03110086 (3) CITY OF CUPERTINO - 'a'' x., '"'"' ' " ','
auamrvc DIVISION PERM CONTRACTO&INFORMA
°a rte, �,.-. �w a
BU ILDING ADDRESS: SHOWCASE KITCHENS INC PERMIT'100
2 578 ROSARIO AV
PERMrr Issue DATE
OWNER'S NAME:
MARSHALL WILLIAM S AND ELIZAB 12333 SARAT G - 7/2003
NE: SANITARY NO. CONTROL NO.
(408) 253-0412
BUILDING PERMIT INFO
ARCHITEC rUJOINEER: BLDG ELECT PLUMB MECH
a LICENSED CONTRACTOR'S DECLARATION
>o Job Description
1 hereby affrtn that 1 em limn" under pro'signs of Chapter 9(commencing
wiN$CI beah,ar. that Ina of the Busincase r.fcssior chapter
(commencing
imm�mre�yaerreq RELACE SHOWER TILE
-❑ Dam Contm -
E ARCHITECTS DECLARATION
t 1 unticmand my pIm..h II M cud An public records
spwProfessional
OWNER-BUILDER DECLARATION '
Z I hereby affirm that I am exempt from the Contractor's License law for the
o following mason.(Section 703 M,Business and Profesions Com:Any city or county
e which requires a permit m construct,almr,improve,demolish,or repair any structure $2300
z�^ prior as its issuance.also requires the applicant for such Permit o file a signed statement
ie that he is licensed pursuant to the provisimmofthe Contractor's LimuseLaw(Chapter Y Sq.FL Floor Area Valuation
(commencing with Section 70(10)of Division 3 of the Business and Profession.Code)or
3$ Nat he it exempt tbmefrom and rite basis far Ne alleged esemptlon.Any violation of
Section 7031.5 by any applicant for a permit mbjccu Ne applicant to a civil penalty of Gro O Occupancy Type
not inort than fw hundred dollen(5500). •.
❑I,as owner of the property,un my employees wish wage as their sole compensation,
will do the.,it.and Ne.wnure is not intended or oeered 1or.1.(S.C.7044,Business Required Inspections
and ProfeLm,tions Code:The Contractor's Lim.Idoes oat apply to an owner of q p
property who builds or improves Nemon,and window;such work himtelf or through his
owneeplayasilding or
wnscatuch prowmenssin ne ouMMmoRered frorthe ow.
r. p�NgLED
however,the Wilding or improvement i.hold within one year or completion,pa owner- ■
builder will have she burden of proving that he did not build or improve fur purpox of
sale.). �s
1,a Owner of the property,em eduaively contrscting with lu
nged contractors to JAN 6 2004
Conswct the projeel(Sec.7044,Business and Professions Code:)The Contractor's Li-
CO.U.dors not apply to an owner of property,who Wilds or improve thereon,and
who contracts for such project,with a conuactoKa)licensed pursuant to the Conimcmrs
LicenBUILDING
se 4w.
❑I sm emrarturad.
Sere�t .B&PCf thismsson
Owner 4 � S(/=Dale
WORKER'S COMPS SATION DECLARATION
1 hereby Affirm under penalty of perjury one of the following declarations:
Ave and will maraud.a Cenifcate of Consenuo self-iuure for Worker's Comfort-
,as provided for by Section 3100 of the Lebm Code,for ths performance of be
work for which Nis permit is issued.
Q I have and will maintain Wmker's Compensation Imuran.,as acquired by Section
3100 of dm Labor Coat for de pertarramcc of the wars fm which this permit is issued. -
My Wmikees Compensation Insurance cat and Polity number am:
CAM...1
l J'9'l� �/!✓!s '�Pal'w Na.:
CERTIFICATE OF EXE' FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need not mcompleted if the permit Is fur One hundred dollars(1100)
less.)
1 calmly that in the performance of the work for which Nis permit Is issued,1 shall not
employ any person in any manner An as to became subject to the Workers COmpewtion
Laws or Calif.mia.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifuare of Exemption,you should
become subject to Use Worker's Compensation provisions of Ne IsMr CMB,you must
)O forthwith comply with such provisions or this permit shill M deemed revoked.
7 wN. CONSTRUCTION LENDING AGENCY
1 hereby Affirm that there is a construction lending agency for the performance or
'> the work fur which this permit Is issued(Sec.3091,Civ.C.)
1 A Lender's Name
z feMes
eYSAddr .
(] I anify Nu I lose read NB.potation And sem that the aWw uromtniun is
F' Carted I agree to comply with all city and county ordimnas and sure laws misting to
V building construction.and hereby auNorim opnsenutives of this city to Cols upon ft
U shove-mentioned property for inspection purposs
0.
(We)agree to uw,indemnify and keep harmless the City of Cupertino againr
. In inmiitie,sonco othe&..ssng and expenses isMr.it. may Inmyway accrue against mid City
)s`[ A APPLICANT
of UNDERSTANDS
of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EREGULATIONS. r
/( Re-roofs
C1
rt of Applic HCZoARDOUS MATERIALS DISCLOSURE D te
AType of Roof l
Will dre applicant or future Wilding occupant stom or Nndlc hazardous material
As defined by the Cupenino Municipal Code.Chapter 9.12,tad the Health and Safety
Code.Section 25532fa)? y(; All roofs shall be inspected prior to any roofing material being installed.
[3Ye ,T no
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanhous air contemi]mu fined by the Bay Area Air Quality Management all new materials for inspection.
ics?
❑Yet Nu
1 have mail the haraNnus materlalsrtquirements under Chapmr6.95 of rhe Califor-
nia Health h SafnyCodc,Sccumn 25X6,25537 and 255N.1 undcrsuM thuif Nc Wilding
does not currently haw a tenant that it is my tepomibility m notify the occupant of Ne
req re cniswhichomgEcmct ' rmissuancc.f certinemaroam er. Signature of Applicant Date
L" All roof coverings to be Class "Bt'or better
w u aam.tixed agent e
t
r /PZ d�
I
1
APPROVED ,
IN ACCORDANCE WITH THE CITY OR
DA AND
CIIPFRTINo CO S
RDINANC
SIGNED
This set of a end sem---i
a kept on M job at oiltirttes and it ifications M yry'
lawful to Make any than es
On same without written or altere?}pr A
the DYllding Dept., Ci pesson• from
The Stam in ry of Cupertino,.
3MALL NOT be held plan'Ind spacitisatibnr
approval of the vietationpef am or t., ar
,f nnv City Ordinance Y pro�7a - '
or Statn t,w
i
4P
• � I
NOW 7 �T1
t
G "
•
ItITY OF CUPERTINO 03110 6 `F6
OF PERMIT APPLICATION FORM
CUPERTINO
'RWPN # S (,
Building Address:
Owner's Name: A� Phone #:
Contractor: License #:
� 3
Contact:_ Cupertino Business License#:
Buildin Permit Info:
Bld Elect ❑ Plur Mech ❑
Job escription-
Residential ❑ ommercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: / Occupancy Gro p:
B�
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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
BMITIGATC Comm. Housing Mit. Fee BUILDING
#23 S/ 0
1of3 � � / �
OITY OF CUPERTINO
CITY PERMIT APPLICATION FORM
CUPEkTINO
uantity 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
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers . PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Stomi/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin 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 Fumace> 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
2of3
; {"gor
OF CUPERTINO* ,
CI OF
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, 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
BSPECML Special Inspection 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3