21519 (3) M W Fantozzi
10915 Linda Vista Drive,
Cupe mo,
January 2, 2002
i
City of Cupertino � a/LL I�
Building Inspection Dept �l�l/Yt �lJl �02 li.
10300 Tone Ave.
Cupertino, CA 95014
Re: Permit No. 21519
Please extend the above permit for 6 months. I am actively working on the
improvements and have been calling for inspections on a regular basis.
Sincerely,
Mark antozzi
Owner/Builder }
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulldin Pm ed tdemlfiatlen PERhBTNO.
B"Rding Address: 2151 9
/5 a
nem ams: t on
e/ CITY OF CUPERTINO-BUILDING DIVISION
r.- centrader, LI Ne: APPLICATION I PERMIT l%^
BURRING-ELFLTRICALPLUMBINC-MWHAMCAL CATEGORY CON¢lG4Nj
1 It r. Llc No ((aa �jj
G S I BUILDING PERMIT INFO
QTY ELECTRIC PERMIT FEE
Adamu:2( daOb Gi: IBLDG uf�l
ANCE w,�..n�v
LICENSED CONTRACTOR'S DECLARATION 'L w
]hereby affirm that l am licensed under provision.of Chapter9(mmmenc AN RESIDENTIAL JOB DESCRIPTION
IngwlthSecHon70W)ofDlWdon3oftheBudrummdProleeslonsCede,andmy; R�ali -
license Is In full(ossa and effect. P
License
Clan
Date Contractor
ARCHITECTS DECLARATION PS r aE
q�q�uu W f understand my plans shall be used es public records, VERT SQ.FT.FLOOR AREA $/SQ.FI.
E Licensed Professional SIGNS � CAL ' t AS �CO 1+a q L„
<<�6] OWNER-BUILDER DECLARATION SPECIALCIRCUIT 'L Ll a� e.,.a�Qa� �r`
f,Toa IherebyaHlrm that lam exempt from the Contractors License law
the / :,701 5171 Te.{" Ko' rzSaCo
po following reason.(Section 70415,Business and Professions Code:My city or 4T
ZI" county which requires a permittoomatryd,alter,bnprove,demolish,orrepalr hMP.METEROR L
'SI < any atrocture prlortolb Wuante,also requbnthe appBantformch perMtto
t U Ola statement signed tement that he is licensed pursuant to the pm% lona oh
f te TOWER DEVICES
IDµ Contractees License Law(Chapter 9(commencing with Section 7000)of Divi- /
3 p SWIMMING POOL ELECTRIC
debasis fo Budneu and Profmbni Code)erthalhek exemptlha1.5 by nd VALUATION
G
the bads for the alleged exemption. U, violation of Section 7Qt15 re any (� ( 1 I 1 I s lG
� °PPBantfora permit mbje bthc applicant too dull penalty of not nnrethan Olm•ETS'"N7ntfr5F7X7VRF5 l ` ` 1 V
Bv�undred dollen(5500). NEW RESIDENTIAL WIT:
�n 1,as owner of the property,or my employees with wages asthetr sok `'�'FT• i STORIES TYPE CONSIRIK;TION
compevaHon,willdo the work and thestruchm,is not Intended or offered for /
qsale(Sec.7044,Business and Profeaalorn Code:The Contractee.License Law
don not apply to an owner or pmperty who builds or Improves thereon,and QCC.GROUIa RES.UNITS
doessuchwork himselforthrwagh his own employees,provided that such
Improvements are not Intended oroffered forsale.If.however,thebuildbg or TOTAL c
Improvement bold wiihieoneyearofcaanplelbn,theavner-bu lderwUI have "
Qxbxan. Pmvingthathaala not bu0d orlmpmve for purposeof.ale.). QTY. PLUMBING PERMU FEE
`{f)L ea owner of the property,am exclusively contracting with Blunted FLOOD TONE APN
o Ren ee mmtrudth.p.jed(See70KB..i ...d Prof.bm Code: PERMIT NUANCE r1
Contractees License law does not apply to an owner of property who ALTER-DRAIN 4v VENT, Ga
bu0ds or Improves themeck and who contracts for such ptojrm with a ® FEE SUMMARY
gp�actor(s)Hcemued punuantbtha Contnctor'a L4enae La w. BACK FLOW PROTECT.DEVICE
LJ I am exempt under Sec B k P C for this reason
DRAINS FLOOR ROOF,AREA,CONS. SANITARY Y_ N_
1+,� Owner Due g_ N
� WORK MAN COMPENSATION DECLARATION } gpS PER TRAP /� QO SCHOOLTAX Y_ N_
❑I hereby affirm that I have•cerHfla[e of consent to call-loves,ora `� RECEFr N
mAifimteo(Workers'Comper Ha Il mmmamdifWmpythereef(Sec. GAS EA.SYSITM.1 INC4 OUTLETS �a� PARK FEE Y N
Policy N RECEIPT N
Cam any GAS EA.SYgrEM-OVER 4(EA) BUILDING DIVISION FEE
S
9Certlried copy is hereby furnished. CREASE/INDUSTRL WASTE PLANCHECK FEE
Certified copy la filed with the city Inspection division. —p
CERTIFICATE OF EXOvIPTION FROM WORKERS' GRF-ASE TRAP PAID17.foQ0
COMPENSATION INSURANCE 55WPR.SANITARY-STORM EA 2fiaF. Date Re I I# 06
(Thissection need no be<ampleted titha pemdt b Iorone hundred dollarss
(S100)orlev3 WATER HEATER W/�./FLp� ENERGYFEE Y N
I certify that In the performance of the work for which this permit is Issued, -
1 shall not employ any person In any manner so a to become subject to the '•�.�O� �L
Wmken'Compen"tkm awsofC.UfomkWATER SYS[EM/TREATING
.Data PAID ` SgLM
Z Applicant NEW RESIDENTIAL PLMB. SOFT. Date Remi t#
E O NOTICE TO APPLICANT:R,af,,making this Certificate of Exemption,you
should become mbkct to the Workers'Comperwtbn provisions of the Labor TOTAL:
N
Code,you=at forthwith comply with such provision or this permit shall be
> deemed mroked. BU
LDING FEE
1 c CONSTRUCTION LENDING AGENCY SEISMIC FE
IherebyalBrm that than b a construction lending agency for the perform ELECTRIC FEE Gb
Z onceofthe work forwhkh this permit la bueuni Ser.3097,CW.C.) TOTAL: a
LO Iender'a Name
F Lendees Address QTY. MECHANICAL PERMIT FEE MECHAMCAL FEE
., W lndi thatlhavenadthbapphotbnandkt tethattheabovelnf.m-tins
lacomect l agree tocomply with all tltyand county ordinance,and date laws I PERMIT ISSUANCE � CZ FEES PAID:
Is. 1 relating to building comtrucbon,and hereby au prize represenlativnafthk
N tltytoenbruponthe ve,men p or Inspection purposes. ALTER OR ADD 7O MECH. Date
Z (We)agree to v de an kee a m the City of Cupertlro Receit#
J agaWtllab nb, sa ex soh ylnanywayamue, AIR HANDLING UNIT 8010,000 CFM) SUBTOTAL:
agaWt con or of amolt. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
7 9 CONSTRUCTION TAX PAID:
gv Hent or Date FXhfAU57 HOOD(W/DI1CT)
HAZARDOUS MATERIALS DISCLOSURE
Will the .finedapplicant the futurebuildinggoaipalCdere orhandle 91Zahazardous the HEATING UNIT(TO IOO,OW BTIn
material as defined by the Cupertino Municipal Coda Chapter 9.17,and the Date Recei [#
Health..d Safety Cod9LLVfth 75532W7 HEATING UNIT(OVER 100,000 BT1p TOTAL:
WRl the sppllaor am.building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISS�I�I�,_DATE
which emit hazardous ab contaminants as defined by the Bay Area Air �v`�1(cej��`
MNo
Qpality Mawgement Qist;kl7 BOILER{10h¢pFB'OR 100,000 BTU)
t Yn ai�%u. r ..
have read tech yCod la(squirenbunderChapler 6.95 of BOILER-COMP(OVER 100,OW BT(1) ;,�T t 1591
the California Health ASafety Code, lora ,75533 and 75534.1 to
understandthatift buildin on m yhrve tenant,that It is my NEW RESIDENTIAL MEIN. SQFI
respemibllky to rged 'q the awhich at be met ft MCuVee
p r h e cup 4� W
O
n auffortwiferut a Date ISSUED BY: YSGD
41 TOTAL:
. ..- _ .. r X
Ole dew Nsert nFymet gatards='Icds-yTJnilow tial#idv6,Bl�lilgvwyn.
.Input Permit Number: 21519
PERMIT#: ® ARCHITECT: VALUATION: 111711
APN: LICENSE#: ISSDATE: 3/7191
SITUS STREET: UNDAVISTA DR. SUBDATE: 17/6 PLCHKDONE: 12A71
90
SITUS NON: 10915
AVE,CT,ST,RD: ® LATE CODE:
N.S,E,W: DESCRIPTION: BLOGDEPT:
ADD/REMODEL
NON: ENGDEPT: 3
CITY: PIANDEPT: 1
ZIP: PLCHKREQ:CATEGORY- CMA:
CATEGORY: CTRFIRE: 1
LOT#: O DATEDUE: 12 SANDIST:
ID: FANTOZd Caommcial HLTHDEPT:
OWNER: FANTOZ21 CAaq#Ilp: ST SPOT :
OWNER CE-egpllp: TOTAL:
ADDRESS: CN.sg#II#: INSPHDLD:
CITY,STR Pfi NIE: Residential
'IN
CONTRACTOR: �.�I REWpllp:
R
LIC#: F S. tryAd6ess
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