02070083 CITY OF CUPERTINO r - ""
BUILDING DIVISION PERMI CONTRACTOR 6&6ib ATI W
BUILDING ADDRESS: PERMIT No.
21731 SANTA BELLA PL KINNUNE RICHTER F AND BARBIRA 02070083
OWNER'S NAME: APPLICATION SUB DATE
KINNUNE RICHTER F AND BARBARA 07/15/2002
PHONE: SANLTARYNO. CONTROL NO.
oro O RCHLTEC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l' l
LICENSED CONTRACTOR'S DECLARATION
O Z w Z I hereby aRrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
F'9 t"dl a
with Sandia.7000)of Division 3 of the Business and Prvfeaiom Cade.and say liana. MASTER SUITE REMODEL /
a J�JJ ix in full foe end eRmt. J—
g o,w-t< License Cl... Lie.N
Data Contnnm
ARCHITECTI'S DECLARATON
(:°'O 1 undersand my plus shall he used m Public TNs Ilastk
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S p O Licensed Professional
OWNER BUILDER DECLARATION O
uai R 1 hereby affirm shot 1 1. .Bump[from the Contrnmr'e a My c Law,for the
t z following tenon.permit
t cont. Basher, ved Pmfessiom Code:MY city or cwnty $5000 5 0 0 0
FO which itsiuu opermitsoconsttua,alter impmva,demolish or repair a6ganyssmcwm, 4
u3$...pnorto ticensece,Wso rtqui be
for such Permit to idea Law( i.,w9
(coabcmmencing with
pSntion 1h of Division
Ne Conthe Basins Littmclsw(Ch^pser9 11p �p(s,O`:�,(s, lQO Valuation
or that
(commencing a with Section 7000)of Division 3 of the Business aqqd i.m.Any violation
i Code) "1�:4i S t'.5'Y.y.f'N f,�•,i�"w. 3.aZ �i;-t.L i;(:�i
°1, owner of P d the basis for the alleged ejempnt to Any l pen lty '
t therefrom an
of Section]OJ LS by any applicant for a permit subject the applicant so a civil penalty
:of or moa than five hundred doll..(5500). 101 APN 1b�ATION Occupancy Type
v-will as Peror the
wumy`mployees with wages as their sole compensation. _
Ne n•arm
art Conor intended or License
Low for sale no,(Sea]o an -
owner of
Professions Code:The Cons there.,and w Low dace naw apply m an 103 - UFER Required Inspections-
owner '
ow
neo of r i o Who loCees or Improves at such
lend who docs such work himself
or through his own however.,provided that such i prot is sol art not ine year
or 104 .__ REBAR _._. ._.._ .. .. _..
s art -or sole.If.however the building or men cif 'i ill sold chid one year of "'
'completion,the owner bu Idler will have the burden of proving ted[he did not build or 105 - ANCHOR BOLTS
mproserearporpoeeofise..). 106 - SEWER & WATER
_.. ._. s 202' - UNDERFLOOR PLUMBING
I as ow rohhe p puny am exclusively contacting with licensed.."at..m
ewm top sent(Sec.70.4,Badness ved Pmfastob Code:)Tile improves
tracers 2 03 — UNDERFLOOR MECHANICAL' '
License I c. does not apply to an owner with
property who bullet or improves to lob, '
..end. hocon[ or such pro,ens.with..con[acsogA licensed puauans.so the.
C
it tra araL .B Law. ..__.....:......2.04...._ '-UNDERFLOOR-'FRAME_:-. ..._...... __ ......._. ..... ....._._.....
❑lama ttSa. - B&PC forNiareaspn 205 - UNDERFLOORS'
"INSULATION
°wDat° ��d 1— 301 - ROUGH' PLUMBING
RKER' COMPENSATI DE RATION 302 - TUB & OR SHOWER
I hereby affirm under penalty vfpertiryanenfthemnewingde.lawitinx:. . 303 - ROUGH MECHANICAL
1 hzve and will maintain a Certificate of Consent to Bess-insum for Weran's 304 - ROUGH ELECTRICAL
ompcnation, m provided for by Section 3700 of the
labor Code: for the
rfomancri of she work for which this permit is issued;. 305 - FRAME ,
°1 have end will maintain Work.,'.Camp...arm.Ins,umntt,as required by Section3 0 6 - HOLDOWNS -
3700 of the Libor Code,for Ibe perfomeare of the work for which Obis permit ie
iuwd.My Workers Compenniionlnsurvncecarriermd Polirynumberae: 307 - INSULATION
308" r, ySHEETROCK
.. Center t i < i "i "'Policy No.: O ..
:CERTIFICATION OF E%EMPfION FROM WORKERS _ T 30�, .-s!Li". .'IsL•'RI VRJ.LATH s,
„ COMPENSATION INSURANCE • I -
..., .._
310. ._..,.INTERIOR LATH
(IOOlm es iectlddneed ear be cvmplesd if the permit is for one hundred dollars 311 - SCRATCH COAT
31-3 "ROOF-NAIL
1 ttmpl that in the performance n the work for which this tin t issued.l •.
Com angios employ
of Cnl'fi "Data
an, become bat to theWe 501 - FINAL ELECTRICAL 'ENERGY
P Y Y Pse Y J
Appy cit - - .-. .._.... 502.. _...FINAL...PLUMBING -ENERGY - _.._. .. _........ ... . __
NOTICE TO APPLICANT If afar making this Certificate of Estimation,you should
Z become subject l the Workers Compensation provisions of the Labor Code,youmuss 503 - FINAL MECHANICAL' BNERGY
opfbnhwdneomplywithsuchprovisionsorthispnontahanbedemedneaked. ..._..50.4 ..-. _FINAL BUILDING..ENERGY ___.._ ....._
.._
CONSTRUCTION LENDING AGENCY
F"> 1'hreb Jr.vthat Mete is a ecmuwnonl d 505 - FINAL ELECTRICAL
a Y B agency f Ohe perfnrmenm -
W.Aonh rk for which Ns permit .ixaan fs..309],ay.e J S 0 6 _ - _GAS TEST
Lend Name' .... .... ....._.., _. .... _._ .... ._.... ._ ..__ . '
U C` Lencia Address : 507 FINAL PLUMBING
I coldly that l have read this application and sate Net the above information is 508 - FINAL MECHANICAL"
Loi.fir 'cord I.gree to comply th all city and county ordinance f d note laws relating 509 - FINAL GRADE
0 to obtaw-ding cit construction.and yfarimmho ¢rtposena,veofinnCry( enter upon 510 - FINAL PLANNING
QQ1A, ,he abo n cmionI property f impaction purpose
.y:: f We)n- c iu s e indemnify and keep harmless the City of Cupertino against
�fq• livb litre,d me con"and caps.which may in any way vccme.against said 514 - FINAL UBIAC WORKS
Cl.M CisY n a se cit the grantor{of Nix permite n
hPPI:I; T V ,I TANDS AND MPLY W ITH'ALL")N-PO NT
sbii Re -L Ns - Issued by: Date
Signature of APP icon✓Cnmmnm pow
HAZARDOUS'MATERIALS DISCLOSURE Re-roofs
;YII Ne appliee,or futum building occupant store or handle boundless material Type.Of .ROOf..
as defined by she Caperton Munieipal Cade Chapter 9.12.a ad the Health and Safety
Coda;s tnn3ss3ztp) All roofs shall be inspected pnor to any.
°Ye / roofing material,being installed.
'e .
Will the applicant o future lwildoll a p t use.qu pment r devices which If a roof is installed without first obtaining ins ection,I agree to remove
out Innuendoes air contaminants as defined by the Bay Ara Air Quality Management g an P g
D1stnct - all new materials for inspection. Applicant understands and will comply with
°Ye all non-point source regulations. •:. .
1 hi a m.dshe hazeNous materials re,i ir.m.ns wide LTapt 6.93 of the.
ebfoma Health of y ode;S.c[iona 25505,355]3 end 33534 I understood[hal
'lithe WlIdi doe of n[ haveatcnan6 Nn it is mY responsibility in notify the
-ocapvm of he e t hich must be met prior to iswance of Cmifi ¢o(' '
oeapen.Y �� Signature of Applicant Date
ownnn a nn in pet .� All roof coverings to be Class "B"or better '
-. :... ..... . ... ..... .. •. OFFICE.. .... _. _ .
ATY OF CUPERTINO O O �3
CUPERTINO PERMIT APPLICATION FORM Z °7
Date: _
Building Address:
21-7,31 SA i &L-LA "C E
Own 's Name: Phone#:
Contractor: Sa License#:
t��.
Contact: Phone#:
Applicant/Contractor,,,, Fax#:
�r-
.414Lding Permit Info:
Bld Elect Plumb Mech
o escription: ,Qs �.00�. ii'+AjlrgfL_Sv >�
Residential: Commercial:
Sq.Ft.Floor Area: A�yn+ rv 'l� $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: -- — Occupancy Group:
R,tee
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Avpliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTA)MQ 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
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
�. BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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The stamping 31 this plan and illec"ficatiOns i
NOT be held fin p6lmiti or to be;an
SHALL
ipproval of the ViOlabOR Of--any POvisionq
Lft
,f Any city ordinance or'state
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