04020063 (2) CITY OF CUPERTINO e 11V
BUILDING DIVISION PER
a C®NTRAC'�TCIRINk',ORMA'®N
BUILDING ADDRESS: SHOWCASE KITCHENS INC PERMIT NO 04020063
OWNER'S NAME: PERMIT LSSUE DATE
• ANDREW IAN
VE: SANITARY NO. CONTROL NO.
(408) 253-0412
ARCHITECD`ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONTRACTOR'S DECLARATION Job Description
y C 1 hereby affirm Nm 1 am licensed under prevision of Chapter 9(commencing p
5zz withscotioo]0f10)of Division3offt Busng* dPmfcssia=Codc.aMmyliccnmis
n<n in full force rC.L / c
��= Llenmclast�� ue.g �?S KITCHEN REMODEL
—o Da G Contnc - —
RNA U)
ARCHITELT50 ATION �tfl�v CJ
laic lundered.1 my plans shall hemed as public meroda
MAR 2 3 2004
;o Licensed Professional
'' g OWNER-BUILDER DECLARATION
CmarION
3:a c; 1 lesson.
(thc thol I a1.eacmpl from the Contractor's :License Law for the
Kp o following tires a er cion]1131.5,Busit r. anti Pro@cions Codc:Any my ler county
m which reyairusae.also toconstruct,mepier,improve,h Perlia orrepaira sigany edstructure R 6 . Clan
Fry
poor Issuance.also requires tW applicant for such Permit ale asigreJ statement
< that he is licensedpursuanuotheprovisionsoftheContractor'sLicenseLaw(Chepmr9 Sq.Ft. Floor Area Valuation
�Fo (commencing with ScniOD70M)of Division 3 of the Business and Profession Codc)or
i may he u exempt therefrom and de basis for me alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of 39&N8k032n8er00 Occupancy Type
not mon On firs hundred dollars($500).
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and Ne structure is not intended oro@led for Sal.(Sec.7814,Business
and Pmfassions Code:The Contractor's License Law does not apply to in owner or Required Inspections
properfy who builds or improves thereon.and whodocssuch work himself orthmugh his
own employees,provided that such improvements are not intended oraRemd for sale.If,
however.me building or improvement is sold within one year of completion,the awner-
builder will have she burden of proving Nat be did not build or Improve for purpose of
gala
0 1,as owner of the property,am=elusively contracting with licensed common m
consuua the project(Sec.71144,Business and Professions Code:)The Convector's Li.
tens,law does not apply to an owner of praparty who Wilds or improves themon,and
who comvacs for such projects with a emoralt.14)licensed prust to rho Contractors
License law.
0 l any exempt under See .B&PC for this lesson
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 belaby afford under penalty of perjury ane of the following deelaratiorw
1 hale and will maintain acerdrnm of consent to ml6insum for Workers Compcm
.tiny,as provided for by Secudn 37W of the Labor Code.for Ne performahce of the
work for which this permit is issued.
0 1 hose and will maintain Wooster Compevatian).,an.,as required by Section
3700 of the labor Code,for the peoformancc of the work for which this permit is issued.
My Worker' ComPena'dn lnsura5la amu and Paliq number am:
v �-�:
CERTIFICATE OF p Pd :M WORKERS'
COMPENSATION ;
err o�
INSURANCE
Gnis section teed cat W completed If the permit is Barron hundred dollars(SIM)
ler Wo.)
I modify Nal in the pooh rmenco of the work for which His permit u issued.I shall not
employ any person in any manner an as m become subject te IM Workers'Compensation
Laws of Califumia.Date
Applicant
'NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject to the Worker's Compensation provisions of Bic Labor Code,you most
.JO foMwith comply with such provisions of Nis Permit Shall W deemed revoked.
Z CONSTRUCTION LEN DING AGENCY
aiE� I hereby affirm that them iso construction lending agency for the performance or
> me work fur which this permit H issued(Sec.309],Civ.C.)
W Lender's Name
D. Lender's Address
L,,Q 1 certify mat I have read this application and state that me above information is
IL F' coma.1 agree to comply with all city and county ordinances and sum laws relating to
0 building construction,and hereby authorlae representatives or this city to enter upon the
r U shave-mcntlaned property roe inspection purposes.
gL (We)agree to save,indemnify and keep harmless the City of Cupertino against /
N liabilities,judgments,cors and carouses which may in anyway accrue agamsl said City `
U in eonuque.c.of megarting,Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale9 .
SO EREGULATIO
�!
I- Re-roofs
wm of Applican✓Conuacmr Dem
HA'LARDOUS pp11ATERIAIS DISCLOSURE• Type Of Roof
Will the applicant or for ildin,dccupantatere,or handle haerhors material
m defined by de Cupertino Municipal Code,Chapter 9.13,and the Health and Saray
catle. 0Yes.Sectionzss3z(a)y a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or rutum building dceupam use equipment ardevmes which If a roof is installed without first obtaining an inspection,I agree to remove
lit havardnu5 air cantarem.a.as defined by the Bay Ana Ail Quality Mavgement all new materials for inspection.
Vle1]
C]Yea
1 have mad the hanrdnus materials mquimmmnvund<r Chapter Q95 of me Caiifor-
nuHcalth&Safety Code,Secdws]3505.3s5lJ anti 25514.1 undersuM thvif the Wilding
does not currently hat a trustee that ilia my ro Pdnibilby to oddly the occupant of the -
m � r-n�tawmenmdStWm✓pdartaiym f cer_irc.w faapaney Signature ofApplicant Date
\2-- /G All roof coverings to be Class "B"or better
6w er or aumonmd agentD1m g
�(d- •CITY OF CUPERTIN•
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN # 5 )/�
Q , ® Date: a14164(-i � 1-0
Building Address: Mailing Address (if different from building address):
-r0 Z iU 2,
Owner's Ne: P
A,!:
Contractor: - License #:
7 sgr3
Contact: Phone:v2 ;�_3-0q--i 2 Cupertino Business License#:
--1 D Ai477% Fax: -.2S3 -Oq// 23 Cy q
Building Permit Info:
Bld Elect Plum Mech
Job Description:
Residential _ er
Sq.Ft. Floor Area: ' $/Sq.Ft.:
/ O
Cost of Proje Occupancy Group:
-214
Type of Co struction: Please check this bo if the proj is a
second-sto addition.
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 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 > I OOOA 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
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I awn ^CITY OF CUPERTINCO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
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
BNUCOMME 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
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
i 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 WaterHeater/Vent 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
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
s
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SenaWITY OF CUPERTINI04�
CITY OF PERMIT APPLICATION I-ORM
CUPEkTINO '
Qua A 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 Sips, 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 n
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
BMISCELL Building Misc Fees BUILDING
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_ 02/11/2004 03: 11 FAX 2530411 SHOWCAStEI KITCHENS � 10001
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