06040006 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT" TO,Rs1NFORMATIQN"
BUILDING ADDRESS: PERMIT N0.
11223 PALOS VERDES CT
NER'S NAME: PERMIT ISSUE DATE
TAVIANI LAWRENCE D AND BAR ARA3345 SELDON CT 04/03/2006
PHONE: (510) 376-4816 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
op LICENSED CONTRACTOR'S DECLARATION
!-W E I thereby arum that I am licensed under provisions of chapter 9(commencing Job Description�,
ve with section 7")ofoivlslon 3 offt Businessand Profcaions Code.and my license is
in fou force and effect. -7 9 y g90 Ai
�q? LicenuClys Lica WATER HEATER REPLACEMENT
nFp Da¢ '1 ��Conlrumr /P/'�✓�/'w s
ARCHf]ECfS DECLARATION
iVi U I understand my plans shall W used as public records
e o 3 Licensed Professional
APR �� 1006
OWNER-BUILDERexemptDE DECLARATION
�p S
D o 1 hereby reaso .(Sinn he 1 am exempt from me Contractor's Code:
:License Law for the
my
00 rullwhnwinti.i.. etch n](DLn t.Alto.
Profviev Co dc:Any city A,County
which rtyuimts a permit m mwmn,alar,improve,de Permit t car repair any.wement
_Ze don heiuissuane,alsopursuer tto the the
evisio s of for such Permit to LICeasign (Chapter
mal heircing wit pursuant 70th)of Division
the Com emcee nd Professions
(Chodtcr9 Sq. Ft. Floor Area I
'iz-M Oath incingwith Sereioan and of Divieion3 of Inc Business And Mia ns Cnde)of
$ mat W u exempt them from and the burs for the subjects
dud exemption.Any violation of
Section 703 1.lby any applicant for a permit subjects me Applicant a civil Penalty of y�
nor more than low hundred dome(15W). 3 MV�TG"f 0 0 Occupancy Type
0 I.u owner of th pmpeny,m my cmployca with wages u tleir mle compo=tion,
will do the work,and the smcture Is notintended oroRered for sale(Sec.]DTI.Business
and Pmmadions Code:The Contractors License raw does not apply to an owner of Required Inspections
pmpenywho builcisar improves thereon,and who doessucli himselfor through his
own employers,provided mat inch impromm rtuare nmimerded moRerod fmsa s.If.
bromma me building or improvement is mid within one you of completion,Ne owner-
builder will have the burden of proving inn be did not Wild or improve for purpose of
salt.).
❑h as Owner of the property.am exclusively contracting with licensed contractors to
construct the pmjem(Sec.7W.Business and Pm@cions Code:)The Contractor's Li-
cove Law does not apply to an owner of pmpeny who Wilds or improve thereon,and
who contracts for such pmjecas with a conuactor(s)licensed pursuant An the Convectors
License law.
❑1.m exemPt under Sec. ,B&P C for this mupn
tonin Date
WORKER'S COMPENSATION DECLARATION
I hereby atom unW,amadly of perjury one of On following declarations:
I haw and will maintain a Cerdficam of Consenun self-insure for WmkersCompen-
mile..as provided for by Section 37M of me Labor Code.for the performance of be
work for which this permit is issued. .
❑1 ban and will maintain Workers Compensation Insurance,as required by Section
37W of the tabor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurarrte carrier and Policy number see:
Carrier._,SCER/C FO.a�� Policy OM � `' �y
CERTIFICATE OF COMPENSATION
EXEMPTION MOM WORKERS'
COMPENSATIONINSURANCE ,
(Thu maim treed not tecomplewd ifft permit is for one hundred dollars($IOr
car IcssJ
I¢oily mat in Inc Performance of the work for which this permit u is tied,I shall not
employ any person in my mannerm As to become subject m dte Workers,Compensation
Laws Ol Califomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making mu Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
.J O forthwith comply with such provisions or this permit shall be deemed mvnked.
Z� CONSTRUCTION LENDING AGENCY
{•. Lhemhy.M.Out thereiso Conawninn lendingagency lm the perfufmance of
t>:1 oc work for which this permit is issued(Sec.309),Civ.C.)
Lenders Name ,
a Lender's Address
U Q I certify tivr 1 hoc read this application antistatic Our the above information is
jy F comet.I agree to comply with all city and county Coinsurers and soon laws rolating to
OU Wilding construction,and hereby authorise representatives of this city to enter upon the
�a above-mentioned property,for inspection purposes.
(We)agree to save,indemnify and keep hatless the City Of CupertinoagaivI
F'N liabilido.judgrecnu.costs and expenses which may in anyway acc=against slid inss4ta9
t.)Z inconsegmaccofoegnntingofthispemit^ APPLICANT UNDERSTANDS AND WILL COMP Y WITH ALL NON-POINT Issued by: Date ^GG
SOURCEEG TIONS.
Re-roofs —�
Signuum of Apphcam/COnueCLOr Date
HAZARDOUS MAT65CiDISCLOSURE Type of Roof
Will th)applicant or forum Wilding oceupentsmm or handle haommus material
as degood by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
41 Cade,Section 25532fa)?
El Y. ,-INo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future building Occupant um equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Omit ha>ardnua air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection.
MWicr?
Dyes KNo
I have read the hvardnusmamdalsrequirtmcnu underCWpmr695 of the Califor-
nufkalth&SofcryCodc,S ms255D5,25533md255N.l unMrsuM muifmc Wilding
does not currently haw a moan oat it is my responsibility w notify the occuPur of On
requirements must W met ' rto issuance Certificate of Occupancy. Signature of Applicant Date
GTS
Owner lir awhoriycd agent Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35621026 . 00
DATE ISSUED. . . . . . . : 04/03/2006
RECEIPT # . . . . . . . . . : 33820
REFERENCE ID # . . . : 06040006
SITE ADDRESS . . . . . : 11223 PALOS VERDES CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER TAVIANI LAWRENCE D AND BARBARA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4721
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
• TELEPHONE . . . . . . . . : (510) 376-4816
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- --- ------- ----------
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 49 . 16 0 . 00 49 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 49 . 16 7099
TOTAL RECEIPT 49 . 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
CITY Of Telephone (408)777-3228
Fax(408)777-3333
UPEkTINO
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:
htto•//www cui)ertino org/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 http:llwww.amlegal.com/cupertino ca/
Greg Casteel / APR 0 1 2006
Building Official +6J OF
'
Community Development
SRI
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
TY OF ClFax(408) 777-3333
&PEI,TINO
Build in De artment
JOB ADDRESS: , /J PERMIT #
/ -V� PXI� V/A)C-� LL O D
OWNER'S NAME: PHO9E #
GENERAL CONTRA OR: U FAX #
I am not using any subcontractors. LI` 3 — O-C
Signature Date
Please check applicable subcontra rs and complete the following information:
60 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
AM Tile
IV
Owner/Contractor Signature Date
CITY OF CUPERTINO
WATER HEATER
• cuPERT`Irvo PERMIT APPLICATION FORM
Date:
APN # O.�
35�D– -2-1—02•LD
Building Address: n I 3
/(,/) 03 p�lo s v end�3
Phone #: p
owner's Name: kGY TAV/ 4Ut! /
License #:
Contractor. 6— %O
�G4� i Fy lLUi1/f/N
Phone #:
Contact:
Applicant/Contractor:
Building Permit Info: Meeh
Bld Elect um
Job Description: Arlo �oree c.`o`` srr
esidential: Commercial;
Sq.Ft. Floor Area: $/Sq.Ft.:
• Architec/Engineer: Valuation: q( 3—z)C) e�
Type of Constructiq Occupancy G/pro :
Qty. if
A lica Fee ID Fee Description Fee Group
BPWHEATER Water Heater/ Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPERMI Bldg Permit Fees BUILIDNG
BMITIGAT Housing Mitigation Fee BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG