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06050135 (2)CITY OF CUPERT[NO 3 Qforthwith .~N., > QLattices z Q Fcorrect. U {27 y Z '?�7.�+°.�*,*.fgX�'�+'tK '�'y��7a,�`' Vr�+' Y+A' BUILDING DIVISION PERMIT >'�-°yRA�`�>•'0'.j'j1 n� a " x,'.r�S:.,,_. •* zS.xea-4 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 r , �. / ...�L.li S//7/d 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 r , �. / ...�L.li S//7/d 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 / O 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 L/ /AI e / aulgN ►Zuh,hin / l/o�i) 2v7 g330 License #: 305OID Contact: BPWSVCS Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb PLUMBING Job Description: // ; e AU/14ni2e Pe 41e�e� W;44 �oDDr� / %per Residential Q Commercial ❑ BUSLIC Cost of Project: y3 / • 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