06010126CITY OF CUPERTINO"sw�ms
BUILDING DIVISION PERMIT
s•%CONTRAC ANON
INFORMATION
110
BUILDING ADDRESS:
PERMIT N0. 0 6 010126
19957 BEEKMAN PL
OWNER'S NAME:
PERNTI iUEDATE
BRYED BILLERBECK
01/23/200p6
NE:
SANITARY NO. CONTROL NO.
ARCHI'IECI'/ENGIt1EEA:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MEM
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LICENSED CONptt CTCRS DECLARATION
Job Description
��to
I bcmhy affom Iba, l un Massed un er pro tit at mapo'e 9 (mmmencint
witb SenbnlIXp)af DlvidonJaf the BvdwWPrafeadori, Coh,WmYlkcm¢u
iq
in poll r«a,oe efrea,.
Clan Lk. w
REPAIR GAS LEAK
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ARCHr1ELT5 DECLARATION
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1 undr M my plw,bdl be ued u public mmrN
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L ka d Pmfudoul
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OWNER BUILDER DECLARATION
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I hereby M. Nu 1 ,m eacmpt from the CanvanoY, L iccuc Law for We
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following muoa (Section 7031.5, Bu, — tlml Pro(emou Code: Any city or only
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which IaquUu .Pamir so cuMrocl, ,Iter. tnpmn, dcmedisb, nor mpair uty naucuuc
$2000
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pAm In iu lsamne.al,u mquirc,tM,pplkem for wch pc.11 to Bkatiincd rwe.of
ftpm.idon.,nrC.for.Lico.Uw(CUPW9
Sq. Ft. Floor Area
Valuation
mm he itliamadpto,ocolIn the
.a
frnmoro in with section'Iff,)) of Oi' on J oftk Budnoa, and Rofevlana Code) or
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Nu be a eacmpl therefrom "t the huit for the dlegcd caempuon Any natation o!
f
Occupancy Type
Suylao N31.5 by Mwppliam for a pem0t rvbjecu Itc.pp4unt m a civil PeothY of
not mmc W.n fin b«dred "bo,, I55BUl.
❑ I, u ower of the proRotY• v my wplgcu whh wgu u 0nv,oW mmpmnUaa
Required Inspections
wBlaonKw«r..ndwe,Bea«.eanoNnwtaed«on�mr«�k(s«.ra+.eud�,
,rd Profemau code Tho Coot LJcraa law don oro tpply W ,n awncr of
proPasY win ddlda a immnvu tbruean, and weer da„uchamk NmvJf err Wmugb ha
^"n emPbYcn,pravided ihtreixhimprovetnonu,rtrotio,crdrW araRaW f«.vie a,
however. sloe MiWint err 4npronotcot a,aW wiNm one Yev of compktian. sloe owner
W 0dcr vitl hue Ue b«den of proving W I k did rot bdW or Improve (m puryoe of
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uta).
I$,La comuerinG with
thrcpofds ec.7(y,wnwodYwr Ic Ccmoavors i-
aruuun Ibe (Sec. las, and Py ou C, to Gammas!, LI-
woos of who or im therein. Nd.
<cue LAw dau mlapPIYman owrc or ptoKnY vba
cot
dnr,unprv.o
who mnvuu r,uch WoleaA tconuaewA,)Ikuued ptnumwLitt, ConoutaS
❑Ismer quMer See .BhP forw'.
C3
Due / O
W COMPENSATION DECLARATION
1 heaebY � tmhr pwlsy of pupny m of Ih following Ikrl,ruimc
-
1ftte no will adnvin, Ce flcue of Coucm in self-Nome for Worter, Canpmm
• u proviticd for by Sccdon 7100 of the I a Code, for the pufmmvee of the
wort f« which NI, pomp Is Lvucd.
❑ 1 hue arta will m inuin Wcr , Compemuiwt loom . u rcyuirtd by SCNm
J'IU0 of Ne I�bm Cade, fa Nc pMmmancc of 0m work far whkh dv, permit a ace!
My Wohu', Comptruadon 1. c,Mer,M Policy monks art:
C... Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
where ch Aced nw M completed lithe pemtk a for ono It mWTI (5100)
or s )
1 cm Y hoL orperforma of a anwart fa whicb Na permit is iwted. I "I nor
,mplmyanype manymanar unbaome j t IeWvocr Caopccct.
taw, of Cdif Dat
Appll a t
Ea
.1, ermakin6 NisCii.a
NGTmlcomc
WCottlyou,hauld
of Nc Code, you mtw
bcctmc wbjito ft th
m the 1 hui oruii,
z
ormidom
oml
f«Wwish camplY vel uch pmvidau «NI, permit thdl M damcd mrukM.
t corny isl..
'
Coot rm LENDINGAGENCY
uCUON
thiseermil a,can,Vunlsc time•fa the pafarm,rta or
1 bor
.Ging
the work for which this permit a 4vucE (Sec. Jo9l, Cir. C.1
wlich
.
z
L<MCYs Nara
LcMeri Adttreu
Q
1 anlrY But I ban rtad Nie application and auc Nu the tbo,c infotm,aon a
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const. I, g= b comply MN Jl city turd county mGim 'tuol,ux laws rtluintb
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building conwunion, and bertby attherin, reprtoanon of Na city on cntn upon the
fbl
abwe.memi«ooll property for lupocuon pop..
Wo) atmc to tan, itdamvfy and ky h,rnrn u Ike City a( CWcoum agdut
raj!
ili' gmenu.eo,u In an)'w.y,an,e agavue,dd City
Z•
hzoft *.1Lbm,Y
in cWyy`v nm of DERSTunj of N'y�D WIL
APPIe'IC// NT UNDERSTAf S ND WILL COMPLY WITH ALL NON-POINT'
Issued by: Dale
SO CREGULATI N .
129
oh
Re-roofs
urt aAWbc`coV9&=US MATERIALS DISCLOSURE w`
Type of Roof
WIII Nc app bwWCn uartorb haurdoudStimy
'cptot
f. Murri
ti
cornea br C Naw MUMcipal fodc. Chaptm 9.12 ,cid Ne Hu1N ,cid Safer
AjKc,h,'
Setoro
All roofs shall he inspected to any roofing material being installed.
r�
❑Yea T
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the yrpliunl or f",� boiWing="nr um equipment «hvlccs which
II ha>mdau, dr mnumincner u dcnned by the Bay Area Air Qudlly Mroo,Vb e o
all new materials for Inspection.
uictl
❑Yu I&fto
ahew tf Ctapim&95 orthe Califm
1 e rt,d Nebvardwtmaerialt rtymk
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Iva HcdN l goYCode,SavaR]y505.255JJW2e5Jd.lwderavdtheirtk hwOEog
dm eat mar hon . , t u a my teprndbdity n nadry do oaap.nt or we
mqn' IH, kbm t riortoamn,cor.crnirrueof pto(Y.
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Signature of Applicant Date
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All roof coverings to be Class "B" or better
0 m,ushadmd, 1 ate
r e Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
�Ury OF Fax (408) 777-3333
UPERTINO
Building Department
JOB ADDRESS:
11957 L«�1-,j PL-�(--
PERMIT #
0 6,Va;26-'
OWNER'S NAME: ; 6v t c.cE23Ea�—'
PHONE #
GENERAL CONTRACTOR J—Tie-. Pc -v vAa, N
FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
Owne -Contractor Signature
V--3106
06
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
l /L LYw 61
e c 9303
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Til
Owne -Contractor Signature
V--3106
06
Date
GCS
,TY OF
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE G 6/ o/D/Z,�
PERMIT APPLICATION FORM
APN # 3 1! 3 Q I y b
Date: / 2 /C),(7
Building Address:
�`l�ls � �EEKvtgv� PL�1Cc-
BPGAS
Owner's Name:
Phone #:
/ PPERMITFEE
Plumbing Permit Issuance
Contractor .� n Phone:
`J I1- PL0 3, c\ ob I2 -7y
License #:
6y9303
Cont ct: Phone:
Cupertino Business License #:
tu4.yLD5,,J&Qq,.(cV- 92-8-30)y
Pbl . Fixture
Building Permit Info:
BPWSVCS
Bldg ❑ Elect ❑ Plumb �-**/
PLUMBING -
Job �Description: P,+s L� hI✓z
Sewers
Residential Commercial ❑
BPSEWAGE
Cost of Project:
PLUMBING
•
Qty. if
Annl,eahle Fee tP
Fee Descrintion
Fee GrouD
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
/ PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING -
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING