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13070045CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19956 BEEKMAN PL I CCONTRACTOR: HILAREY AND PAUL I PERMIT NO: 13070045 I DAVIS OWNER'S NAME: HILAREY AND PAUL DAVIS OWNER'S PHONE: 4082550069 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 1-4 9.18. Signature Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 Signature Date 1V /I3 19956 BEEKMAN PL CUPERTINO, CA 95014 JOB DESCRIPTION: RESIDENTIAL DATE ISSUED: 07/08/2013 PHONE NO: COMMERCIAL TO CLEAR CODE ENFORCEMENT CASE: INSTALL (1) DESIGNATED GAS LINE FOR FIRE PLACE INSERT Sq. Ft Floor Area: I Valuation: $2000 APN Number: 31630114.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DA RMIT ISSUANCE OR 180 DA M L CALLED INSPECTION. �7 Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sections 25505, 25 33, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional MEPMiscApp_2011.doc revised 06121111 Em CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE 19956 BEEKMAN PL DATE: 07/08/2013 REVIEWED BY: MELISSA IlaADDRESS: APN: 316.30114 BP #: *VALUATION: 1$2,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex $70 PENTAMATION PERMIT TYPE: 1 RPGA i WORK To Clear Code Enforcement Case: INSTALL N DESIGNATED GAS LINE FOR FIRE PLACE INSERT SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Piping, Gas < =4 Outlets 1PGASRES 1 # $70 Permit .Fee: Suppl. Insp I'ee PME Unit Fee: $70.00 PME Permit Fee: $47.00 Consiniction :Tax. Administrative Fee: IADMIN $44.00 Work Without Permit? (E) Yes 0 No $117.00 TOTALS: A _ $70.00 Strong Motion Fee: 1BSEISMICR ,Llech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 Elec. flan Check iLl,eh. Perinit Fee: Plumb. Permit Fee: IPPER1l1IT Elec. Permit Fee: Other ,Alech. Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec. Insp. 11ech. Insp. Fee: Plu1,17h. Insp. Fee: Elec. Insp. Fee: VOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). "These fees are based on the preliminary information available and are only an estimate. contact me Dept for aaan -t rnfo. FEE ITEMS (Fee Resolution 11 -053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check 1 'ee: Suppl. PC Fee PME Plan Check: $0.00 Permit .Fee: Suppl. Insp I'ee PME Unit Fee: $70.00 PME Permit Fee: $47.00 Consiniction :Tax. Administrative Fee: IADMIN $44.00 Work Without Permit? (E) Yes 0 No $117.00 1 financed Planning trees: A Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldiz Stds Commission Fee: 1BCBSC 1 $1.00 $326.50 $0.00 S LF $326.50 Revised: 07/01/2013 �gS.l9Js OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(alcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property. improvements specified at: We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of . your responsibilities and.possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building_ permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I. understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner— Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. WW2. I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may �pro ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. .44. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license n4mbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 117 - t al value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered. an "employer" under state and federal law. 6. I understand if I am considered an "employer" under state and federal law,1 must register with the state and fe al government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 4 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family res ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pelformed under contract with a licensed general building Contractor. . I understand as an Owner - Builder if I sell the P roperty for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 - .. - We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of . your responsibilities and.possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building_ permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I. understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner— Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. WW2. I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may �pro ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. .44. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license n4mbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 117 - t al value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered. an "employer" under state and federal law. 6. I understand if I am considered an "employer" under state and federal law,1 must register with the state and fe al government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 4 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family res ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pelformed under contract with a licensed general building Contractor. . I understand as an Owner - Builder if I sell the P roperty for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 J&n-ue I understand I may obtain more information regarding my obligations as an "employer° from the Internal Service the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSL13 (2752) or www.cslb.ca.gov for more information about licensed contractors. ,ZY10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide 'by`-a 'by`—a1f applicable laws and requirements that govern Owner - Builders as well as employers. X12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY. (DIRECTIONS: Please complete the following construction lending agency information.) 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and _ returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's sign0ire. Property Owner's Signatur e_i--� Date: �r -------------------------------------------------------------------------------- - - - - -- -the- --------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: _ Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 Beekman Place Yfomeawners Associatian c/o Affirmative Management Services P.O. Box 477 • Campbell, CA 95009 -0477 Phone: (408) 244 -0909 • Fax: (408) 244 -0090 April 8, 2013 Hilarey Davis 19956 Beekman Place Cupertino, CA 95014 Your gas line has been approved. You can paint it or the association can arrange to get it painted during the paint touch up project scheduled to occur this summer. Sincerely, Property Manager Beekman Place HOA Enclosure: Approved Exterior Architectural Application ?ye Ye /sere to imp) ove yozl,.- ga«rlty oflfe Building Department City Of Cupertino 10300 Torre Avenue - Cupertino, CA 95014 -3255 C O P E RT 1 N O Telephone: 408 - 777 -3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR: LIST JOB ADDRESS: �;_' al PERMIT # OWNER'S NAME: YZ PHONE # 006 9 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY /ZIPCOD,E: '. a O / *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL' BE .SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 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 Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /, kea&'. ' Owner / Contractor Signature ale Date I I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 19956 BEEKMAN PL I CONTRACTOR: HILAREY AND PAUL I PERMIT NO: 13070045 I I OWNER'S NAME: HILAREY AND PAUL DAVIS 1 19956 BEEKMAN PL DATE ISSUED: 07/08/2013 I OWNER'S PHONE: 4082550069 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class Lic. Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provi r by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date I� OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. It after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sour?4 regulations per the Cupertino Municipal Code, Section 9.18. - Signature Date Q� 3 TO CLEAR CODE ENFORCEMENT CASE: INSTALL (1) DESIGNATED GAS LINE FOR FIRE PLACE INSERT REVISION #1- RELOCATE GAS LINE -ISSD OTC 7/29/2013 Sq. Ft Floor Area: I Valuation: $2000 APN Number: 31630114.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA S F OM LAST CALLED INSPE TION. Issued by: Date: % ZR l RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. �I Owner or authorized agent: 607,eG Date: /� C CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building a2cupertino.org CUPERTINO 1 1-9 1 S ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PRO APN # O N PHO E Off/ ' STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUnAER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGLNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME - E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WO all �I n EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) 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 M_A_JTDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDrrION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES r ` ry 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 auth /ze gent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to in ing traction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Date: i / ;W 3 Signature of Applicant/Agent: l' SUPPLEMENTAL INFORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_201 I. doc revised 06121111 Page 1 of 1 ] u—I �' ` REVIEWED FOR CODE COMPLIANCE CHECKED BY Reviewed By. rj ' T - C, L: 6 (D .�J Is MUST ha K"Pt at the i, +c, M,2k 0 any 6"le CJ;.1i!dinq, Official. `sPI.i , ~ications SHALL NOT rz, of �r .ter, rovai of ine wic _<tion :u iiS of �,;y City Ordinance or State Law. -T 2Q�3 PERiN' I T NO. _ 1 3 ()7 E -Q lac. 0 ent r m -- �.._... ME REVISIQN# ( https: // mail - attachment .googleusercontent.com /attachment / ?ui= 2 &ik =84f l 6089a7& view =... 7/22/2013 i Beekman Place'qfomearvnersAssociation c/o Affirmative Management Services P.O. Box 477 • Campbell, CA 95009 -0477 Phone: (408) 244 -0909 • Fax: (408) 244 -0090 July 23, 2013 Hilarey Davis 19956 Beekman Place Cupertino, CA 95014 Your gas line has been approved. You can paint it or the association can arrange to get it painted during the paint touch up project scheduled to occur this summer. Sincerely, 4 - Blake F eeman, Property Manager Beekman Place HOA Enclosure: Approved Exterior Architectural Application Ve'-e ., ere to improve your quality fife t Beekman Place Exterior Project Application Homeowner name: 0- l Address: Beekman Place Cupertino Email: i (i ' Phone: d 6 O w o c TYPE OF PROJECT • Windows • Frame material O Vinyl, color O Wood, color O Metal / aluminum • Sliding glass door • Frame material O Vinyl, color O Wood, color ROOF O Flat portion (check a box for type) O Foam O Tar & gravel (aka "built -tip roof") O Other 0 Sloped portion (check a box for type) O Tile, color weight O Composition O Wood shake • Air conditioner 0 Antenna O Front door, color (must be a color used on the building) • Garage door 0 Satellite dish 0 Skylight(s) O Solar panels 0 Other Provide a brief project description and attach a picture or sketch showing where it will be installed along with co e.g., for window frames, sliding glass doors, or roof tiles kloW. .L C Willa licensed contractor* perform the work? fYes 0 No • Proof of contractor's insurance provided: 13 Yes I Contractor's name: _ �� 4zo-w- 1rljee-1L ,4CG CoN5/, v- i�'%2L Contractor's phone #: License 9: PLEASE READ & SIGN BELOW I understand or agree that: 1. It is my responsibility to determine whether a permit is required for my project and if so, to obtain the permit. 2. This project may require a contractor *. If it does, I must use a licensed and insured contractor. 3. The BPHOA Board may require modifications to the job specifications or request that special conditions be met. Said modifications or conditions shall be provided to applicant in writing. Such changes or modifications shall be made at the applicant's expense. 4. The Board may require additional information in order to make a decision. 5. My application is not approved until I have received this form with the approved box checked below. 6. The project must be approved before I can begin. 7. 1 am responsible for maintaining the improvement and this responsibility shall transfer to the new owner(s) and subsequent owners indefinitely. I also agree to disclose the nature of the installation and the maintenance responsibility that goes along with it to any buyer. 8. I indemnify the Association and hold it harmless against any darnages or costs of a lawsuit that may be filed due to the project / installation described above. Homeowner signature Date NOTE: BPHOA's board meets monthly, therefore please submit your application several weeks before you plan to start your project. When completed, scan this form and supporting documentation, e.g., product data sheets (aka "cut sheets) and email them to blake@thehoamanager.eom or mail them to Affirmative Management at P.O. Box 477, Campbell, CA 95008. Y OU will receive an acknowledgement within 48 business hours. Approval could take longer ifyour request is not routine or more information is needed. HOA USE ONLY Check the rule that was sent with this form or include actual text of rule below. 0 Air conditioner 0 Driveway 0 Front door 0 Garage door 0 Roof 0 Satellite dish or antenna location 0 Sliding glass door 0 Skylight(s) 0 Solar panels 0 Window 0 Other W Approved 0 Approved with contingencies 0 Denied, additional information requested Reviewed by (printed name & title) Date 0 Reviewed or V Approved * Licensed & insured contractor required for the following installation§ or projects: Air conditioner, satellite dish_ garage door, window(s), sliding glass door(s), skylight, and projects involving I l OV or 220V electrical (not low voltage devices, e.g., some lighting, irrigation controllers, etc).