06060178 CITY,OF CUPERTINO
BUILDING DfVISION PELT �U _�'1LA.Cr��'�O,N f
BUILDINGADDRESS: PERDUE CONSTRUCTION PERM"NO.06060178
19028 TILSON AVE
OWNER'S NAME: PERMIT ISSUE DATE
ROBERT & CLAUDIA TEMMERMAM 171 MAIN ST
NE: SANITARY NO, CONTROL NO.
(650) 941-8795
ARCHITECDENGINEER: BNLPERMITINFO
BtELECT
u 1� PLUME
MECH�
Sop LICENSED CONEACTOR'S DECLARATION Job Description
1 Wmby affirm that 1 am Ikessed under previsions of Chapter 9(commencing
with Section 70110)of Division 3 oflhe Businm and Profcasium Code,and my liconse is
^.� in full fame and effect, REPLACE FURNACE - INSTALL A/C
j n Zt,, License Class Lk.I
t J Do¢ Comment,
0 ARCHrIECrS DECLARATION
Q I undmann l my P Ma ehail be used u public mends
0y
u. Licensed Professional
S 0 3 Oat 1 am exempt
from
DECLARATION
m
ZOO hmhy.(Sete on 1 am uempt item tite Coniraerars a cense law for the
ypo followhich
roman.Permit
7omst 14 aincused)",demli Code Any city carcounty
I$ which mqulm a pcnnil m constru t alter.WPmw,demolish,nr repair any su enure $5000
prior.its issuance.the requires Ute applicant for such permit On file a signerlatslemat Valuation
Mthat he is licensed pursuant to be pmvislons of he Comment's Idcenee law(Chapter 9 Sq.Ft. Floor Area
t-g (commencing with Schon 7000)of Division 3 of the Business and Profeulou Cade)or
that as is the basis
r One
ed
- violation of
Section 7031.5 by any applicant for a permitsubjeeu Ne applicant to a civil penalty of
not more Nut 6.hundred dollars(5500} Occupancy Type
❑I,ut of NepropMy.mmywploymwlmhwagautimbuleampemadw.
will do de work and Nl Montan,is notmlemed.-Rated fown(Sec.7044,21td"••• Required Inspections
and Pmreat Int Cade.The Contractor,Licems Law dM3 act apply m so-Of 9 P
property who builds or im prom Merton,and who dm such wok himself or dmomgh hu
awvempltym,provided mho wch imProwmenu see nolinlendetl ooRcmd(car nle lf.
however,Ne building oImPmwmvin4hat withinorc year of ample (Or ase owof
builder w01 Mw the WNa of proving that h did Out Wim m improve far Purpom Of
ule.).
9J 1,is Ower a(the Property.am Inclusively anueting wish lured conuMas m
amused the prolan(Sec.7006,Business and Profraslou Code:)The Contractors LI-
cove law docs not apply to an ower of property who Wilds or improm Nerttn,ad
who contracts for such pmjemt with a conuexor(s)licensed M'nuant to she Contractors
Lice.Law.
131.9 mpwn�d}m 5t��yj ,�-(/� Bk PC far Nia an
t37`10
m t6A.v �✓,^^"�`^i`�`�_"-' Dame
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
I have andwill rmu Wm a Cenifiau of Consent to cif-alumforWorkers Conpcn-
iun,u Provided for by Section 3700 of the labor Code,for she perform ua of the
k for which this Permit is Wove
1 have and will maintain Workeff Compensation luuance,u required by Section .
of Ne Labor Code,for Ne performance ofthe wok for which Ods permit u issued.y Workers Compemauan Insurance ander and Policy number art:
Cartier: Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Crus section reed am h completed nth permit is i.e.hondmtldels.(SIM)
Or kat)
I cant fv that In the performance of work((caar which this permit is issued,l shall not
employany�rsunmtryarmy,t�ah�e LbleclieNeworkms'Compensation
Laws, C• m��aL^ !JJ W70-4 11..
NOTICE
Nsubject
0 the APPLICANT'.If.Mur making this CeniOum of Exemption,you u most becomeicompto it Workeb Compensation provisions of Nelabor Code you meal
O vim. foMwiN comply with such provisions other permitshall hodametl revoked.
OCONSTRUCTION LENDING AGENCY
1-m I hereby affirm that Nem is a constructed lending agency for the performance of
C 7 the work sur which this permit Is issued(Sec.3097,Civ.C.)
aQ Lenders Name
0 z Lenders Addmas .
U 0 1 certify that 1 haw mad this application and sum asst she show information is
correct.l agme w comply with all city and county ordinances and sum laws toladng to
O V building comwmimn,and hcmby suthorim rtpmenwiws of Nis cirytocntorupnnthc
above-mentioned properly far insaccuon purposes.
(We)agme to sew,indemnify and kap humlat the City Of Cupertino against
„E"w fA Iiabilifics,(udgmemu.cam and expema which may in try way amus,alaimt said City
V^z" consequence of the,
ANoaddrig,of this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
FP R�ER�cu Dlvs. G�j��Ob Re-roofs
Signuuunt oo�l'ApplianVContraclor LOU,
HAZARDOUS MATFJUALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding aaupulport orhandle hamdous material
all defined by the Cupenina Municipal Cade.Chapter 9.13,and du HcaM and Safety
Code,Section 2.5532(a)7 !ate All roofs shall be inspected prior to any roofing material being installed.
❑era
Will the applicant car future building occupant use equipment o dcvlm Mich If a roof is installed without first obtaining an inspection,I agree to remove
.mil haafdnua air contaminants u defined by she Bay Area Air Quality Management all new materials for inspection.
Disuict7
Cl Ya 244-
1 have mW the haaMnusmaterlals am ulmmenu under Chapurh.95 ditto Caller.
riaH.a]"Safety Cade,Seedau25505,25533ud25534.Iundermndlhuirthe building
d nct currtenet,N
ently how a at It u my responsibility aponsihility notify the occupant Of the
u men less ntetpriorwissuanccofsCcrtif¢ate of Signature of Applicant Date
X770All roof coverings to be Class"B"or better
owe,mamthadoedager Dom
CITY OF CUPERTINO
�n 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37509007 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34939
REFERENCE ID # . . . : 06060178
SITE ADDRESS . . . . . : 19028 TILSON AVE
SUBDIVISION .. . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROBERT & CLAUDIA TEMMERMAND
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ROBERT TEMMERMAND
CONTRACTOR . . . . . . . : MICHAEL PERDUE LIC # 27924
COMPANY . . . . . . . . . . : PERDUE CONSTRUCTION
ADDRESS . . . . . . . . . . : 171 MAIN ST STE 301
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
TELEPHONE . . . . . . . . : (650) 941-8795
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 5 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO
.-' FURNACE/AC
• CUPEkTINO PERMIT APPLICATION FORM /
AM#
3 7�—� 9 do —DV Date. wc� /9 20 o-6
Building Address:
1902 / � /
Oyy�ggr's Name: I Phone#:
I 4r Ger C/audiaJ 1G��nr,,e�►yrcctick ��a 7 -�S
Co tor. ( � License#:S-) 9(>o �I
Contac Cupertino Business License#:
�cdGer-' cl," z 7 9 2,
Building Permit Info:
Bldg ❑ Elect L7 Plumb Ef' Mech'
Job Description:
Residential M Commercial ❑
For Re ' ential Installations:
Attic El 1" floor ❑ 2nd floor ❑
Adhere to min set back reauirement M",
For Commercial Installations:
• Replacement same weight ❑ Additional weight(structural calcs)❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project:S,/4,9 Type of Construction: Occupancy group:
o,
Strapped El On Platform M Bonded El Sq.Ft. Floor Area:
❑ z, ZS -7
New Location Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Recptl, Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldiz Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•