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03110138 (2) CITY OF CUPERTINO PERMIT � !Co FORWORNI 0 BUILDING DIVISION ILDINOADDRESS: SHOWCASE KITCHENS INC PERMITN0103110138 I F-7A Rr)SAPTO A17 OWNER'S NAME: FERNUTMUEDATE ^' WILLIAM iT AND P.T.TZAR 12';V1 qARATnCA-.TTNNY1iAT,T7. R-) 11 /24 /2003 NE: SANITARY NO. CONTROL NO, (408) 253-0412 ARCHITECTIENGINCER: BUILDING PERMIT INFO RLDGLUMB MECH ad' E9 P= I Z, LICENSED CONTRACTORS DECLs,RATION I hereby affiran that I am licensed under provisions or Charter 9(commencing Job Description z wird Section 70W)rf Division Sof Ne Dtimine,smod Poificashm,C.da,..d my license is infomb.bdcffrcl.,e UPGRADE ELECT (GUEST BATHRM) IF License Class Lica DDamC,air. f�7� W AZT ruir ARCHITECT'S DECWATION I understand my darm.h.11 W used as biblismerod. aDU Licensed Professional us OWNER-BUILDER DECLARATION I hereby affiren that I am exempt from the Communes License Law for the following mason.(Section 7031.5,Business and Pocircashms Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure iy poor to its issuance.also requires the applicant(or such permit to fi lc a signed statement 222 that W is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation mO (Commencing with Section 7W(B of Division 3 of the Is ushes,and Professions Cod,,)or dust he Is exempt therefrom and�basis for ft alleged ciamputfirm.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3WNXtIi1n9er00 Occupancy Type not mom Ian five hundred dollars(SSW). 1,as owner of the property,or my employees with wages as their sole compensation, is not d or d far sale(See.7044,Barras and Pr re Code:no Concractor's Licembse Law dicas not apply W in owner of Required Inspections pro,pary,who build&or improves thereon,and who doessuch work thintradfor t4m.,h his own employ=,provided that such Improvements me not intended interfered Became.It. I,building or improvement is audit within*a bartufarnplixi...0....F builder will have due burden of proving%at the did not Wild or improve for purpose of sm..h a J C] 1.as owner of the property,am exclusively contracting with licemcd contractors to construct the project(Sec.7W.Business and Professions Codc:)no Contractor's Li. am Law does not apply to an owner or property who Wilds or improves�pcom,and, who contracts for such projects with a contractor(s)licensed pursuant to dm Contractor,. License Law. C] I arm exempt under See B&P C far It...a Owner Data WORKER'S COMPENSATION DECLARATION I hereby affiron under Penalty of perjury one of the following decimations: I ban and will maintain.Certificate of Comment in scir-lomme for Woricar's Court ,tion,arth . provided for by Section 37M of the Tabor Code,for the pbschusionro of the I work for which this Permit is issued, rhaw and will maintain Worker's Comorsensafinn Insurance.as required by Section wcurIe%!Wr Cons,for ft Performance of Ne work for which ffie.'nona's. bad. My Worker)Cn pen at,..,Instance airier a'and Policy number am: at Chel-Ld policy NoD�,�w CERD CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissectirm recount Wcomplowd fine permit is foronc hundred dollars(SIM) or loss.) I cenify Net in the pc,formanm.(in.work per which this permit is issued.I shall not employ any Notion in any manner so as to become,subject to the Workers Compassation Laws of Cmirm-ria.Data Applicant NOTICE TO APPLICANT.Ir,after making this Cardricam of Exemption,you should harms subject to the Worker's Compensation previsions of due Ltivor Code,you mum z forthwith comply with such provisions or this Permit shall W scented!reverse. Z 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending a,cmy for Is pantrunumbec of dic.turkhoWittil,thi.parmitisiabsed(Sec.3097.Civ.C.) Lenders Name =,z )z Lender's Address U 0 1 cenify I.,I have read his application and made that No,bow information is D, correct.I agree to comply with all city and county ordinances and state laws misting to building construction,and hereby mo1ruirs,representatives of this city to enter prior the U advive-noctumned property for laureation purposes. Ill. (We)agree to...,indemnify and keep harmless the City or Cupertino against v) liabilities.judgments,costs bad as pens,which may to eby way acc.against said City in coAPXLICANTnsequence,of the Standing of this permit. UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date S*RCEREGU a, NI r e2 Re-roofs C, 79cmure ol'Applianst/Ccusinure ill, 'Dwe H A 0 OUS MATERIALS DISCLOSURE Type of Roof to to, Will too applicant. turn building cati,sm,sume or handle huxtudiria,material sor defined by ft Cupertino Municipal Cuba.Chapter 9.12,and ft Health and Safety Code Section 25532(a)l All roofs shall be inspected prior to any roofing material being installed. future building occupant use equipment or devica which If a roof is installed without first obtaining an inspection,I agree to remove El Y`c applicant 9''Da"" xa�'pda-it embabomants as&fined by the Bay Area Air Quality Management all new materials for inspection. Iricil hyes I he,ve read ffic harephasson.WrisIS requirements book,Chapter 6.95.f&Calif.,. nia Health&Safety Code,Sections 23505.25533 and 25534.1 understand Nm if the building dos rouguyluives crom could hen melonr C nificau,of Oc p cy Signature of Applicant Date require Owr:7. = 3 All roof coverings to be Class "B" or better r mithisn'ed agent D a CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ! CUPERTINO o� ( o APN# 3S 6 Date: Building Address: Owner's Name- Phone # Contractor: / License Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Meche8-� Job Description: Residential k Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: In Cost of Project: Occupancy Group• Z; Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> l 000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING 1 of 32. Z2`�• an, CITY OF CUPERTINO • 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 BNUCOM vM 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 I Pblg 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 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 Water HeaterNent 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 Ask BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM ' Qua ' i 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 BSPECIAL Special Insection 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