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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
WATER QUALITY PLUMBING
PERMrf N006050135
10294 DEMPSTER AV
OWNER'S NAME:
PERMIT ISSUE DATE
JOHANNES VAN DEN CROMMENAC
ER1860 ALMADEN RD
05/17/2006
NE:
SANITARY NO. CONTROL NO.
(408)267-9330
ARCHITEC (ENGINEER:
BUILDING PERMff INFO
BLDGO ELECTO MECH
O
LICENSED CONTRACT'OR'S DECLARATION
Job Description
p
I hereby affirm that I Am licensed Older Provisions of Chapter 9 (commencing
with Section 7WU) of Division 7 of the Business and profuntioru Cade. and my licenuu
in full fame and 41fsm.
- 4'
GALVANIZED PIPE REP N IY(B PPER PIPE
Lknnec Clcu Lk.g
g�i
- Contractor
DemARCHITECTS
DECLARATION
I undersand my plans hall the Used Wbit. records
�,q.�
Licwed Professional
OatNEm ER
m the CaATON
1 botchy affrrm that I exempt law for tiro
exempt (mm the Csdam,
Coe: MY c m as county
(Sadat 7dudmoS. B Ams. and Aofessuu Code:
following ro I.
$431
or mpnig any
ma • permits consent, alar. Impmw, pm
res a
which rots
h perUW,
also requires um applicant statement
i re
prior m its i ensed C-- permit m OIC a signed namment
Sq. Ft. Floor Area valuation
iwdpursuantmthe ofDisouofthe eBuacmrinicerlaw(CNpter9
p W
(commencing of Business And on, Cook)ation or
wit Section 7000)ofalis
Any vi of
Al exemption,Any of
f r xe
ththeis burs for uta Alleged tum
Nasi m campy Nem(rom and
r Occupancy Type
io or she Ot Be l really
ndendldell.(SS Permit), eubfau she applkanRm adult pearly a(
setSection
art Nu BTIb
1, u owner of de WOPenY. ar my wplawes veld urges u dmb sole compeuaden,
Required Inspections
will do the wart. and Neavunum m not intended er orradd formal (SOC 7d4,Buainea
and Professions Cade: The ConuacNYa License Law does rot apply m an Owner of
q p
pmpeny who builds m ire proves Nemon. and who does such wok himself a Uuaugb his
own employees, provided Nm such improvements am not intended or offered for Sale a,
however, the building or improvement is sold within one year of completion. Ne owner•
builder will haw the burden of proving that he did Out Wild a Improve for putpom of
oak.).
&I, Be owner or the property. am exclusively conuscting with licensed enm moxem, m
coestmert the pmjm (Sen 7044, Business and Profosons Cade:) The Conummoes U.
cense law docs not Apply m an owner of property who build, or improves Nercon, and,
who conimca for aak pro w a anummer(s) Rented pursuant A, Me Contractor's
'
Lkerru
❑lama u r f .Bk PCfar Nism-,n
Owner Data
0 K 'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury, me of ere following declarminow
10
I haw and will maintain aCmiBestaaf Cannem to mlf-inurt far WaM1sra Campen.
cation, u provided fa by Sean, 7700 or de Raba Cade. for the performance of We
warp for which this Permit is issued.
❑ I bow atld will maintain Workers CompeuWan Wormse, u mgWmd by Semon
7700 of mm tabor Cade, for Ne perform. of Use works far which this permit is island.
My Worker's Compensation Insurance artier end Polley number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA71ON INSURANCE
from amlan send not be complemd lfthe permit is form hundred dollars ($1001
'
or leu)
1 unify, that in the pe o film work fm hick this permit ts intend. I shall But
cmployan9permn r( L , b� .Object to the Wahen'CompeuWon
Lawn of Colin
NOTICE TO . If, sAcr Nm GiNRcem of Exemption. C you
ushould
d
bahwi subject m tiro Workefa Capcuahis pmvuiam arum labs code you menu
Compensation
comply with such provmiou or this permit shall be domed mvnked.
CONSTRUCTION LENDING AGENCY
I hereby alRrm that tem U a cowmetion lending agency for the performance of
Ne nark for which Udo permit m Issued (Ser. 7x97, Civ. C.)
Name
Lenders Ad
1 emir, that I have mad this application aM sou Nat Me above iNarmatiaa u
) agree to comply with ail city end County ardinarmes and Bute laws milting a
building convection. and hcmby authorite mpresematim or this city roenmr upon Nc
above-menduned Property for inspection purpoes
(We) agree to caw, indemnify and keep harmless she City of Cupenino against
liabilities, judgments, cuss which may In Any way aaroe against said Cityin
APPLICANT NT UNence of C ST ng AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCEREGU
S11o
Re -roofs
Type of Roof
Siknmum of i anmKmr Dain
HAZARDOUS MATERIALS DISCLOSURE
91911 Na applicant or rutum building uccupantsmrc orhandle hazardous material
As d.Rmd by um Cupenine Municipal Code. Chaim, 9. U, and Ne Health and Safety
cede, Section 25572(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes @Teo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building m%=Penl ensu equipment Of devices whkh
Olt huardous air contaminants As kflncd by the Bay Amo Air Quality Management
all new materials for inspection.
Dmuict9 y.-
❑Yes I
,
I have mal the huardon3 nwedW mquirtmew umkrCMpmr695 ollWeCaiifm-
nuf5calrhhsai 25507.25577 au125534. 1 undcmend thatif Nc Wilding
does not c ly h ant. Nat it is my responsibility m airy the occupant or the
mquim n bcmetplo ar.cadrmatar any.G
Signature of Applicant Date
All roof coverings to be Class "B" or better
ar'umd agent Dam
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• • Landscaping runoff containing pesticides or weed killers; and
Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees. .
For more information on construction -related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
http://www.cupertino.orci/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at httip://www.amlegal.com/cupertino ca/
Greg Casteel
Building Official
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CITY OF
IDU P E kT I N�
Fax (408) 777-3333
Building
Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• • Landscaping runoff containing pesticides or weed killers; and
Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees. .
For more information on construction -related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
http://www.cupertino.orci/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at httip://www.amlegal.com/cupertino ca/
Greg Casteel
Building Official
• x
CITY OF
4§UPEkTINO
JOB ADDI
102941
OWNER'S
GENERAL
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Buildin De artment
PERMIT #
er /eve Q 64
> nna !Dm e �Gt PHONE #(40 332
TOR: FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
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Date
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
C(%q 2� Qup`i
/ ,y
Lum •� !nc
30 0
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
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Date
!m 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32647072.00
DATE ISSUED.......: 05/17/2006
RECEIPT #.........: 34425
REFERENCE ID # ...: 06050135
SITE ADDRESS .....: 10294 DEMPSTER AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: amyw
COPY # : 2
OWNER ............: JOHANNES VAN DEN CROMMENACKER
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
RECEIVED FROM ....: CROMMENACKER
CONTRACTOR .......: SATALINO,_MARTY LIC # 21526
COMPANY ..........: WATER.QUALITY PLUMBING
ADDRESS ..........: 1860 ALMADEN RD
CITY/STATE/ZIP ...: SAN JOSE, CA 95123
TELEPHONE ........: (408)267-9330
%EE ID UNIT QUANTITY AMOUNT
-------------------------------------------
BPWSVCS WATER SERVICE 1.00 9.00
PPERMITFEE FLAT RATE 1.00 38.37
TOTAL PERMIT : 47.37
PD -TO -DT THIS REC NEW BAL
------------------------------
0.00 9.00 0.00
0.00 38.37 0.00
---------- ---------- ----------
0.00 47.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 47.37 VISA
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------------------------------------------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CI OF
CUPEfZTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
uco 1,35
APN # "I j ^ V 1 Z
Bldg. Permit Fees
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Building Address:
10211/ /Je, sber /V2 .
SO ! y
Owner's Name:
044mkies AIN GeN
60njMeN4ej1eL
PCoWne #: /
(qo& -) 33 z 'n60
..Phone:
Contract(o�r/..)�y
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License #:
305OID
Contact:
BPWSVCS
Phone:
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
PLUMBING
Job Description:
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AU/14ni2e
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Residential Q
Commercial ❑
BUSLIC
Cost of Project:
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Qty. if
Annlicable Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Repipe of Fixtures
PLUMBING
BPFD{TURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING