04080118 (2) J/ LI
CITY OF CUPERTINO
BUILDING DIVISION PRRN� r CONTRACT( R INFORMrr�ON ,
BUILDING ADDRESS: SHOWCASE KITCHENS' INC PERMIT No.04080118
OWNER'S NAME: FERMrT ISSUE DATE
ONE:VIRGINIA FARTHING 1 ?223 'A
ANITARY ONTROL NO.
l/. — Z ~ — G'b Z
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
aQa
LICENSED CONTRACTOR'SDECLARATION Job Description
y P 1 heathy affirm that 1 am liecnsed under provisions of Chapter 9(commencing
w with Section'Rakfof Division Sof me Businessand Professions C de.and my license is
^a a in full from and effect.
pi2
_ License Class Lick 7Sr�5i3 BATH UPGRADE/TILE & 'PLUMBING
w Dalc Conuaztor
J
ARCHITECTS DECLARATION _
or a 1 understand my plans shall W used as public records .
�yU
u.t— Licensed Pmfexsianal
"a3 OWNER-BUILDER DECLARATION
'a Y I heachy mlirm mat I am exempt firm the Comae ars License Law for the
o O following reason.(Section 7031.5,Business and Professions Code:Any city ar county
s,m which requires a Permit tar cnnstmct,alter,improve,demolish,or report any Struetme
.y poor in its issuance,also rcyvires the applicant for such p<rmiuu Glc asiFneJ statement
that he is licensed pursuant to the provisions of the candonsar4License Law(Chapter 9 Sq. Pt. Floor Area ValUaL10❑
atFo (commencing with Section 0000)of Division 3 of the Business and Professions COJe)ar
i Nat he o esempl them0om and me basis for the alleged exemption.Any=of -A r�cri int.. q�
' Section 2031.5 by any applicant for a permit subjects me applicant to a civil penahy of 3 2\09 74 akMer 0 0 Occupancy Type
not marc than five hundred dollars(8500).
0 I,as owner of the pmpeny,or my employee with wage as their sole compensation,
will do me work,and the swctum is not intruded or offered far sal.(Sec.IDM,Business
_ and Probation;Code:The Comrade ad License Law does not apply to an owner or Required Inspections
property who bunds m improves thereon,and who does such work himselfor through his
own employees,provided that such improvements arc not intended or offered for sale.IL
hower,me building or improvement is sold within one year ofcompletion,the owner-
builder will have Inc burden of proving that he did not build or improve fur purTme of
sale.). I -
0 I,as owner of me property,am exclusively contracting with licensed comments oro .
construct the project(See 7W,Business and Professions Code:)The Commission's U
nae Law docs not apply to an owner of prupeny who Wilds or improve daemon,and.
who contracts for such projecas with a contractor(s)licensed pareuanuo me Canumead s
Liked"Law.
0I am exempt under See. B A P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of factory one of the following declarations:
0 1 have and will maintain a Cenifimm of Cmoent to self-insure for Worker's Compen-
sation,as provided for by Section 3200 of the labor Code.for Out pcRmmana of the
work for which this permit is issued.
0 1 ban and will maintain Workers Compensation Insurance,az required by Section
3200 of me Inbar Code,for the performance of the work for which this permit is issued.
My Workers Compensation lnatmns,carrier and Policy number
�am- y
Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section aced rumascompleted fiber permit is formus hundred dollars(2100)
less.)
1 certify that in the performance of me work for which mice permit is issued.I shall not
employ any perso any manner so as to become subject m the Workers'Compensation
Laws of Californias Dare
Applicant
_NOTICE TO APPLICANT:If,after making this Cennicate of Eaemption,you should
Wismar subject in the Worker's Compensation previsions of One Latter Cade,you most
�p forthwith comply with such provisions or this from it shall he deemed revoked.
Z CONSTRUCTION LENDING AGENCY
i~ 4 I hereby anion that there is a construction lending agency lot the Performance of
a 7 me work fur which this permit is issued(Sea'.3032,Civ.C.)
!A Q lenders Name
= z lender's Address
U O 1 ccnify that I have mad this application and some mat for above information is
Lg. P coned.1 agree to comply with all city and county ordinances and sure laws mlatmg to
0U building construction.and hereby subsides representatives ofthis city to cater upon me
r� above-mentioned property for inspection puriwers.
(We)agree to save,indemnify and keep harmless the City of Caperton against /t
h
liabilities,judgments,costs and expenses which may in any way accrue agiinstsaid CityAa&_ — +/
U Z in consequence of the gmraing of this Permit.
APPLICANT��11yyDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EOOLATION�
c� .c Re-roofs � 7
Sig stored pplicant/Conia or Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant snore or handle hazardous material
as defined by me Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)2 Nr All roofs shall be inspected prior to any roofing material being installed.
tum mea applicant future building occupant orae equipment of devices winch If a roof is installed without first obtaining an inspection,I agree to remove
PP 6 pan quipme
mit haardaus air condominiums ss defined by the Bay Area Air Quality Management all new materials for inspection.
District,
O Yes IRNu
1 have read the haaNnouss materials requirements under Chaprer 6.95 ofd s Califm.
nice Health A Safety Cade.Sectoe 25505.25533 and 25534.1 understand ban rhe Wilding
dna nor centrally have a Gahm,that itis m sponaihiht,is andly the necupanl of the
requircmenta 'ahmost Wmet Pnoaw lnean:ar
acoraCunescapino. Signature of Applicant Date
�.
own -b� orivedagcm Da All roof coverings to be Class "B" or better
o :
O :APPROVED
�0 6� e" IN ACC'.'iANC�a'�T�l�/�D��
\Q DATE_-/V Q fti% /A-AI IZ4t
SIGNED
This set of plans and specifications MUST
be kept on the job at all times and it is un,
lawful to make any 0ennes or, alterations
,,n some wrthnv�, riftnn nnrmiacion from
the building C,pt., City of Cupertino.
The stamping of this pinn and specifications
SHALL NOT be hold to permit or to be ar.
pproval of tho violation of any provision
iav City nAmmrn nr wto I_nwww .
ROMO INAUG 13 2CC4
C►TY OF CUP'ERMN®
40'1671�iA'l� RI111 ('1lhIf� pEPA97T�Ifl�N�'
OTT CE I R
:( 1 `CITY OF CUPERTINO• v v
CITY or PERMIT APPLICATION FORM
• CUPERTINO
APN# 32� 5 7 Date:
U
Building Address: Mailing Address (if dif rent from buildiqg address):
Owner's Name: Phone #:
Contractor: License #:
Contact: ✓J / Phone: Cupertino Business License#:
/o Liyr Str�q if Fax:Z G�
Building Permit Info:
Bldg Elect ❑ Plumb Mech ❑
Job escription:
Residential ❑ r/ ¢ Commercial ❑
Sq.Ft. Floor Area: � 6i ;� $/Sq.Ft.:
Cost of Project: Occupan Group
/G Goo ----
Type of Construction: Please check this box if 6e project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ 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 IM 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 3 7 b/ 77 72-
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