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06050235 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT yCONTRAGTORIATF ORMATIQN BUILD114G ADDRESS: ROBERT & CLAUDIA TEMMER E ""'ND'06050235 19028aTILS ONTNER'S NAME: PERMIT ISSUE DATE ROBERT & CLAUDIA TEMMERMAN PHONE: SANITARY NO. CONTROL NO. 14 CHMSCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i00 LICENSED CONTRACTOR'S DECLARATION Job Description vF 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing .Zut wilt Sec6un70(10)of DiAi on3ofthe Busincaand Profetsiov Chde.endmylkcnmis t,H infull fame and effet. REPAIR FRAM, SHEETROCK, ELECTRICAL DUE TO DRYRO i n b Licanm ants Lk.p DAMAGE n;: ()am_Choosier ARCHITECTS DECLARATION Iz< 1 undersand my plans shall be used as albite man& 5yU 'stn Licmued Four cssiana[ OWNER-BUILDER DECLARATION I hereby affirm Was I em'.cop,from she Contractor's License Law far tM ❑O following mason.(Section 103 1.5.Business and Profusion Code:Any city or county <m which squirts a permit to consuact,a1mr,improve,demMish,on repair any struerure semi prior to its issuance.also requires the applicant forsuch permit to file a signed m¢mem z< Wail¢uliwnscJpuwamtoone provision OfWcConuxmhlJxnmLaw(chapor9 Sq. Ft. Floor Area Valuati$2800 ai- (commencing with Schon 7000)a Division 3 of use,Business and Proftssion;Code)or 9 that be is emmpt therefrom and roc basis for We alleged emmption.Any violation of Semon 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 37509007 . 00 0 L u owner of ore property,or my cmPloycu with wages as Weir nele compeosaoon, will do the work and dm structure is not intended or offemA for aalc(Sec.7014.Business and Profession Code:The Comracofs Licerue Law don not apply o an owner of Req 'r nspections property who builds nimprow thercoe,and whodenessuchwoh himself ter though hu own employ=.provided Watsuch improvements arc not intended or offered forreala If. however,the building or improvement is sold within one year of completion.dee onm a. builder will have os burden of proving that he did not build or improve for purpose of / 61 as ewecr of the property,am one s and contracting with n<The, conoenhn o on La it hot (Sec.o an Business and Profusions Code:)The Cs dimmer. Li- cove law sou not apply je eo ewer of property who bullas or improves thereon.utd who contracts for such projects with a canvmor(a)licensed pursuant o the Conuactoru Lian 01. IaP C f Owne // nde _Dm Zf�m0 , WORKERS COMPENSATION DECLAA710N 1 hereby affirm under proudly of perjury roc c f the fallowing declaration: I have and will maintain a Certinnm of Covent o al(-inwm for WadvasCompen- tion,as provided for by Section 3700 of the labor Code,for the Performance of We "ark for which this permit is issued. I have and will maintain Worker',Compensation I..v required by Schen 3700 of the Labor Code,for on:performance ofom work for which this Famous Lssocd. ' My Worker's Comperasaion Irmvvu¢Carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tru sectio had cot4 eanpimed if rhe permit u ferooc hundred dollars($100) r or less.) I certify,oos in the parmu nce of the work for which this Permit is issued,l shall not employanyrimmym a rsa doe subimoWe Warkut Compensation Laws r;•D}��c _ D NOTICE TOO NOTIAPPLICANT;If,afte_r making this Ccninu¢of Exemption.you shuuW .,Obecome subject o it Woah ro Compensation Ulm provisions of the labor Code,you muse forthwith comply with such provision w this permit shall be earned rewtkcd. zVj CONSTRUCTION LENDING AGENCY I-+ Ihemby affirm dem there is a constvction lending agemy for the Performance of 6i the work for which this permit Is issued(Sa.3097,Civ.C.) QLenda's Name gL ] larder's Address V Q I certify that 1 have read this application and stem that the,above information is ly H coma.l agree be comply with all city and county ordinances and state laws relating to Q V building construetion.and hereby authorim representatives of this city to enter upon the r 0. above-menuunea propertycosts for and ext hies purposes. (We).,me m save,indemnify and keep harmless one City mCupertino against Z I.ceieacjudgments, ue gmc tho .dna of this permit. may in any way ettroe against sold City V z I.cMCAN m of DERSTAN of this penult. / '-" APUQQkkkjjj ERE UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DaleSqU�C — 24,6, EREmar • Gll�`ATIO �/ b�2Z/�/ Re-roofs Signature er ApplicandConhzctor - SW HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam ter future building occupant no.mhandle ha comas material a diluted by the Cupertino Municipal Cock.Chapter 9.12,and the Health and Safety caac.Section 25532(a)? ❑Yu xtNa All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hto ors is contaminants as defined by Use Bay Ama Air Quality Management all new materials for inspection. �autrin? ❑Yrs 5itNo a 1 have read the hvardaw materials rammorcnu under Chapter 6.95 of IM Califor- nia Health&Safety Code,Scctiom 25505,25533 and 25514.1 undersand that iftM building d of currently have a moan that it u my responsibility to rrotify,the occupant of the ne it a whi hm.I apier to issuance of a Cemfinte of Occupancy. Signature of Applicant Date All roof coverings to be Class tB"or better Owner or authhozDan,agent Dog aClOF' CITY OF CUPERTINOUlQ(�JU23�JCUf PERMIT APPLICATION FORM APN# Date: 3 - o - -cc) 26 20 6 wilding Address: Mailing Address (if di ferent from building address): � o i 8 7� lSoh ve.�-►ve� ' Gv � � �1- O is Name: Phone #: d belt eIQttc(�w IPrrt t� 7- -8"S-y 3 Contractor: © License#: 0 u> h ✓- Contact: Phone:,-22- S-cf-' r"13 Cupertino Business License#: rZ'J6A'-tgimme cn Fax: Building Permit Info: Bldg ❑ Elect, Ef Plumb ❑ Mech ❑ Job Description: awe— v—aA 4-W2 -1v dr1roT— ct&i a,Q. Residential © a t/✓ Skee-frVC1c �L-"CCommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 28nt) Occupancy Group:� L-� TyAof Construction: Please check this box if the project is a '16V1 40'A-I s 1 n 5 l- -5 to second-sto addition: ❑ Project Size: Standard E Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ on. 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 Y CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM : CUPERTINO 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 BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> 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 Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL • 2of3 aq/gBpm_��,, CITY OF CUPERTINO CU.P TY6F O PERMIT APPLICATION FORM Quantity 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 13SCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . 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 -121 10"A 4 7 ,v AVENUE • FILL 5TRUCTURRL SANTACIATIMCA9SOSO PHONE: (408)559-0340 CONSULTING ENGIN ERS,!1U FAX- (408)559-2015 August 28, 2006 To Whom It May Concern: SUBJECT: TemmermandUUResidence Remodel 19028 Tilson Avenue Cupertino, California Dear Sir or Madam: At the owner's's request I have visited the subject property to inspect the installation of the anchor bolts for holdowns into the existing concrete, the rough framing and shear wall installation. The anchor bolts are installed using all thread rods in drilled holes with ICBO approved epoxy resin. The anchor bolts are installed according to the structural drawings, the manufacturer's specification and the structural standards. There are no interior or exterior walls removed. Redundantly, the contractor added some �'• additional hardy frames and a shear wail at the pantry. Since these elements were not requested by the approved plans nor resulting from the floor plan change, the rough framing and shear walls are acceptable as built. Should you have any questions or require supplemental information, please call. Sincerely, ALL STRUCTURAL CONSULTING ENGI y FIB p o`c�s• 3" Ge rge Dicu SE Structural Engineer • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: amyw • COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37509007 . 00 DATE ISSUED. . . . . . . : 05/26/2006 RECEIPT # • • . . . . . . . : 34592 REFERENCE ID # . . . : 06050235 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 -------- - ------------ ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 2 , 800 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 2, 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ELECTRIC SQUARE FEET 637 . 00 50 . 96 0 . 00 50 . 96 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 207 . 85 0 . 00 207 . 85 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 207 . 85 1108 TOTAL RECEIPT 207 . 85 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. _ All the work authorized by this permit . B. _2S A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. ZC A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to Clt'v'ttlt�ti r Go-",S-f- r» 640 U/ 879S 00 Desi. Nitw,l 3o► Los !-Fb 400z 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A • Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Ownei s Signature:P,, Date 2-606 T Job Address: 124 T/ IsOh T} F7�/Ni3 .Gi� Permit# Any changes to the information vrovided on this form shall be submitted to the City of Cupertino Build Department. I � City of Cupertino Building Department CITY OF 10300 Torre Avenue C U P S't I N O Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect vourself from Possible liability if that person applies for the proper permit in Iiis or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation •contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento, California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Peper ..b., Community Development 10300 Torre Avenue iHJCupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEkTINO • Building Department JOB ADDRESS: q0? 5� T�JSP H Ave, PERMIT # G� e f n !CA so Q O6 a OWNER'S N e,,'t T PHONE # S— ?j, ' 3 GENERAL CONTRACTOR /}- FAX # I am not using any subcontractors: S Signature Date Please check applicable subcontractors and complete the followinginformation: 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 •�o Com$ ���� Owner/Contractor Signature Date