 0 . 00 3 . 00 0 . 00
EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
---------- ------- --- ----- ----- ---- ------
TOTAL PERMIT 1087 . 66 0 . 00 1087 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CK 1087 . 66 006852
AL RECEIPT 1087 . 66
OCITY OF CUPERTINO*
CUPEI�F PERMIT APPLICATION FORM '
APN# 2 Date:
z� o� 2— G
Building Address- / Mailing Address (if different from building address):
Owner's N Phone#:
Contractor: License #:
X7..5 3
Contac Phone: ,2 Z Cupertino Business License#:
�-� O NT/ Z Fax: 1S> G
Building Permit Info:
Bldg Elect Plumb tR— Mech
Job Description: oc
Residential a o ercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Grou . /
Type of Construction: Please check th's box if roject is a
second-sto adds ion: ❑
Pro'ect Size: Standard Laze ❑ 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> 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
1 of
C) � 7
WITY OF CUPERTIN(*
OCITO PERMIT APPLICATION FORM
CUPEkTINO
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 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 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 cfin MECHANICAL
BREMAEUTAN A/C Units <= 10,000 cfin 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
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
WITY OF CUPERTINO
CUPEIiITINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch. ELECTRICAL
BREMSIGNS Remodel Si s, Marquee ELECTRICAL
BREMTHEATR Theatrical Lioj#ng 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 Inection 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 i Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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SHOWCASE KITCHENS 12333 Saratogo-Sunnyvale Rd., Saratoga CA 95070 Client: PON d ELAINE CLEMENT MFG: Crystal View: Plan
(408) 253-0412 Phone: 408-873-8780 Door Style: Claremont fo-CPF Scale: Scale-to-fit
NOTE: THIS IS A COMPUTER RENDERING ONLY" Design: CLEMENT-KITCHEN-ROM Pull: None Date: 6/18/04
IT IS NOT INTENDED TO BE AN EXACT DEPICTION. Designer: JOHN SWARTZ Builder: JOHN SWARTZ Page: 1
•
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JUN 18 004
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