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06080167
CITY OF CUPERTINO n '•z rF �N �� '`'£' 't`'"' BUILDING DIVISION PERMIT zaCONTRACTOR INFORMATION __ BUILDING ADDRESS: ROBERT & CLAUDIA TEMMER nRMITNo.06080167 19028 TILSON AVE. OW NCR's NAME: PERMIT ISSUE DATE ghk ROBERT & CLAUDIA TEMM MAN E; SANITARY NO. CONTROL NO. ARCHITECTYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !Op LICENSED CONTRACTOR'S DECLARATION Job DOSCrIphOn wI hncby affirm that 1 am IkrtnaM under provisions al'CMpicr 9(Commencing to with Scnion 701)(3)of Division 3 olive Business and Profcrosiuns Code,and my liccnu is low9 in(ulifa..mdc(fcct. SERVICE UPGRADE TO 200 AMPS 2 License Class Lie.N - F9 onto Card., ARCHITECTS DECLARATION i K< I understand my plans shall M used u public records iyU ot� Licensed Professional 3OWNER-BUILDER DECLARATION i 1 hereby mTirm Nat I em exempt from tM Convenors License Law for the 0 O fallowing mason.(Section 7031.5,Business end Pmfzssions Code:Any City or county m % t Construct, ly al ,improve,demolish. . machine MY ctu 2_9 which require.permi !iy prior to its issuance.also requires the applicant for such permit w File a signed SIMmem is that he is licensed pumunt to the provisions of the Conuacm.•s U..Law(CMpter 9 Sq.Ft. Floor Area Valuation %. (commencing with Section 7000)of basisonlaftoeged essandon.Anynvi Code)of j�$ Nat M u exempt therefrom and de,bus for Ne ailtged exemption.Any violation of $2250 Section 7031.5 by my applicale for a permit subjects the applkanuo a civil penalty of APN Number Occupancy Type nut mote that fin hundred dollars(5500). ❑I,as owner of the Property.or my employees with wages u de,u sole eompewdor. will in the work and the swciure is not intended or Offered for sale(See.7044,Business and Pmfessiau Code:The Contractor's Limine Law does rat apply to in owner of Required Inspections property who builds or improv drercon,and who doessuch wurkhemselforlluough his awn emplay¢s.provki:d thmmah imProvemenu art not immMed arorfetN(Cowie If. bOwevep the Milling or improvement u said within ham year of completion,the owner- howevr will have the burden o ement i that M did not build or improve for purpose of r. sale.). m'1 u Owner of the property,me exclusively conuacaing with Bowed Contrxcmrs m construct the Mjcct(Sec.706x,Business and Rofessiou Code:)The Contracts Li- cense law tlms not apply in an Owner of property who Milds or improv Neneon,and who contracts for men projects with a conwaor(s)licensed purm int in the Contractor's Law. 0 lan" Copt undyer Sec.�" .B6:PC for Nu rtamn a,l// owner MAA-y a�/VawLWy✓Y.� Dam 2Y L WORKER'S COMPENSATION DECLARATION 1 hereby afrum raker perulty of perjury aro of the following deelerstiou: I ham and will maintain a Ceniftmte of Concent to self-imus.for Workers Compen- sation.u provided for by Section 37M of de,Labor Code,for the performance of the work for which this parmir is issued. ❑1 have and will maintain Wallach Compensation I..u required by Schon 37(10 of the Labor Code,far to,performance of the work rat which this pemtil is issued. My Workers Compensation Insurance carrier and Policy number are: Cmricr. Policy No.: CERTIFICATE OF E)[EMP ION FROM WORKERS' COMPENSATION INSURANCE (Thu section recd seat Mcomplemd if our permit Is furan,hundred dollars(SIM) nr ltsa) I certify that in the perfwmanee of the work for which this permit is issued,l shall not cmployany rmn inan anpNrsa a5lo p��Com susbmc`` War kms'Cma maidon Laws of C f-L "I 2f 'L(J�J Applicant Ia.sA� NOnCE TO APPLICANT:If,afmr making Nu Certifies¢of Exemption.You should become subject to Ne Workeri Compcuauan provisions of Ne Labor Code,you muse ,J z forthwith comply with such provisions or this permit shall be deemed mvnked. z 14� CONSTRUCTION LENDING AGENCY [-� I Mswy affirm her then u a ed(Secti097.C,agency Tarlo performasum of Ne work fur which this permit is issued(Sec.J097,Civ.CJ W� A Lenders Name D z Under's Address U O 1 certify that I have read this application aM mule that the Move information is IL F" conte,.1 agree.comply with all city and county ordinances and sum laws slating to O U building Conswction.and hereby authorive represematives ver this city to enter upon the L37 ahovt-mcmioncd pmpCrst for Wpmaces purposes. (~ C1 (We)agree to Cave,indemnify and keep haamless the City of Cupertino against N inconscquW,ofdoo Costs and ex this pu ob. may in any way accroe against said City Uz in XLIC NT of Ne RSTA Starting Of this pc WI AP LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 5 RC RE ULAT Signature �OG Re-roofs of AppliaHAZARDO HAZARDOUS MATERIALS DISCLOSURE . Type of Roof Will the a Cupertino no(Muni building le.Chaptmort m handle Health ud Safety u defined by to Cupertino MYnitlpal Code.Chapter 9.13.and the HC9th and Safety Code.Section 25532(e)? All roofs shall be inspected prior to any roofing material being installed. C Yam VN. If a roof is installed without first obtainingan inspection,I agree o remove Will the applicant or(tams building accupam use cyuipmem or devices which t P g ' trait hnmardou air contamimnts as defined by the Bay Arta Air Quality Management all new materials for inspection. District? p Yes t3j. 1 have sad the herardus materials requiremcm under Clwpmr6.95 of de,Califon ria Health d:SafetyCede.Sections 25505,25533 sm125534.1 understand thol Mildog does not currently have•e,nank Nat it u my respectability m notify the occupant of the a entswMChmtr�metpriorwissuanceOraCertioamofat ps ay:mmaaracenirreateofae pmay. Signature of Applicant Date rt $�2i1 All roof coverings to be Class"B"or better owner or aoth.n.d agm, g Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *UPEkTINO Building Department JOB ADDRESS: PERMIT # / 967t T;j&h 4,.concje- O 6a(f-e16`7 OWNER'S NAME: kc,o be�-f Tewt m ,t't ei h PHONE #t-/o 8 725— 8 yq Zi GENERAL CONTRACTOR: Z=e; FAX # I am not using any subcontractors: 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 L -- Tile •�1O�u' 1/ 2( 2 6 Owner/Contractor Signature Date CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37509007 . 00 DATE ISSUED. . . . . . . : 08/21/2006 RECEIPT # . . . . . . . . . 35695 REFERENCE ID # . . . : 06080167 SITE ADDRESS . . . . . : 19028 TILSON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROBERT & CLAUDIA TEMMERMAND ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : ROBERT TEMMERMAND CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : ROBERT & CLAUDIA TEMMERMAND ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : *EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ----- --- - - ------------- ---------- ---------- - ---- - - --- ---------- ---- ------ BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 2 , 250 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 103 . 16 0 . 00 103 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- - - ---------- - ----------------- CHECK 103 . 16 1122 TOTAL RECEIPT 103 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • 4 CITY OF CUPERTINO ) �� OF PERMIT APPLICATION FORM CUPEkTINO 'RPKPN # 375 _ o c ' - ©p 7 —o d Date- 21 Z0,0 6 Builyig Address: T�Jso i ,` ��ue, Mailing Address (i different from building address): Ow. r7s Nam f Phone#: Alv e.p- 6 CJtudtA %emme-rMAP164 tic 72s- k'S113 Contractor: License#: Erzoe- feff�S 8 y 70s1 Contact: Phone: S ?,ib Cupertino Business License#: C—gig Fax: $S(cO Building Permit Info: t V/'—�/_ t)P cr.-�� 02!06A M p5 Bldg El Elect L�' `1 Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Z; i su CZ,-�s Type of Construction: ^ Please check this box if the project is a E% second-story addition: ❑ *rojectSiz: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CTIdF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING M URE Pbl Fixture PLUMBING AS Gas Pi in System Fee PLUMBING RCEP Ind Waste Interce for PLUMBING CHK Plan Check Fee BUILDING KADD Plan Check Add Multi BUILDING KREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power )evice/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CIN Or PERMIT APPLICATION FORM CUPERTINO uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3