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CITY OF CUPERTINO
BUILDING DIVISION PE IT
- - '-
CONTRACTOR INFOROTION: "
BUILDING ADDRESS:
PERMIT NO.
908 PROVIDENCE CT
SHOWCASE KITCHE23S INC
02060165
OWNER'S NAME:
APPLICATION SUB DATE
GRANT THOMAS J AND MELINDA K
12333 SARATOGA-SUNNYVALE RD
06/25/2002
PHONE:
N0. CONTROL N0.
(408)SANITARY
253-0412
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
1_7 u I-, LJ
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am IicermadA�nder pmvisions of Chapter 9 fcommencing
with Section 70001 of Division Joflbe N,,msend Professions CodOired my license
Job DescrT tion
P
REVISION SUBMITTED ON 06/25/2002
is in full fo e ✓
Uciemra ar U Lic.«,
(ORIGINAL #02060122)
Date •' Co.' a
3 ARCHITEC Co LARA 1 N
NO NEW PERMIT ISSUED.
I und<rman my plans sluill be used es public records
xLicensed Professional
OWNER -BUILDER DECLARATION
1 hereby arum Ihat 1 on""I from me Complete"'License Law for the
2 following reeaen. (Salion ]0l IS. Busina s sed Pmfe s WI Code: Any oily or county
which rcquirta v permit m consuacs. vhcr. imp5vva, damo'I! orrepairany structwe.
priorlo its issuance._io -itu dm epPlrtanl Porsuch pearmI.OleasigrmM suumem
,
Ihm he islicanxd plusuanl re the provtsions of the Compactors Lianse Uw(Ch-Par'
lcommenciog with Scelion 700010(Division l of the Busixss and Processions Ceder
S Ft.. Floor Area.,
; -l. l 9'
$11iluation
or tMi he is exempt Therefrom and IM basis for the alleged aemprom Any sivlim n
1 y )•
'" " " " ' " • "
pissed.
fssed '13 L5 by any are icam for a permoodsjacu the applica t to m civil Penalty-
Ofnot more Than Ove hamdred did(SSW ).
N yy�
3 5 61tip(7 6"ll'."U�r
Occupancy Type
° 1, as owner of the properly, or my employees with wages os their sole compensation,
will do the'wO*, and the structure is not Intended or Offered for sale (Sec. 7014,
- -
101 - FOUNDAT I Mquired Inspections
Business and and Professions Code: The Cmurucror's License Law door nm apply to as
owner of propeny Who builds or improves mesion, and who does such work himself
or through his own employees, presided The, such improvements ere not Intended or
offered Far late. If, however, the Wilding or improvement is sold within on. year of
102 - PIERS •,
"'
completion, ide
n, the meaner bolr will have the human of proving that he did mat Wild or
1O 3 - UFER
improve for purpose ofxme.).
104 - REBAR
co L as owner nl me property, am exclusively contracting with licensed contracmrs no
10 5 - ANCHOR BOLTS'
congm,t the pprejeet (Sec. 76 . Bell.. mrd Nolessiom Cnd=D The Conlmclor's
License Uw doex not apply as an owner of property who Wilds or improve domon,
106 - SEWER & WATER
". ..ad who cmltracu for urth ptvj=cu with a compactors) licensed pompom to Ne
Contracmr,Licenselaw.
_„
202' - UNDERFLOOR PLUMBING
El I am,xempt pMer See & P C for Oil reason
203 - UNDERFLOOR MECHANICAL
ower Date'
WORKER'S COMPENSATION DECLARATION
204 - UNDERFLOOR FRAME
,M.
205 - UNDERFLOOR INSULATION
I hereby ands, pares, of Perjury one of the following drolmadcom:
301 - ROUGH PLUMBING
❑ I has= rend caul maiden a Cby Section cons nl to saLabor a roe work re
Compensation, as provided for by Se,tion J7W of Ne Lobar Code, for Ihe
3 02 - TUB & OR SHOWER
Parliarmence of wank for whim this permit i5 issued.
3 0 3 - ROUGH MECHANICAL
111 have and will mm d I mker's Cemportance routines. m required by Section
304 - ROUGH ELECTRICAL
37W of the Labor Code r r he performance of p
° war or which Ihin pail is
Iuucd. My rkarmC aq nsa[ion lnsumnce ynumber are
and rout
305' FRAME
�,,�-{�
er Policy rvo: rl� 1 L
306,
CERTIFICATION OP EXEMPT ION FROM WORKERS {
307'. 'INSULATION ...
COMPENSATION INSURANCE
'308 - SHEETROCK ... __
)(This section diced not be, completed if the Permit is for on, hundred dollars
(SID(rises.)
309 - EXTERIOR LATH
_
' ..I cemplo than in the work fur which this trail lured,,
nany
310 - INTERIOR LATH"
ns i Winn r s
shell not employ any Pecan in any menet,r m as to become subject to the Woll:eri
ct c
311 - SCRATCH COAT '
Compensation Upas at Culifomia. Data
Applicant
.313 -' ROOF NAIL... .... ..._ . ... ...
NOTICE TOAPPLICANT:IL alpr making this Cerificate of Exemption you should
WcomesubjectmthaWoher'sCompenwtionpro,isionsof,h.LOW,Code,youming
-
501 FINAL ELECTRICAL ENERGY
forthwith comply with5am Intimidates or him p mil5nann d reed e.nkad.
502 -..FINAL. PLUMBING.ENERGY
CONSTRUCTION LENDING AGENCY
I hereby infirm hot Nem is o smomtclio t lending urgency Por the Notern once
503 - FINAL MECHANICAL ENERGY ` ,
-the work for which this Permit isIssued(Sor3097.Cis, C.)
504 FINAL BUILDING ENERGY
Lender's Name . - ....
Lendm's Address
_ .. ..
505 - FINAL ELECTRICAL.
Icmifythatlhuvereedthisvppiicmionendsmtelhmlhuahovalnfomarionis
506 - GAS TEST
nate lowsmlil
conch.Lngu<mcomply With all ciryand Itpre oNutletso this
m -ad ".,on
507 - FINAL PLUMBING
th movegcontoned en,fo inspection paperenmtiveseFthiscityuremerupon
pollen, inspection p
the abov>mcmlee
508' - FINAL MECHANICAL
m on keep Unpls.
(We)agreet, Save, indemnify andn ,orind whi ImIa I."dl<L'llo mCYpmlllla In old
I in co sequence cogs and expenses which may its any wey n core °gains said
5 0 9 - FINAL RAD U
city
City in consequence of the ming of Nis permit.
�s'V[ICANT '\'DERST .' A 'D WILL CO\IPLY N'I NOV.POI�T
1 O r1 F A G
Issue
yyksY� CER ! AT10�'. e�fr �1
W
Date
Re -roofs
Si,n of p'leanV mrucmr Dau
HAZARDOUS MATERIALS DISCLOSURE
... III the applicantmfdwrtWildingm -upon gemmhandle hazvdummaterial
'as
TypeOf.ROOE......
defined by the Cupcnino Munici ode. Chapter 9.11 andlhe Health and Safety
Code.
'. '. ' ' I .; .:.
S„tion U5J1ta)?.. ..
°Y”
' ' . • ; . • . ':.... .
All roofs shall be inspecte prior to any roofing material being installed.
Will the applicant or future Wilding.,.pant In, egpiprom or devices which
emit hazardous
If a roof is installed without first obtaining an inspection, I agree to remove
air ecomminan s as ed b he Bay Amt Air Quallly Management
Dir,"cl?
°Y"
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
I"'read the hazard us mammals requirements under Chapter 6.95 of Ne
California H. [I & Safely Code, Sections 25505.155)1 and 25530. 1 understand ohm
if the building does not currently have a lenany diet it is my rcspnnsib' iry to n°sify to
'
Occupant of the regUolou wI Imus, W met prior to i"romee of . caroolaam of
upset v
11 }
Signature of Applicant Date
ill
All roof coverings to be Class "B" or better
Vanne dmneed. eat Dole
OFFICE
z
CITY OF
CUPERTINO
A
•CITY OF CUPERTINO
PERMIT APPLICATION FORM
112,41 64 /6r
Quantity Fee ID
Fee Description
Date:lding
BAPPLOTHER
74,PN#
Address: qner'
MECHANICAL
Name:
Phone #:
BUILDING
I\ INK
Ind/Off/Comm/Quasi
BUILDING
Contr
fAD^
License #:
BUILDING
Contact
Hotel and Motel
Phone #:
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= IOOOA
Appli ontractor:
Fax #:
Elec 600V > 1000A
R Lx
BELEC200
Elec Svcs 600V <= 200A
Building Permit Info:
BENERGY
Bldg Elect Plumb \ Mech
BUILDING
Job Description: bWz)W llu — W • ( � M
Energy Add Multi
Residential: — :J Commercial:
BINVESTIGA
Sq.Ft. Floor Area:
$/Sq.Ft.:
BMITIGATC
Architect/Engineer:
Valuation:
Type of Construction:
Occupancy Group:
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
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 <= IOOOA
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. Housing Mit. Fee
BUILDING
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BNEWMULTI
New Multi -family Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
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OF PERONPERMIT
BUILD NG D
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
908 PROVIDENCE CT
SHOWCASE KITCHENS INC
02060165
OWNER'S NAME:
APPLICATION SUB DATE -
�GRANT THOMAS J AND MELINDA K
12333 SARATOGA—SUNNYVALE'RD
06/25/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)253-0412
Z 0 ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
__I
i - LICENSEDCONTRACTOR'SDECLARATION
1 hereby om tha
fBrt 1 am license oder previsions of Chapter (commw
cing
Job Description
o witnSection 7")ofDivision 3of1li bass and Profe.wim,CNe,and mylicense
in full fn Ih
REVISION SUBMITTED ON 06/25/2002
am.a a<.x
Da" cont°°
(ORIGINAL #02060}}��p
n ARCHITECT'S LARA N
NO NEW PERMIT ISSIIEIAA,ee®
g 1 undentan my plans shall be used as public rcrnNs
SEP 1 9 2002
J Licensed Professional
y OWNER -BUILDER DECLARATION
1 hereby aRrm the, 1 am exempt from the Convector's License Law for the
following reason. (Section 7031.5, Business and Profcshime, Code: Any city or county
[� which requires a permn
it ) conso et. alter, improve, demolish, or repair any structure.
U! LDIMr
_.Orin, to its issuance[, ad. equhh, use applicant for such'hunum file assigned s...an,
-
S Ft.Fl000-Area luation
r„��;4t j i1h i.R yq, u tirA 4'?5'i:'xP �rS:1T iJ���` e.W
- ihatheisllttnsedpunue,1.hepresihlonsoffieContracmrsLicenseLaw(Chapter9
(coinmericiag with Section.7000)of Division 3 of the Business and Professions Cale)
or that he IS cxeriiprthercfrom and the basis for the allege' ciainptiuri. Any violation
”
- of Section TO 15 by any uppileum for a panni, ab,,,,o the applicam m a civil penalty
of not not mom than five hundred dollars ($50oI.
356 jA PhjuV6r Occupancy Type
° 1, as owner of the property, or my employees with wages us their sole compensation,
will do the work: and the structure isnot intended or offered for sale (Sece:'7044;
Business and PNfessions Code: The Convenor's License Low dues not apply man
- - -----
101 - FOUNDATIMquired Inspections
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements am not intended or10
2 — PIERS
offered Toe sale... If, however the building or improvement is sold within one year or
103 — UFER -
completion, the owner -builder will have the huNen of proving that he did not build or
improver„rparp,,se ,,,solo).
104 — REBAR
- ”' . , - - -- . ... with IimnxE coovvcmrs to
."on:ateowner"pii the p(Sec.7am <ndinessacomroning
...
105 - ANCHOR BOLTS
construct the the project (Sec. ]loan Busies and Professions CWo:)The ves Contractor's
License Law does nmapply man owner property afmprovesttoth,
s+
106 - SEWER & WATER
with
f .and who commars for such projects with a cummnnrp) licensed pursuant to the
mrs Liceade Law.
__....._._ ....... ..... .. ... ...
2'02 "= "UNDERFLOOR PLUMBING —
_.
D I a.
❑lam<semptuneersa.•- e�Perntms nn
203 — UNDERFLOOR MECHANICAL
o f ''
204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION UF,CLARATION
I hereby affirm under Penalty ofpar by, one ohne meowing declarations:
205 — UNDERFLOOR INSULATION
3 01 - ROUGH PLUMBING
.' 0 1 have and win'n,aimam'a Cerdficam of Consent ,, x if„more for Worker.
302 - TUB & OR SHOWER
Compensation, as provided for by Section 37W of the Labor Chile. far the
performance of the w ark farwhich thfsm
,petitisissue.
303 - ROUGH MECHANICAL
0 have J willmountain Worm Co.. of t surasrequiredby Section
- 9.n
304 — ROUGH ELECTRICAL
4700 of the Lab or Code, f th p ro f work f hich tl's Permit .
-
3 05 — FRAME
issued My W ker's Cn n aeon Insu c and I' I' y be e:
. _
tt' anaN : r��
.... __..... _. .. ». ,.-....�... ,.�. ..... ...-,......., .... ...._.._ .
306 HOEDOWNS'' 11.,.",,V,
s , f CERTIFICATION OF EXEMPTION FROM WORKERS
'
+_h� 13"0 T` INSULATION''at_1-1
COMPENSATION INSURANCE ° "
to _
3'08 SHEETROCK __,._. __.... .
mriss,ctroneJ no,he completed tithe .it is for one hundred dollars
309 EXTERIOR LATH
(500
-
wifth,
310' -'INTERIOR LATH ... .... ... ... ....
I nytary pr ndna of ih'dwmk for wha,I a f,fasted, 1
f ,, .f„
shall not employ an, person of any manner so as to twer me sobiect m the Workers
311 — SCRATCH COAT - - '
Compensation Laws of California. Dote
.Apptcaat.
- - .313 -- ROOF NAIL.
501 - FINAL ELECTRICAL ENERGY
NaICE 10APPLICANT. If, after malangthis CertincmeatExemption. you.shnmd
herome tsubjec,, the Worker's Compensation pro, inions ofahe Labor Cale, you must
j rortnwimcomply 'with such pro.ismnsnrthis permit shall bedeemed revoked
'
_ 502 - FINAL. PLUMBING _ENERGY
” `CONSTRUCTION LENDING AGENCY
503 - FINAL MECHANICAL ENERGY ' "
1 herchy affirm that them is a construction lending agency for the performance
untie,oivarn,,,,'m<hthis_prnonitissued(s<c.3097.Cov.C.)
50,4 — FINAL BUILDING ENERGY
j
Imam. Addre, -
.
505 - FINAL ELECTRICAL;_
I c nf, that l have hand this application and state that the abooe 'rani is
carts Ia to Cohn, with allatY and< ry mdanothar1l and.t't Irg
506 - GAS TEST
507 - FINAL PLUMBING
taWld Wildingconstruction. ndn by auto p . mtiv of this city to int pun
a m bo e,p p<nyr nspectinparpos.
508 — FINAL MECHANICAL
<I
(W'g em x indemnify and k pha I . the City of Cupetims gain.,,
509 — FINAL RAD
libli. md'unerr est. and eapcnce hchmyin any yc gat:traid
cty q -'D ria- ungmm.ps i
• I „ AaD WILL COMPLY �7
.. ATIO\ rJ. (�
\Dnata
C,
_
10 t) F A G
IssuPTT Date
S n p a nV< rnvwmr ,Dara �
g
the
�
Re -roofs '
Re -roofs
applicantmr.rrt Wildin•u:cupam smrt}I
HAZARDOUS MATERIALS DISCLOSURE
uior handle wrwuan measured
_.. Type of Roof_...
as d f W by the Cupertino M' u p W Chapter 9 12 d the Health and Safety
code
OcYon 2557214) ; r
•, , ?'.-R t y r !'}<. %
All roofs shall be inspected prior to any roofing material being Installed.
' will the ppicent or future bu Id' g occupant use equipment or devices hicn
emit hN it contamnams as d edh h Ry, A`�5 Quality Management
If a roof Is installed without first obtaining an inspection; I agree to remove
for inspection.
D t t
°Y
all new materials Applicant understands and will comply with
all non -point source regulations:
I have read the hoz us matenakh rtqornaments under Chapter 6.95 of Ne
California Health & Safety CWc, Sections 25505. 25533 and 25534. I understand that
ithe building does not currently have thathis mYmse'orsi,'ityro notify the
ccupam ,,f the rcyuimme uhell must be mot prior to wn:mce nL Cenifcaa of
- �"° "
yaytenant.
Signature of Applicant Date
`-' "�
i m„rrzW .gent Data
All roof coverings to be Class "B” or better
i
OFFICE