06040182 (2) �(C�,y CITY OF CUPERTINO
CITVOF PERMIT APPLICATION FORM OW00
CUPEkTINO
N4 Date:
3501-- y_ -
Building Address: Mailing Address (if different from building addre ):
,-Z o s 5 ss
5 7,e. s. Tri
1
Owner's T e Phone#:(Oc•y) W0,– V(/ -7 ,7-
Contractor: License
License
rc 50
Contact: - 37Phone: 3777 Cupertino Business License#:
K Le)r ¢S Fax:
Building Permit Info:
Bldg El""
Elect ❑ Plumb W Mech ❑
Job Description: &ep •,S b,W^ .r,, 11cLL r, T:&c, P S'T. A—d 13,,to Lsr Ti{t
Residential 44e,, v,L,t <nJ Commercial EJ T,4'-4 `r
Sq.Ft. Floor Area: `., S. Sq.Ft.: 2 D G,lssp
Cost of Project: ,je I/ $3b Occupancy Group:
–3
Type of Constructions Please check this box if the project is a
�*"— second-story addition: El
ro'ect Size: Standard C"- Laze ❑ Ma'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 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
BCONSTAXR Constax–Resi/Mobile BUILDING
BELEC1000 Elec 600V <_ IOOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elee Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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SCITY OF CUPERTINO
Uri 6F PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW 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 Plan Check 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 Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> IOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRE -OCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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(I CITY OF CUPERTINO
C1W OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
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
BS WIM 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 Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
3 of 3
CITY QF CUPERTINO
BUILDINGDIVISION PERMIT �£CONTRt1CT0IiINFORMATION �;'
BUILDING ADDRESS: BILT, BECK PERMIT NO.0 6 04 0 18 2
20985 PEPPER TREE LA
OWNER'S NAME: PERMIT ISSUE DATE
Ift BILL BECK 04 2.7/2006
.ONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB NECH
loo LICENSED CONTRACTOR'S DECLARATION Job Description
u Fj I bereby affirm tat 1 he lisvd under Pmvivmu of Chaptar 9(commencing
wigs orcemeoffee"w on3nrumBa n�ananorruiamcae..ndmyReam is REPIPING DOWN STAIRS HALL FOR TILE
in full force as cera. 9S645p
Liccgc n. Loc.
Date y-2-a- a ConnectorM
�. w.��-..��_ UP STAIRS HALL AND ASTER BATH FOR TILE
FF
ARCHITECTS DECLARATION INSTALLING SHOWER VALVE AND MOVING SHOWER DRAIN
l k 1 understand my plans shall W used as public records
>yU
-Oy
Licensed Professional
<g OWNER-BUILDER m Ce ConanON /
f 1 harchy as 1 I. .Boxes perm the Conan rs License Law for IW
p O folloWhich mason.Permit
7 mebr, .etc,.and Pla.dmiaN C,or My say
ter rue my
<m which im its.a permit requires c� 0. alter,improve,demolish,a repair any aurum c
?iy tAIAA
ormisscensed pursuantoto pro pplisionso far each Permit micarel. n gneJstam.m
< terWis licensed parser roto of Diving of or
eo Busiest Lag.taw(s Cat)or
Sq. F[.Floor Area ['
'1-0 tan a is exempt
with meiane and of Division l di Ne Busmen and Professions late,of JUAI 5
Nal he u exempt tMmfrom and Om basis for Ne alleged exception.My violation of
Schon 7031.5 by arty applicant for a permit subjccu to applicant to a civil penalty of APN Number _ by
mm re NType
moan five burden]dollars(S5M).
0 I,uownerofl pmpmn mmyemployeeswitwagesuIheamlecompegadon,
will Pr cite work and the metier i nosinmndes ora w du(snot&(Seca 7066,Bear.
= r
and da to wrir.can:The cture n Lining law sae..a apply m an owner or Required Inspec
property who builds or improves Nercan,and who do:ssuch wartlemselfur through his
awn employaa.provided Nat such improvements me not intended maReres for sale If.
however.Ne Wilding or impmromeret is mid within am year of campletia,the manner-
builder will have the tender of proving that he did nm build or improve fm PURow of
sale.).
0 1,as owner of am property,am exclusively conuawting wit licensed.raacmns m
construct to project(See 7060.Business and Professions Co]e:)The Commences Li.
Genu law does not apply as m owner of property who Wilds or improves demon,and
who eontemss for such pmjeeu tit aeonuzme(s)licensed pure ant m the Comaetors
License Law.
0 1 am exempt under Sec. B&P C for this mason
Owner Dace
WORKER'S COMPENSATION DECLARATION
1 hembY a(fim under pwltY of perjury arc a(ac following dalandag:
0Iham and will maintainection 37M of Cagebto ode.fore, Wmrma ce of d- /\d•A_`//,/Naa�d//�
soba:,u provides for mi Section 7]00 of tc later Cae,for the performance of dm
wort for which du permit is ix.ua.
37 I have and will maintain o pcors Compensatas.,ifte%Iguana,h mydar]t i Same i.
My
3700.1'ft Labor Code,for ande peRae camx ofthework for wbrstis permit i.issued AIT1
My Worker.Campegadon hmra.e Arnim as Policy number art: (1
Cartier.�Policy No.: IJ
�XCERYIF(CATE OF
E EMP ION FROM WORKERS'
COMPENSATION INSURANCE
(IMssettbn recd nos bo complomd if ter permit is poor.hundred dollars(SIM)
or Ica.)
1 anify dent in the per(omaac of IW wart for which to permit is issued.I shall.t
employ any person in any manit ?asm�rm becoemce subja t to an Workers'Countermen.
Law s of Califomia�Daue <,�?—
Apps0 11....E
NOTICE'FO APPLICANT.If after making to Certificate of Exemption.you should
become subject in to Workch Campcntadun provisions of use,Labor Code,you muss
.JZ faMwit comply with such havotex;or tis permit shall he domed revoked.
zO CONSTRUCTION LENDING AGENCY
.�
E~ Ibor Which.Where ementernitat leading agenry far dm perfomana of
D: > La were far wninn uta permit B a..a(sera 3097.iia.c.)
CL M Lenders Nam.
:)Z larders Address
U Q 1 ardfy that I have lead this Wiseman mal.ale that the above iNoma kin is
U, ^F correct.l agmc to comply wit all city and county ordignms and sus laws relating to
O V building convection,and hereby auhorlm repreuratives aides city to enterupnn the
C2) ahovo-mondoned es.property for ie penes puryaua
t,+G. (We)agree m ave,indemnify and kap harmless to City of CupeNna against
Z incoidnscrec,of to
expenses which may in any way accrue a{slut mid City
C)z to easnequenee of the{ranun{o(tis Remit.
ASOURCE_REGULATIONS.PPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date y� 27_,-6 G
V-27-fiG Re-roofs
Sigwure of Applicare Conlrxtor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will toapplicantor(.hero Wildingoaupantvomor Mndlcha oomamdal
as debond by de Caputo.Municipal Cade.Chapter 9.12.and the Heslt and Safety
Code.Section 25532(x)7
CY. [W All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection,I
Will the applicant or(mum Wilding occupant use equipment or dcviw which g anns agree to remove P
..it havardous air contaminants as de0ncd by the Bay AM.Air Quality Management all new materials for inspection.
Dimict7 - ,l,�
0Yu lyra
1 have mad the h.a aaia materials myuimmcna.der. Chaptor6.95o1"due CAi(ar.
nix Heald&SaRtYCae,Secdoa 25505,25533 msd25534.1 undersand dazifte Gelding
dw not cumhnly have•tame tat it is my responsibility m notify ter Occupant of to
myulremcnu which myth be mel(alar m issuance of a Cmdfium a(Occupancy.
/Wi��•'r�/"/W4.� ¢_Z.,_r,a Signature of Applicant Date
Owner onuthamcd agentDate All roof coverings to be Class "B"or better
Community Development
4
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
ef.M �TINO
Building Department
JOB ADDRESS: PERMIT #
PQ � Q 6 o Cr o/ F-7z--
OWNER'S NAME:'ir3 l PHONE # r�f 2mz-3?7 7
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: l�C�r
Signature Date
Please check applicable subcontractors and complete the following information:
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
wm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35912018 . 00
DATE ISSUED. . . . . . . : 04/27/2006
RECEIPT # . . . . . . . . . : 34175
REFERENCE ID # . . . : 06040182
SITE ADDRESS . . . . . : 20985 PEPPER TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER BILL BECK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95015
RECEIVED FROM . . . . : RICK FLORES
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : BILL BECK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95015
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- - --------- ----------
BPERMFEE VALUATION 1, 550 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
BPFIXTURE UNITS 3 . 00 27 . 00 0 . 00 27 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 1, 550 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 293 . 95 0 . 00 293 . 95 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CASH 293 . 95
TOTAL RECEIPT 293 . 95
C
CITY OF
C ki 0
UPE TIN 24Alf Mi
Assessor's Parcel Number:
Name of owner. 73-1 1 L e k,
Project address. 'Z In 11,f 5 Ta-
Contact person. 2 e- r..5 Phone. ��6 -2 -337 7
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y� N
Is privacy protection planting required for the project? y
On what floor(s) is work being done?
Brief description of work. ll'ee, ZwA� rx, /I e,
yr\
Code editions: 2001 CBC (Y - N)2001 CFC (Y -N)2001 CMC (Y- N)
2001 CPC (D N)2001 NEC (Y - N)
Effective II/1/02
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CUPEI�TINO ? -
Assessor's Parcel Number:
Name of owner. 731
Projectaddress. 20 C1&15
Contact person. 2 I c is Phone. 4��o$ 2 2 - 3-77 7
Fax.
Net square footage of lot. NA
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y>` N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
lNu �
Brief description of work. 1,0%e 2
Code editions: 2001 CBC (Y -N)2001 CFC (Y-N)2001 CMC (Y- N)
2001 CPC ( N)2001 NEC (Y- N)
Effective 11/1/02
LAPR
Copy 2 a 2006
ASSESSOR a
Plan Review Process Work Book Page-8-Revised 4/28/04
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