03020123 CITY OF CUPERTINO �•'% TM*'sraa+;-�-' 3-'; 'a+�'a : , 'tit
BUILDING DIVISION p$R1yljrr CONT.RA.CTOR INFO$MATI. "^
yuhsl n:;2xe z >f x➢-w,Sy"'i"»a,nd v —S:E^�'YY �..u'
BUILDING ADDRESS: CUTNISIRUCTLOINI INU PERMIT NO.
21945 HYANNISPORT DR 03020123
OWNER'S NAME: 16U S 14il7i S1PERMITLSSUg DATE
RAVIZZA RAYMOND F AND SANDY L 02/28/2003
E: SANITARY NO. CONTROL NO.
ARCHIIECTIENGINEER: BUILDING PERMIT INFO
0 PLUMB
nee, 9
0 (�
u� ARATION
Ihemby.LICENSED
m wtE Amlice�d.oderPDsiisfi..of Chapter 9(commencing Job Description
veil Swe..7000)ofDiAi on3oflheBusi aMN fwt)mCode..ndmylittnmis UPGRADE BATHRM
me
o y in full fuend effect 7
5 License Class cimg /yJ}C
t� Dau Con DECLARATION Q�
ARCHITECTS Wuse DECLARATION /Z /
?W I uMerwnd my pons shall W used as public records �C
3 C G Licensed Professional O
OWNER-BUILDER DECLARATION
M 1 hereby affirm than 1 am exempt from the O mmactora License law for lir
i❑O following mason.(Section AD I.S,Business and Profcaiuns Code:Any city or county
+�$ which reepures•Permit a construct,eller,improve,demolish,or repair any nructurt
FZr prior a its iuuance,aim requires theapplicanl formch permiuo m...igned statement
Q
that he is licensed p.=arttotheprovi.m.ofthe Contractor's License Law(Chapter 9 Sq.Ft.FloorArea
$ (commencing with Section 7")of Division 3 of the Busines and Pr,fmions Cate)or
— Net he D merept Orr omen and the buts for the alleged exemption.Any violation of
Section 7031.5 by any appl;amfey a permit subjects the applicant to a civil penalty of APN um et Occupancy Typ
not more Nan five hundred dollar(5500), e
i.aowrca of the propenY.I my employee wlN weguatheir cele mmpewtion,
will do Ne work,and 01.1romue is nminunded aroRered forsale(Sec.7Wq Business
Pd Podim mu Cade:The Conumtora License Law doom Amt apply to an ownu of 102 - PIERS Required Inspections
Property who Wilda-lbol.thereon.and wbod,essuch work himselfor thiough his 103 - UFER
own employees,provided that such Improvements are not intended arogered formic.if.
hoverer,the Wilding or Improvement is mid within ere yess ofmmpledon.the owner- 104 — REBAR
ydm,will haw the Wrden of proving Wt he did nm Wild or improve for purpose of 105 — ANCHOR BOLTS
0 1,as owner of the property,am exclusively contracting with licensed con nommen;as 106 - SEWER & WATER
comtmn the project(See.7Wa,Busineu and R,futions Cade:)The Contractor's U.
come law dna OIL pply to an oven of property who builds or impmva Ihemon.and, 202 — UNDERFLOOR PLUMBING
Lwho amene acufor such projectswith.contractor(s)lianscdpursuantmtheC,nuanor. 203 - UNDERFLOOR MECHANICAL
Lkerue law.
❑lam�empt and rSe � ,Bk PCfor dols noon 204 - UNDERFLOOR FRAME
D Z D 205 — UNDERFLOOR INSULATION
OR ER5 'MPENDECLAR N 301 - ROUGH PLUMBING
I WAmy u0er penalty of perjury one of the following declantions: 302 - TUB & OR SHOWER
nawInd win toatmal A a Comore.of Consent to mIf.more forwakera Compo..
m3O3 - ROUGH MECHANICAL
tbs..a provided for 00 by section 37of the labor Code.for the Performance of Inc
wmkforwhichthisPermitisissued. 304 - ROUGH ELECTRICAL
❑I Mw and will maintain Wmkeri Compensation lrwomes.ar uimd by Section 305 - FRAME
37M.1fthc L.W,CodC.for the puformanm of the wort for which this Permit is issued. 3O6 — HOLDOWNS
My Worker. mrtce
.Compensation Im � carrier and Policy number am:
Carrier. Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS' 308 — SHEETROCK
COMPENSATION INSURANCE
(This cense need not be ccmpkmd if one pcmtit ts r«arm hundred di(SIM) 309 — EXTERIOR LATH
Ilea.) 310 - INTERIOR LATH
1 certify doer in IW pos(v&mace of the work fa which this Permit a Hsucd,I Nall net 311 - SCRATCH COAT
employ any perm.l ymanncr) a became subject to the Worken'Compcm.ion 313 — ROOF NAIL
Laws of ail' i Da
Apr II k 501 - FINAL ELECTRICAL ENERGY
I{OTIC APPIJCANT !tar m king that w'¢rte of Exempion,you shnulJ
.Jp ,Come subJmt a the Wor ompmuation provisions of the tabor Code,you most 502 - FINAL PLUMBING ENERGY
rmthwithcomply with s hProvisions Ar Permit.halhedmnmrewkd.
'� 503 - FINAL MECHANICAL ENERGY
� .
CONSTRUCTION 504 - FINAL BUILDING ENERGY
E-: I here by aRBm that Vert is•ce!(Smon .Ging agcay far du perfurmerue of
C>
the work anon, Hpermbu;mmd(sx3B97.civ.ca 505 - FINAL ELECTRICAL
t7]Q Lcndch Name
5Z L,der.Addeu 506 - GAS TEST
U O i ccnee that I haw rod thb city
and Court and du¢this the above information rmuiun la 507 - FINAL PLUMBING
[g.:F corrett 1 agree to elcomply with all chi and county ordinances and sou laws elating m 5 8 - FINAL MECHAN I CAL
OU Wildinmentioectioq and hereby mthonimmprexnuliws of this city mcome upon the
W shove-mentioned Propertysaw fliapecWn keep ba. O FIN GRADE
y (We).gree a mw,indemnify and keep harmless the City of Cupertino against O F I
to Ilabilifaujudgments,cons and apevu which may in any way ammc against mid City
in eansequenm of Ute gnming,f this permB V
'7 APPLICANT UNDERST AND WILL COMPLY WITH ALL NON-POINT Issued by 5 WORKS Date
SOU EREGU TIO S.
S' nuueofAppliv ,nuaee Re-roofs
Date
RDO S MATE" ISCLOSURE Type of Roof _
Will the applicant or future building oceupent store or handle havalloa maunal
m defined by the Cupertino Municipal Code,Chapter 9.12,And the Health and Safety
Code.Section 25532(a)?
❑Yes Mid., All roofs shall be inspected prior to any roofing material being installed.
Will[be applicant of future Wilding occupant Lm equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air contaminants a cmiumd by the Bay Arca Air Quality Management all new materials for inspection.
isuict7
C3 Yes pgya
1 have few the henrdous materials requiremenu under Cl Apur 6.95 of the Cali fa-
nu Heal"Safety Code,Secdao 25505,25533 and 25531.1 undnsand does iflhe Wilding
Jou not currently haw A unanr,that It u my MsIrsi hiliry At puffy the emopant of the
myul nu which @uv be m pn m issuance of a t Cervi of upmry. H Signature of Applicant Date
owner or..,Amiued.torli Dae All roof coverings to be Class"B"or better
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SRO ATY OF CUPERTINO * 0 3 v a L) l��
CITY
CUPERTT INO PERMIT APPLICATION FORM
APN# Date:
Building Address: 5 —C>3
v 4� vtb
er's Name � Phone#:
-2 S334L.
Contract r.,)< License#:
E L 3 833-3
Contact: Cupertino Business License#:
V SAS v 4
Buil ' Permit Info:
Bl Elect Plumb
ech
Job ription:
Residential ❑ Commercial
Sq.Ft. Floor Area: Q $/Sq.Ft.:
Cost of Project: ��) Occupancy Grou
lypeot-Constructiork
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uantit 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 SOOK Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu'
MECHAN CAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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
BCONSTAXRNElecSvcs600V<=200A
Resi/Mobile BUILDING
BELEC1000V <= IOOOA ELECTRICAL
BELEC1001V> 1000A ELECTRICAL
BELEC200 00V<=200A ELECTRICALBENERGYer BUILDINGBENERGYADD . Add Multi BUILDINGBINVESTIGA ation fee BUILDINGBMITIGATC using Mit. Fee BUILDING
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1 of
tTY.OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
uauti Fee ID Fee Description Fee Grou
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamil 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
13PBACKFLOW 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
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP PlanCheck 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 TM 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
BREMAIIZHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIX Li tin Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace >'10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance I ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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i � CITY OF CUPERTINO r
CITY OF PERMIT APPLICATION FORM
AML CUPERTINO
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
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 Plu-m--bing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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