04080093 CI'PY OF CUPEV14NO
nmunNC DIVISION PER 'CONTPtAC1'®R=INFORM. N .
BUILDING ADDRESS: PERMIT NO.
SHOWCASE KITCHENS INC 04080093
ERS NAME: QAK QT PERMIT ESUE DATE
PHONE: ANITARY OL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ran
n 0 Z LICENSED CONTRACTOR'S DECLARATION yp l�.
yes,F I hereby affirm that l am licensed under provisions n(Chaper 9(commencing LJB e- Ory •
?iw with Section 7")ar Division 3 of the Business and Professions Code,and ylicensa is Lk
ml�pp��canderrea. � 7 �5��- KITCHEN REMODEL
.]n Fe LiccnaCEI., Lic.M
AR HITECTS D[CLA$ TION
as< 1 understand my plans shall he used as per lic records
JyU
3 u Licensed Profassiaoal r
OWNER-BUILDER DECLARATION
1 hereby,affirm Na I am exempt tram the Contractors License Law far the
a Y
cc following Mason.(Samon
71131.5,Business and Professions Code:Any city or county
K m which eaincs a permit to construct.alter,imprnve.demolish,or repair any structure
',—V Prionnits issuance,also squires th
cappllcant forsuch permito rile a signed statement
ee�6 that he is licensed pursuanto the previsions of the Contractors License law(Chap¢r9 Sq. Ft. Floor Area V31U'tlOn
ee�FG
(commencing with Section 7000)of Division 3 of the Basin.and Protestation.Cape)or
i
that ke is exempt lhe.from and Ne basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a pcomilsubjecu the applicant to a civil Penalty of 3 2VNjJld0 qr0 0 Occupancy Type
not more than five hundred dollars(S500). r_
❑1,as ownef of the property,or my employees with wegcs as their sola compensation,
will do On work and the swans is not intended or offered for sale(Sec.?Ots,Business Required Inspections
aced"Professions Code:The Carmelites Li,..Law dors not apply to as owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employers,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year,ofcompletion,the owner-
builder will have the burden of proving Nat he did not build or On prove for purpose of
sale.).
❑L as owner of the property,am exclusively comeming with licensed contractors to
construct the project(See.9044,Business antl Pon"sions Cape:)The Contractor's Li-
cave raw docs not apply w o owner of property who Wilds or improves thereon,and
who contracts for such projects with a enntnmor(s)licensed pursuant o the Contractors
License Law.
1 am exempt under Sec .B h P C for this mason
Data
WORKER'S COMPENSATION DECLARATION "
1 hereby all under penally of perjury one of Be fallowing declarations:
73WW'
thin and will maintain a CeNTsase of Consent to self-insure for WarkcrSCumpen.
on,u provided for by Satiun 39110 of the labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,sa activated by Section
of de labor CWe,for Ne performance of the work for which this permit is issued.
Workers Compensations Insurance carrier and Policy number ate:
Ca 'cr�`�<1/C< I2://<��/ Paliry ryu,�
CERTIFICATE OF EKE?,[MO MWORKERS'
COMPENSATION INS R NCE
mons stttion need tut be completed it the permit is(or one hundred dollars($101)
r less.)
1 certify that in the performance of the work far which this M'rmit is issued.I shall nal
'employ any person in any manner so as to bttm„c subjem to the Warkers'Compcosadon
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificae of Ecom pion,you ahauld
become subject to the Worker's Cam pensation provisions of the Isom Code,you must
.J O forthwith comply with such provisions of this Permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(rte Iherehy affirm that there is a construction lending agency for Ne per(urmansc of
f$7 Ne work far which this pem,lt is intued(Sec.3097.Civ.C.)
W Q Lender's Name
kL IGnde,S Address
U 0 1 certify that 1 ban read this application and state Nn the above information is
W P correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby audtoriM mpresenutin,,of this city to cner upon the
W above-mentioned property for inspection purpaxes.
(Ric)agree to save,indemnify and keep humless the City of Cupertino against as —
hliabiliticajudgments,costs andexpcvcswhich may in any way accrue againmsaid City IPIT GI.
U in consequence ofthe graining ofthis Permit.
�-^ APPLICANT UNDERSTANDS AINP.WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ,LATION _� 1 _ACY�_
Ge% � z/if Re-roofs
atur< pplMar9Cen am ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will this applicen,or future building oavpanl.norc ar handle hazardous material
as dcMed by the Cupertino Municipal Code.Chaps,9.11,and the Health and Safety
We.Sccdun 35531(.)? - All roofs shall be inspected prior to any roofing material being installed.
❑Yes
W01 thea applicant future building occu t use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rap s pan Area
emit haradnus air contaminants as dcfincJ by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes gnu
I have Mail the h,ked o s 25 r 5.25533emcnts under Chapter 6.95.r&h Califon-
nicesnotimremlynanaSections estiti.35533and1553a.1undersmndmatIf thebuilding
dos oat<urtenhi have a tewnL that it is mY responsihilitY m notify We acupant of the
reyui¢ whicM1 mus Ax me to issuance of a Certificate o(Occupancy.
�` � � Signature of Applicant ate
c'
r.mnarired, en, ,_ape All roof coverings to be Class "B"or better
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r - 10CITY OF CUPERTINO� 0 g3
CITY.OF PERMIT APPLICATION FORM
CU
PERTINO
APN # 3 2 Date:
v Z � 7
Building Address: Mailing Address (if different from building address):
G G �
wner's Name: Phone#�'
Contractor: License#:
Contact: Phone:.Z-5f Cupertino Business License#:
frit Z Fax:
Building Permit Info:
Bld Elec� Plu��` MechqnT
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: ` Occupancy Gro
ype of Constructio : > Please check th the project is a
second-story addition: ❑
Project Size: Standard ❑ Lar e ❑ 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> IM 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
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