06060179 CITY OF CUPERRv: - �
au1LDlN6DIVIs1oN PERMIT C01�ITRACIQRIIYF0tMt1TI0,N
BUILDING ADDRESS: PE E CONSTRUCTION PERMITNO'06060179
19028 TILSON AVE
OWNER'S NAME: PERMIT ISSUE DATE
ROBERT & CLAUDIA TEMMERMAN 171 MAIN ST STE 301 2006
NE:
SANITARY NO. CONTROL N0.
(650) 941-8795
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0
mS+Op LICENSED CONTRACIDR'S DECLARATION Job Description
C I hereby affirm that 1 am licensed under Provisions of Chapter 9(Commencing
d with suction7WM.fDivision 3afthe 11i.and Professions Cade.and my tic..is
S te in full force andenea REPLACE WATER HEATER
LIZ Lken. Cl.s Lie.g
AFI Dam Comrxmr
ARCHITECTS DECLARATION
U1 understand my plans shall k used as public records
sW Licensed Pmfcasional
5 OWNER-BUILDER DECLARATION
if 1 herchy.from Thal 1 am(MCh pt from the Contractors License Law for the
p o following Mason.(Section 7(/31.5,Business and Professions Code:Any city or county
u$9 which requites a permit m eondruet sher.improve,demolish,in repair any someone $1100
LZ< prier in its issuance.alio MQUlma Ne applicant farmch KM14 to rile a signed statement
that W is licensed pursuant to the provisions of Ne CountLicense raw(Chapter 9 Sq. Ft. Floor Area Valuation
zxC
t— (commencing with Section 7000)or Division 3 of the Business and Professions Code)or
y 5 that he is exempt therefrom and dte bass for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of er Occupancy T
not more Nan five hundred dollars(5500). P Y YPe
❑I,as owner of the property.tar my.,toy.with wages as then sole compensatlen,
will do the work,and the structure as not intended oroBemd for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conmetnrs License law does not apply m e an owner of q P
property who Wilds m impmvestinsec ,anti who doetauchwork himselfenthmogh his ® M ®®maw
nwwevem, yWildin orINat such iris sold improvements intended oroRemdfor amen.If. y A p BI gsk
however,Ncea,provided of Improvement imprvementtsA one year of rompffered themvner. rltlil�lYN[ �p®PImVAa�►IYRMZ6�}
builder will have the burden of proving Oil W did out Wild m improve for purpose of
n
as owner of Ne property,am exclusively contracting with licensed contractors to
Comtmct Ute pmject(Sec.7044.Business and Professions Code:)M Comtnmor's Li-
Co.Law docs act apply to an owner of property who Wilds m improves themon,rod,
who Contracts for such projects with a Contractor(s)licensed pursuant in the Contractors I� t�ppp .,, ppp �( .�ky
own.04tu{n-dgr See m PCfor than u 1'IL t5N
owner .v.//�-- tr,'1t..'YI tYl A�p�5{I't\i1G./27
WORKER'S COMPENSATION DECLARATION
1 hereby a/Brm under penalty of perjury,aso of Me following declarations
1 have and will maintain a CeniBnte of Comer to self-insum for WmkcrsCompen-
sation,As provided for by Section 3700 of Me Labor Cade.for Ne performance of the
work for which this permit is bound.
0 1 have and will maintain Wohers Compensation Insurance,As required by Section
3700 of Me Labor Code.for Me per(orwec Clubs work for which this permit is Wood. '
My Workers Compensation Imuma.car and Policy number tie:
Cartier, Polity No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scets.need not W completed if the permit Is We.hundred MO.(5100)
or last
I eenifv Nat in Me perform...or M9�ory for,which this permit u issue4 I shall not
employ any' ninany so o coo the Workcti Compmaidon
Laws Macy
Applicant
NOIICE TO APPLICANT:If,after making this Cenifmcam of Exemption,you should
become subject to the Workers Compensation provisions of the LAW Wr Cade,you most
.J aZ forthwhh comply with such provisions or Nu permit shall W deemed mvoked.
z CONSTRUCTION LENDING AGENCY
'e+ 1herehy affirm Nm More iia Conswction lending agency for Me Performance of
ra the work for,which this permit is issued(Sec.3097,Co.C.)
aQ Lcni Name
z Loodsrt Address
O Q 1 certify Nat 1 have read this application and sou that Ne above information is
U. f"' Cortaro.l&gree 10 Comply with all city and county ominances and state laws offering to
0 building construction.and hereby authoMM MPMsemaives of Nis City to enter upon the IF I[ ,/Lfyt(/1 //�///�/7
shove-mcmiegin Cost for inspection which a
4 (We)agree to save,indemnify and kap harmless the City of Cupertino against
Uh in consequence
or M,cmuand ex pis es poomich may inanywayamue against saidCity
U z 'ncooaCANTeof UNDERSTANDS
ing of riaD WILL
Issued by: Date
'—' A LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
S RCE R�GU}�'aNS.
66�9/of, Re-roofs
Signature of ApplieanUConuaetar Nate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Mme applicant m future Wilding aaup.,mom or handle hanrdous material
As de0 rad by the Cupertino Municipal Code.Chapter 9.12,and Also Health and Safety
Cale,Section 25532(.)? All roofs shall be inspected nor to an roofing material beim Installed.
❑Yea @No P P � Y g g
40 Will Mea licam or future building oecu If a roof is installed without first obtainingan inspection,I agree to remove
pP g pant use equipment or,M... which P g
cosh hmartluus air cmtamirunu u dcriad by the Bay Ama Air Quiliry,Management all new materials for inspection.
D stricm?
Dyes dlsr
1 have mad the ha mdnus materials requirements under Chapter6.95 office Cable,
ria Haith&Safely Cedc.Seen"25505,M533 and 25534.IundersuM Msifthe Wilding
does not currently have a tenant Met it is my responsibility m notify Ne acupans or the
rgRO}cmcnq'Wnkn met Me,columna of.ccMil,m,of aj pm Signature of Applicant Date
Z{//�?!`l(AC�4Y}� 6/ ;79 e,6 All roof coverings to be Class"B"or better
Owner en a otllci agent Dame
CITY OF CUPERTINO
om 2 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 # . . . : 06060179
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
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 260 . 26 1113
TOTAL RECEIPT 260 . 26
VOICE ID DESCRIPTION VOICE ID DESCRIPTION-------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
1, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
GVUPEkTINO
Building De artment
JOB ADDRESS: PERMIT # 0 6,' 0/7
l 610 2 2e Tl' )9 W� ,6' 0 / 7
OWNER'S NAME: 1-wt c— 0j"kk c 7 Ph mevwi eL 1.1(( PHONE #(k#(kg 72S--K-43
GENERAL CONTRACTOR FAX #
I am not using any subcontractor-,.Q
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 wouo q
Sub WATER HEATER
On OF
• CUPEKTINO PERMIT APPLICATION FORM
APN#375— . og — 06-7 — ?� 0 Dat�IJYIP�/ -zvOb
Buildin Address:
2 8' 7 1S u+✓
OA's is Name: Phone#:
a 725- �� 3
Con tor: License#:
ContCupertino Business License #:
�f i /E'en w<CJ- +7 G� 2 7 ?2 L '
Building Pemmit Info:
Bldg ❑ Elect tk� Plumb (!' Mech I:r
Job Description:,/) n t—
Residential Commercial ❑
Cost of Project: �a 0
Strapped ❑ n Platform M Bonded
• New Location Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•
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T'-^me wm C-V1
1 90 28 71 k7an Ave
CU
Per-�'tnU , CA
' 409 725-9543
tr(p 1GKGe�; -Ter„, 7� c�GE hl,11Se,• AS, /`C f UlMd.
QR�plc�-ce foF plafe amd 3fvds whe►r, reccsso.Py.
@ RP F A"1 r,An d rip/tett Aerrn�i ve da en e"Il'o
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_ _ O �emove��r�pluce f�eader, {ramc �' rc/�alr as heywr��1
I
- - - - O Pernove. 4' fr,Plac<, Joists and sfrohybacks vJhere necessary.
e le�fiv� &J r >7 h V I >7 Yno►n k_is 1►eH i t, F /� f 1 fle
5 .5 �
D f n`f-3 d
4r -\C RESIDEI�ITIAL PROJECT" COVER SHEET
CUPE1T INO
J 2 L
7S'09 -007-OU \ \ ezc06 rJ\
Assessor's Parcel cel Number: g \
Name of owner. pDr!ie.rt Fi
Projectaddress. 140Vg T; 100#1
Contact person.09d bel tTC' nWtC v-0Ait kd Phone. IVY 72-T-81'43
i
Fax.
Net square footage of lot.
Existin Proposed
r� Square footage: First floor: 14 -7 1 7 57
Second floor:
Garage:
TOTAL: 2. IS 7 -7-
Are there at least two 10 foot by 20 foot clearspaces inside the garage? N T1 — \ i n / h
Is privacy protection planting required for the project? Y >e N
On what floor(s) is work being done? Bmt - to o r'
1
Brief description of work. ttr✓ R.h ,/ Y� 6cCE. e>c1Sy/na WA14clue Ta
-tervni7pe-:—dry rot dcch+Q"?Ce PYGee 1h a10d&r3 e/eG ri CAS,
Code editions:2001 CBC (CD-N)2001 CFC (7-N)2001 CMC (Y-N) \ \ ,
2001 CPC (Y-14)2001 NEC N) i , . i ;
Effective 11/1/02
SSoR CO I
ASSE ,:
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Plan Review Process Work Book Page-8-Revised 4/28/04
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tOA�N NOF
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Val
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vaa�uata��,ges o` aa,. l 90 28 Ti lSon Ave
ta�skedr oa t ka aaY c�ea cetm M1�tto tai' G ut?e�'�'t n o , eA
� aitoat � 40$ 72S-x`3543
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ow, p�og �� �r i a h!�• 1'i°p JUGS • er•rn 7G LIGE fir,0.9'C� - AS', re �vl rCGi.
VEDNA
MAY2 g 2006 $ o`°��cfZeP o ce fop p Iafe g ri d s i udS w hem /reecss at-y
@RFpAIrand replace. 7eLr,-, '7�e darY,44,P
Remove r?,�p/uce, header, -;Ora me. � mpAir as 11:57vlrec1
I f
Ot2e•noYe replace Joists and S7raryback r ;4here necessary.
o- eleGft f, h hvin5 roof") k•; tcheh l�9hfin� jev
Dn f c�co r i
-
'' RESIDENTIAL PHOJEGT COVER SHE
i Y
CITY Oi -• " � .. _.. 4 � +,S
j
CUPEIJ INO I \
Assessor's Parcel Number: 37 S'O 9 —OO 7—00 I Q \
Name of owner. PoGe.rt
O)IplceProject address. f90 2$ 71
Contacterson.`p MtCr►tea Phone. 7� � \ O\
p Fax. CPR & !
-Net square footage of lot. ilk
Existin Promgsed
r
First floor:Square footage: _ j 3 x, 73
7
7
Second floor. \
Garage:
TOTAL: 2, 2,57 -2-
rn9
Are there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? Y \
\ .
On whai floor(s) is work being done? FIM:t - Io o r
' n8 , \
Brief description of work. r✓' h G� e r /h ` \
- 2001 CFC Q0l- 2001 CMC (Y-N)
Code editions:2001 CBC Qj 1� _ _ _ �\ -- _ _ \ \_ ,\ � � A
2001 CPC (Y-N)2001 NEC i_'. _1 1 '. ��=
Effective 11/1/02I I
MAY 2 6 2006
COO
FFiC x
o �
I � I
Plan Review Process Work Book Page-8-Revised 4/28/04 {