02050184 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOKMORMATION:
BUILDING ADDRESS: PERMIT NO.
21945 HYANNISPORT DR 02050184
OWNER'S NAME: APPLICATION SUB DATE
RAVIZZA RAYMOND F AND SANDY L 05/30/2002
rHONE: SANITARY NO. CONTROL NO.
s '
BUILDING PERMIT INFO O ARCHITECDEIJGINEER: BLDG ELECT PLUMB MECH
I -1
L--Li f.-_. LJ
Z
to-
2 LICENSED CONTRACTOR'S DECLARATION Job Description
O z to 1 hereby whom that 1 um licensed under provisions of Chaper 9(commencing
pY � n,SectionnwmofnivismnaoftheBusinessandPorressiorsCode,andmylicense ADD WI QW�SON SIDE OF FIREPLACE
is in full force and effect e
rd0 a License Class Lim.p f'q
Date Contmnor
a u G ARCHITECTS DECLARATION
t- g 1 understand my plans shall be used az public records NOV2 6
IY v } 2002
r�ir a 9 p Licensed Professional
c��� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt form the ContrecoWs License Law for the
following reason.(Section 1011.5,Business and Professions Cade:Any city or county' BUILDING $2000
SSC which requires a permit m ns
coouct,alter,improve,demolish,or repair tiny structure
ce
Me -prior..its issuance,alsorequirevciii,dearm forsuchpermitm Rl...igttcdawtement. - -- --
c. Natbemikereedpursuant totheprovssimrsofineContractors License Law(Chapter9 t Fdyr.Atear` Valuation
(commencing with Sectmit;7000Bof Division J of the Quadmssend Qprrppfquions Code) �,"e-��R i'!P�j'Q �'.�L„iQ QI,E1:�`l f'sd��l.N:
or that he 1i exempt therefrom and lie basis for the&*jcid eiemp.laa.My violation i
of Sxvmxa 7831.5 by any,,pIican for a pmnit subjmta.he epplicem to a civil peml'p D,���
Intent mare than ave hundred dmlaa(rio.), 101APN F'RATION Occupancy Type
01.as be,mthe property,or my employees with wages as their sole compensation,
PiERS
will do the work.and the structure snot.mended or offered for sale(Sec.]044; --' - - - Required Inspections'—
B . anA Promc
fess mss Code The Contmrm s License Law does not apply an 103 - OF ER e 9 "
owner of pmperty Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or . 10 4,.=__REBAR.. ._..__...._ _..-_- ..... ----------- _...._._......_...._..._.._._.-_..._..
-:offend far sale:If,however, he building&inap)uvementi is sold within one year of -' ..
'"`- - - , .
complesion,the owner-builder will have the burden of proving that he dict not Wild or
105 - ANCHOR BOLTS
improve for purposcof sales. 106 - SEWER & WATER
--
y6yi.snwne .fiWpmpe�y.anteusinesejyc.mrocegwhCodeneaeCompacrsm 202 - UNDERFLOOR PLUMBING
c.nmm�.he does
n (Sec.9044,Business and Prorcry who
Code:)The improve,
dromi s , .,.
c _i ud,whocwdocsnmapply r.suchoanownwthaconywonbalmsrimpmeeatherenn. 203 - UNDERFLOOR MECHANICAL
i 'i' Cmamcmer; esr..suchpl n uamor(s1.Iicensed.Pursuent tutNe. '_,._^ ..______
' c t . r License L win mon ..._..._.204' - UNDERFLOOR ;;FRAME�,.
rets
o1 ptormetie _;_:B'aPCfnrndsars„n 205 - UNDERFLOOR` INSULATION
�yn�eQ+f/LA�C//h �} 'am 'S'�-o2""'' 301 - ROUGH PLUMBING
c&,
302
DECLARATION
.` Thereby ahrm sneer penalty of perjury,dne cf tea moowing dcclmaduns: 302 — TUB & OR SHOWER
303 - ROUGH MECHANICAL
1 01 have and will ormtrie a Certificate of Consent to self-insure for Worker's
'^'-�::':% Compensation, m provided-for Section 37W of the labs Code. for the 304 - ROUGH ELECTRICAL
performance of the work for wmclt this permit is issue. 305 - FRAME
01 have dnd•will muintuin Worker's Compensation Innnrhrac,as required by Section 3 06 - HOLDOWNS
.17M or the labor Code,for the performance of the work for which.his permit.is
kind.My Workers Compensation hormone comerand Pacy moriber.m. 307 — INSULATION
IC.anterlal+e r s. U s0P014N 308 ..1 SHEETROCK.-,y... ,, ,
I CERTIFICATION OF EXEMPTION FROM,WORKERS' C.:Y�' S sc � ( 1 1
I -.l �: _' '309_-_ EXTERIOR-_LATH
COMPENSATION INSURAN1. to vis .
i r`1 Missectionneenot hecompletedifthe permitisPorone hundred dollars 310
($1001 orless.) 311 - SCRATCH COAT
ma
d..s m hecnme b er n 3] 3 - ROOF NAIL ,(;, . .
I nfy int .1 per firma ca F.h kCrwh stns perm. i. QI I, •�,,;���+:t
ahu . aftyany per, _ ' 'W' ""' 501 FINAL EI,ECTRICAii ENERGY
O 11,after
making
previsions n..o.ffdExe Exemption,
._.._ . 502_ _.FINAL` PLiJMBING"ENERGY__
Comps. s u n ory rC Id Etc�y
o the
oath inti 503 - FINAL MECHANICAL ENERGY
Compensation ,yo must
vywi r pm. ke -504- - -FINAL -BUILDING ENERGY ---- ,--
' t- '' CONSTRUCTION LENDING AGENCY "' - t'�D
;� Ihrebyaffmthat Nrc. acoswcuonleading ugnyharm pHomanca 505 - FINAL ELECTRICAL ,
.. of the workfor which this p rat..issue(Sec J099'C C) 50.6._ GAS..TEST._. _ _. ..... ..._ ....--..-.._. .. __.._
� z -L JreNm f --Add, ,
-507 - FINAL PLUMBING s.,l;
ll
1 minify that I have read the apple( d state that the above info, tions 508 — FINAL MECHANICAL
P. correct I agree to comply with all miry and county ordinances and state laws relating 509 - FINAL GRADE
.o building construction,and hereby hu.honee repmsen.atives of this city to enter upon
y Ig] -N- Wv ie . red property for inspection p pse'._ -.. 510 — FINAL PLANNING
L (We) gree iu ac mdesnntfy and keep hmmlcss the City of Cupemno geinn
fA liabilities,judgments.cosis and exprc,nocs which may in any way accrue against said 514 - FINAL U C WORKS
U.Z City m consequence of the Starting of this peri OyU �y '
"' 'APPLICANT UNDERSTANDS'AND WILL COMPLY WITH ALL:NON POINT''' VV
Gu -.F. MIATI vs. •1 Issued by: Dale
ApplicanVGimnorm., ".'i' Y '•` ncr !Date Re-roofs '
l „HAZARDOUS MATERIALS DISCLOSURE
W11 the applicant or future Wildin,cesupartstomorn ndl naiardous motcnal .Type Of Roof ._. ,.., ._.. ,�. ..
undefined by the CuMinnor Municipal Code.Chapter 9.12and the Health and Safety v
Cal ❑Yes 255131 ) i) / #+� a. it ( 5�: Y + '''. l °. ..il•. tx ^ a 1It?s.: t 0
All roofs shall be inspected.prlor_toiroofing material being installed
Will thic,appharam o In t as W la g occupant use equipment-or ate n co' If a roof is installed without first obtaining an inspecti6n;'I agree to remove
c t h d atrc iii defined by theBay Are Air Quality Management
•D v . all new materials for inspection Applicant understands and will comply with
-r` ` all non= oinf source regulations- -
a' 1 q remind dr Chpmr s.' r p :UU
I ave read toe's d moons 6.95'd tfar
hat
fthe buil Health Safety Cole.Sections15505, itis yn155J4.Iunderstand that,
;Omabuilding mcmicapent,which ericas W .hubris mYrcurance of.ymnficin Ne
dccupam of the requirements which must W tact prior m issuance of a Ceni&ere of
z' Ocfu'anc
- --
Si natur a of Applicant Date _
For au.horizedagest em,7 � Date All roof coverings to be Class"B"of better ,
-
. .__..OFFICE _
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOKMORMATION:
BUILDING ADDRESS: PERMIT NO.
21945 HYANNISPORT DR 02050184
OWNER'S NAME: APPLICATION SUB DATE
RAVIZZA RAYMOND F AND SANDY L 05/30/2002
rHONE: SANITARY NO. CONTROL NO.
s '
BUILDING PERMIT INFO O ARCHITECDEIJGINEER: BLDG ELECT PLUMB MECH
I -1
L--Li f.-_. LJ
Z
to-
2 LICENSED CONTRACTOR'S DECLARATION Job Description
O z to 1 hereby whom that 1 um licensed under provisions of Chaper 9(commencing
pY � n,SectionnwmofnivismnaoftheBusinessandPorressiorsCode,andmylicense ADD WI QW�SON SIDE OF FIREPLACE
is in full force and effect e
rd0 a License Class Lim.p f'q
Date Contmnor
a u G ARCHITECTS DECLARATION
t- g 1 understand my plans shall be used az public records NOV2 6
IY v } 2002
r�ir a 9 p Licensed Professional
c��� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt form the ContrecoWs License Law for the
following reason.(Section 1011.5,Business and Professions Cade:Any city or county' BUILDING $2000
SSC which requires a permit m ns
coouct,alter,improve,demolish,or repair tiny structure
ce
Me -prior..its issuance,alsorequirevciii,dearm forsuchpermitm Rl...igttcdawtement. - -- --
c. Natbemikereedpursuant totheprovssimrsofineContractors License Law(Chapter9 t Fdyr.Atear` Valuation
(commencing with Sectmit;7000Bof Division J of the Quadmssend Qprrppfquions Code) �,"e-��R i'!P�j'Q �'.�L„iQ QI,E1:�`l f'sd��l.N:
or that he 1i exempt therefrom and lie basis for the&*jcid eiemp.laa.My violation i
of Sxvmxa 7831.5 by any,,pIican for a pmnit subjmta.he epplicem to a civil peml'p D,���
Intent mare than ave hundred dmlaa(rio.), 101APN F'RATION Occupancy Type
01.as be,mthe property,or my employees with wages as their sole compensation,
PiERS
will do the work.and the structure snot.mended or offered for sale(Sec.]044; --' - - - Required Inspections'—
B . anA Promc
fess mss Code The Contmrm s License Law does not apply an 103 - OF ER e 9 "
owner of pmperty Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are not intended or . 10 4,.=__REBAR.. ._..__...._ _..-_- ..... ----------- _...._._......_...._..._.._._.-_..._..
-:offend far sale:If,however, he building&inap)uvementi is sold within one year of -' ..
'"`- - - , .
complesion,the owner-builder will have the burden of proving that he dict not Wild or
105 - ANCHOR BOLTS
improve for purposcof sales. 106 - SEWER & WATER
--
y6yi.snwne .fiWpmpe�y.anteusinesejyc.mrocegwhCodeneaeCompacrsm 202 - UNDERFLOOR PLUMBING
c.nmm�.he does
n (Sec.9044,Business and Prorcry who
Code:)The improve,
dromi s , .,.
c _i ud,whocwdocsnmapply r.suchoanownwthaconywonbalmsrimpmeeatherenn. 203 - UNDERFLOOR MECHANICAL
i 'i' Cmamcmer; esr..suchpl n uamor(s1.Iicensed.Pursuent tutNe. '_,._^ ..______
' c t . r License L win mon ..._..._.204' - UNDERFLOOR ;;FRAME�,.
rets
o1 ptormetie _;_:B'aPCfnrndsars„n 205 - UNDERFLOOR` INSULATION
�yn�eQ+f/LA�C//h �} 'am 'S'�-o2""'' 301 - ROUGH PLUMBING
c&,
302
DECLARATION
.` Thereby ahrm sneer penalty of perjury,dne cf tea moowing dcclmaduns: 302 — TUB & OR SHOWER
303 - ROUGH MECHANICAL
1 01 have and will ormtrie a Certificate of Consent to self-insure for Worker's
'^'-�::':% Compensation, m provided-for Section 37W of the labs Code. for the 304 - ROUGH ELECTRICAL
performance of the work for wmclt this permit is issue. 305 - FRAME
01 have dnd•will muintuin Worker's Compensation Innnrhrac,as required by Section 3 06 - HOLDOWNS
.17M or the labor Code,for the performance of the work for which.his permit.is
kind.My Workers Compensation hormone comerand Pacy moriber.m. 307 — INSULATION
IC.anterlal+e r s. U s0P014N 308 ..1 SHEETROCK.-,y... ,, ,
I CERTIFICATION OF EXEMPTION FROM,WORKERS' C.:Y�' S sc � ( 1 1
I -.l �: _' '309_-_ EXTERIOR-_LATH
COMPENSATION INSURAN1. to vis .
i r`1 Missectionneenot hecompletedifthe permitisPorone hundred dollars 310
($1001 orless.) 311 - SCRATCH COAT
ma
d..s m hecnme b er n 3] 3 - ROOF NAIL ,(;, . .
I nfy int .1 per firma ca F.h kCrwh stns perm. i. QI I, •�,,;���+:t
ahu . aftyany per, _ ' 'W' ""' 501 FINAL EI,ECTRICAii ENERGY
O 11,after
making
previsions n..o.ffdExe Exemption,
._.._ . 502_ _.FINAL` PLiJMBING"ENERGY__
Comps. s u n ory rC Id Etc�y
o the
oath inti 503 - FINAL MECHANICAL ENERGY
Compensation ,yo must
vywi r pm. ke -504- - -FINAL -BUILDING ENERGY ---- ,--
' t- '' CONSTRUCTION LENDING AGENCY "' - t'�D
;� Ihrebyaffmthat Nrc. acoswcuonleading ugnyharm pHomanca 505 - FINAL ELECTRICAL ,
.. of the workfor which this p rat..issue(Sec J099'C C) 50.6._ GAS..TEST._. _ _. ..... ..._ ....--..-.._. .. __.._
� z -L JreNm f --Add, ,
-507 - FINAL PLUMBING s.,l;
ll
1 minify that I have read the apple( d state that the above info, tions 508 — FINAL MECHANICAL
P. correct I agree to comply with all miry and county ordinances and state laws relating 509 - FINAL GRADE
.o building construction,and hereby hu.honee repmsen.atives of this city to enter upon
y Ig] -N- Wv ie . red property for inspection p pse'._ -.. 510 — FINAL PLANNING
L (We) gree iu ac mdesnntfy and keep hmmlcss the City of Cupemno geinn
fA liabilities,judgments.cosis and exprc,nocs which may in any way accrue against said 514 - FINAL U C WORKS
U.Z City m consequence of the Starting of this peri OyU �y '
"' 'APPLICANT UNDERSTANDS'AND WILL COMPLY WITH ALL:NON POINT''' VV
Gu -.F. MIATI vs. •1 Issued by: Dale
ApplicanVGimnorm., ".'i' Y '•` ncr !Date Re-roofs '
l „HAZARDOUS MATERIALS DISCLOSURE
W11 the applicant or future Wildin,cesupartstomorn ndl naiardous motcnal .Type Of Roof ._. ,.., ._.. ,�. ..
undefined by the CuMinnor Municipal Code.Chapter 9.12and the Health and Safety v
Cal ❑Yes 255131 ) i) / #+� a. it ( 5�: Y + '''. l °. ..il•. tx ^ a 1It?s.: t 0
All roofs shall be inspected.prlor_toiroofing material being installed
Will thic,appharam o In t as W la g occupant use equipment-or ate n co' If a roof is installed without first obtaining an inspecti6n;'I agree to remove
c t h d atrc iii defined by theBay Are Air Quality Management
•D v . all new materials for inspection Applicant understands and will comply with
-r` ` all non= oinf source regulations- -
a' 1 q remind dr Chpmr s.' r p :UU
I ave read toe's d moons 6.95'd tfar
hat
fthe buil Health Safety Cole.Sections15505, itis yn155J4.Iunderstand that,
;Omabuilding mcmicapent,which ericas W .hubris mYrcurance of.ymnficin Ne
dccupam of the requirements which must W tact prior m issuance of a Ceni&ere of
z' Ocfu'anc
- --
Si natur a of Applicant Date _
For au.horizedagest em,7 � Date All roof coverings to be Class"B"of better ,
-
. .__..OFFICE _