11100168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19837 BEEKMAN PL CONTRACTOR:RENEWAL BY ANDERSEN PERMIT NO: 11100168
OWNER'S NAME: BRYSON JAMES D 30800 SANTANA ST DATE ISSUED: 10/24/2011
OWNER'S PHONE: 4088930322 HAYWARD,CA 94544 PHONE NO:(510)400-7470
LICE�NISED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f- PLUMB
License Class 1 T Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date N
I hereby a that I am licensed under the provisi ns of Chapter 9 JOB DESCRIPTION:REPLACE 6 WINDOWS&3 PATIO DOORS
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$11834
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31630129.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regu ti s per the Cupertino Municipal Code,Section
9.18. Issued b s Date/Q�� y
Signature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I rereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner nt:
become subject to the Worker's Compensation provisions ofthe Labor Code,I must Date: ZY 4
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of"ark's
1 certify that I have read this application and state that the above information is for which this permit is issued(See.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
-ig of this permit.Additionally,the applicant understands and will comply
all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31630129. 00
DATE ISSUED. . . . . . . : 10/24/2011
RECEIPT #. . . . . . . . . BS000015131
REFERENCE ID # 11100168
SITE ADDRESS 19837 BEEKMAN PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BRYSON JAMES D
ADDRESS 19837 BEEKMAN PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM BRENT M ANDERSON
CONTRACTOR BETH JOHNSON LIC # 31991
COMPANY RENEWAL BY ANDERSEN
ADDRESS 30800 SANTANA ST
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510) 400-7470
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- -
1BCBSC VALUATION 11, 834 .00 1. 00 0 . 00 1.00 0. 00
1BSEISMICR VALUATION 11, 834 .00 1. 18 0. 00 1 .18 0 . 00
1WINREP EACH 8 9.00 522 . 00 0. 00 522 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 524 .18 0 . 00 524 .18 0 . 00
CONSTRUCTION PERMIT APPLICATION
IM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildingCcDcupertino.orq
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION
rr/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 19'1
^ APN
OWNER NAME PHO l 6322 E—MAIL
V- Ota— 1
STREET ADDRESS ) M �l'1 CITY, TATE,ZI� %0 q� l� FAX
CONTACT NAME I ✓✓ PHONE E—MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 2 LICENSE NUMBER gtkIe67 S LICENSECI� BUS.LIC#
COMPANY NAME ✓ � E-MAIL FAX
STREET ADDRESS ` CITY,STATE,ZIP PHONE
�Jt7$Da Sow-iz�,.wa..`� � t,J�l„� R`lS`l�► �a 4 Li
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E—MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK 1
464 Weio CLk-\
o� �o�eor Z l d\�v wS
EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY 0
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co frac'o I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: /n D H
7_27—SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit forC3� R TI�_cornvTER Er suII_=Tr REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. 1:1 MAJOR ElSANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19837 beakman pi DATE: 10/24/2011 REVIEWED BY: bob s.
APN: BP#: "VALUATION: 1$11,834
RIPERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK replace 6 windows and 3 patio doors.
SCOPE
T7
711; 7
Lj
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelindina information available and are otdy an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 L f�. 1'1I) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 9 # Window/Sliding Glass Door
Suppl.PC Fee: (D Reg. OT0.0 hrs $0.00 $522.00 1WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp. Feee. Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
F7
............. .
Work Without Permit? Yes (j) No $0.00 1 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $1.18 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2.18 $522.00 TOTAL FEE: $524.18
Revised: 10/01/2011
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set of plans and specifications Ml.1ST b� ary
jo sits c�urinr construalon. It is uniaw#ui .o r
crdr, e;or alterations on same,or to doviaie
t erefrom,without ap?roval#corn the wild;�y �rs`ici<1.
Th stamping of this plan and spe
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Building Department
City Of Cupertino
LM 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: % PERMIT#
OWNER'S NAME: PHONE # 408 Bq3 O rU ,
GENERAL CONTRACTOR-.-12&,,,«,,oQ ��ec BUSINESS LICENSE#
ADDRESS: g�� a CITY/ZIPCODE:& A. CVV51
*Our municipal code requires all businesses working in the city to have a City of Cupe no business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 2 ��
Signature ate
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
7/71'0'�wne—r/Contractor Signature Date