13090021CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19996 BEEKMAN PL
CONTRACTOR: BUILDCO ENGINEERING
PERMIT NO: 13090021
& CONSTRUCTION
OWNER'S NAME: DILIP KHADYE
799 FLETCHER LN APT 204
DATE ISSUED: 09/05/2013
OWNER'S PHONE: 4089666162
HAYWARD, CA 94544
PHONE NO: (510) 706-8933
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
9> e o
INSTALL (1) DESIGNATED GAS LINE FROM MAIN LINE
License ClassC Lic. #
——+-
Contractor �_WA(.- � ate
TO
(N) KITCHEN STOVE
I hereby affirm that I am lice a rider t provisions o Cha er 9
(commencing with Section 700 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
of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $1500
)erformance
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31630110.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 18 OF RMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D T CALLED INSPECTION.
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
e�
sue b Date• ./
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source reg tions per the Cupertino Municipal Code, Section
9.18.
6 cr
RE-ROOFS:
installed. If is
Signature Date O
All roofs shall be inspected prior to any roofing material being a roof
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ ER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cuper 'no Municipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 25 , 25 and 25534.
Owner or authorized agent: ` r Date Ay
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
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address-
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
n'1
GENERAL PERMIT APPLICATION V
MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION (�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
MISC(408) 777-3228 FAX (408) 777-3333 • building(cD-cupertino.org
MEPMiscApp_2011.doc revised 06/21/11
PLUMBING MECHANICAL []ELECTRICAL MISCELLANEOUS
PROJECT ADDRES P mo \
APN # I
OWNER NAME 01,1_110 A^ J r
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E-MAIL
STREET ADDRESS
CITY, STAoTE,E, ZIP �(o
FAX
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CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS n r
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CITY, STATE,
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FAX
❑ OWNER ❑ OWNER-BUII,DER ❑ OWNER AGENT
- CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME P O
LICENSE NUM7
LICENSE TYPE e��
BUS. LIC #
COMPANY NAM
E-MAIL (7 p �� �I
FAX
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STREET ADDRESS �/
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CITY, STATE, ZIP �� ��'/
PHS1,- A, C29 a3
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD .,DUPLEX ❑. MULTI-FAMQ.Y
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
-
k eta
3 !A/ 64Lim 1-.s�
TOTAL VALUATION: •
"�
By my signature below, I certify to each of the followi
I property owner or authorized agent to property owner's behalf. I have read this
application and the information I have provided is c ect a read the DescriperifF it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c tru
n. authorize representatives of Cupertino to enter the above-idenf ed property for inspection purposes.
Signature of Applicant/Agent:
Date:
S PL
RMATION REQUIRED
(p
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
1VQ r7nAr A Tn1D — R'FTT7 ."11T%T("_ nl[VlQl(1N
APPLIANCE / EQUIP TYPE
ADDRESS: 19996 BEEKMAN PL
DATE: 09/05/2013
REVIEWED BY: MELISSA
UNITS
APN: 316 30 110
BP#:
*VALUATION:
1$1,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
$70
PENTAMATION 1 RPGAS
PERMIT TYPE:
USE:
;.upx1 /. Insp T, ee
WORK
INSTALL N DESIGNATED GAS LINE FROM MAIN LINE TON KITCHEN STOVE
SCOPE
$70.00
APPLIANCE / EQUIP TYPE
FEE ID
--
QTY/FEE
QTY
UNITS
BP FEES
Piping, Gas <=4 Outlets
1PGASRES
1
#
$70
Permit Fee:
;.upx1 /. Insp T, ee
PME Unit Fee:
$70.00
PME Permit Fee:
$47.00
Construction Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes (E) No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRAVDOC
$70.00��
Strong Motion Fee: IBSEISMICR
iWch. Nam Check
ilfec,h. Permit Fee:
Oilier Hoch. Imp.
jAleeh. Insp. Fee:
Plumb. Plan Check 1 0.0 1 hrs $0.00 1 f'lecr- Plan (.heck
Plumb. Permit Fee: IPPERMIT I IFaec. Permit Fee:
Other Plumb Insp. 0.0 hrs 1 $47.00 c)ril", Iilec. Insp.
Plun?b. husk). Fee:
IElec. Insp. Fee:
NOTE: This estimate does not include fees due to other uepartmencs (ie. rianning, ruuuc rr ulna, 1'SIV, uunwwiy .��•.��•
—d nra nnty nn O¢tisnntP_ Cnntaet the Dent for addn'I info.
" Lr LG I, eu:. Z. uswa cw w.r. .............. I...
FEE ITEMS (Fee Resolution 11-053 E . 7if ILI2)
_.---------- -- -------
FEE
--
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC 1"ce
PME Plan Check:
$0.00
Permit Fee:
;.upx1 /. Insp T, ee
PME Unit Fee:
$70.00
PME Permit Fee:
$47.00
Construction Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes (E) No
$0.00
A dvanced PhMn ing 1 ees:
i
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
PA L
$209.50
$0.00 d
$209.50
Revised: 07/01/2013