06080141 CITY OF CUPERTINO
.SUTL yyNG-DIVISION PERMIT 6'CU ' A4TQI2INTa� M X, y
a , :7a.:prP t_M�a •ts� • -
BUILDINGADDRESS: DRAEGER CONSTRUCTION INC CPERMIT N0.06080141
10872 CANYON VISTA DR
OWNER'S NAME: PERMIT WOE DATE
RANCHO DEEP CLIFF HOA 605 COMMERCIAL.-ST
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
M ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION lob Description
f I hereby aMon that 1 am licensed under provision of Chapter 9(commencing P
with Section 70(10)of Division Sof Ne Butlness and Pro(mloru Cade.and my Itmnseu
ore snfullromeandcffecl. REMOVE 3 TO 4" OF TILE, FELT Sc BATS . INSTALL NE
;qz License I Lm oscuer Gft) STI-POUNDING, FELT & BATS . ROOF REPAIR.
1 Deu Contractor
apt. CHnECTSDECLARATION
i2 I understated my plans Nall he used u public records
'G Licaued Pmfenional
s OWNER-BUILDER m DECLARATION
0 9 I hereby a(Hnn that 11. exempt from she Gonion Co License Law for Nc
'p o O fallowing moon.(Scedm 70m A,Business and improve.
de oli Code:Any eitym or manly
J$ which rtqulma n eerm0 m airs do alar.improve,h perm N,or repair any atrucmm
-Zi~^ Priormiuiuuence,alwrequimalMapplicant for suehpenniltofilesigned statement
Valuat�ag208
G Nos he a licensed pursuant tothe provisions ofthe Contractor's rkenselaw(Chapter 9 Sq.FtFloorArea
.
f 9 (commencing wish Section 7000)at Division 3 of the Business and Profraslnm Code)or
that he u commit manefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by arty applicant fm a permit subjects the applicant to a civil penalty of FN Number Occupancy Type
not more than five hundred dollars(5500). 3 5 6 02049 . 00
❑I.u owner of Ne property,m my employees with wages u their sulecampewdon,
winaaNewak.maths,wmtrrtnmatmnmdwaranewrm.e(sm.7ou.eane„ Required Inspections
and ProfeaalOm Cade:The Contractors,rdmme raw doe,col apply m,n owner of 9
property who builds m improwa Merton.and who doea,ac h work himwlf m through his
ownemployd,,provided that such improwmem are netinlended reoffered ferule If.
however,Ne building or Improvement is sold within one year of completion,the owner.
builder will low He border of proving that he did out build or improve for purpose of ®®®
old.). NA t F
❑1.as Owner of the paopeny am inclusively connecting with licensed mntractoss to �����a1111
convect she proim(Sec.7014,Business and Pmfessfons Code:)The Conwcwrl U. -
ceue law don out apply to an awrcr Of property who builds or improves Noreen,red, y
who contracts for such projects with a mntnctar(O licensed p swum to the Contrantor's /
Lice.law. G
❑lamuemptunder Sec .Bk PCfarshlarecom
Owner Data BU' Luir�a
WORKER'S COMPENSATION DECLARATION ��V■
1 hereby affirm under penalty of perjury one m(she following dech ndom:
have Doul will maintain a CeAOceto of Convent to self-Imus for WorkebCompon-
uder,u provided for by Sion 7700 of fu labor Cade,far the performance of shm
work for which this permit he issued.
2-1 haw and will maintain Worker's Compensation Insurance,u required by Section
3700 of has Labor Cade,for the performance of the work for which this permit is issued.
My Worse, ComPemamm 1 rano Univ and Polity number art:
Grtier Policy No.:
CERTI LATE OFEXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This anion need net hemmpleud if sle permit Is forms.hundred dollar,(5100)
or leu)
1 certify but in the performance of the work for which this Points is Issued.I,hall ata
employ any Person in any manner an u to became subject to the Warkers'Campumation
Uwe of Calif..!..Dau
Applicant
NOTICE TO APPLICANT:If,after making this Counmw of Exemption,you should
become subject to the Worker.,Compensation Provvisions of the Lehr Code,you most
.J0 mm forthwith comply with such PeoimOr Ni,Permit shall be deemed mvekcd.
zCONSTRUCTION LENDING AGENCY
[ti 1 heathy dfum thatNen its comtruclion lending agencyfor N.pert omancc of
ori .�-i the wish for which thb permit is issued(See.NMI•Civ.C.)
hW Q Lender's Name
z Lendels Add.
U I certify that I have read Nis application and sou that the show information is
U,f" correct.l agree to comply with all city and county ordinances and sou laws slating to
OU building convection,and hereby suthorim reprucnnties of this city to cnwr upon the
W above mentioned property for inspection purposes.
F 0. (We)agree to save,indemnify and keep harmless she City of Cupertino agaiml
fn liabilites,judgmenu,casu and expense,which may in any way accme agdmluid City
Uin consequence of she grsnOns of this permit.
,..i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �]
S U CE ON .
Re-roofs
Slgneaumo trsaor Gats
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will fu appl)mnl or future building M"Panutare or handle hausrduus material
as,defend by the Cuperdna Municipal Code.Chapter 9.11,out the Health and Safely
Code.section 15531(4)? All roofs shall be inspected prior to any roofing material being installed.
Yes !H�
Will do applicant or future building Occupant use Nuipmcnl or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
colt ba'rardnm air ccoumimnas u dcfmd by she Bay Asa Air Quality Management all new materials for inspection.
Disaic,7
❑Yrs AN.
I haw mad the hsvnrdousmaterials requirements under Chapter 6.95 of Ne Califon.
nu Health&Salcey Cale,Scetimts 25505.15333 and 15534.1 undennnd thmif Ne building
docs net currody haw a anent,that it u my responsibility to notify the occupant of Nc
-R41, m_usbe 5Ip ormisscm
Signature of Applicant Date
All roof coverings to be Class"B"or better
her or au onzed agent Dow'
CITY OF CUPERTINO
em 4 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35602049 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT 4 . . . . . . . . . : 35684
REFERENCE ID # . . . : 06080141
SITE ADDRESS . . . . . : 10872 CANYON VISTA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RANCHO DEEP CLIFF HOA
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DRAEGER CONSTRUCTION
CONTRACTOR . . . . . . . : DRAEGER, JOHN EDWARD LIC # 21895
COMPANY . . . . . . . . . . : DRAEGER CONSTRUCTION INC
ADDRESS . . . . . . . . . . . 605 COMMERCIAL ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 536-0420
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------- --- ----------
BENERGY PERMIT FEE 115 . 56 55 .47 0 . 00 55 . 47 0 . 00
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 4 , 208 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 171 . 53 0 . 00 171 . 53 0 . 00
•
a1F'
CITY OF CUPERTINOCUPf PERMIT APPLICATION FORM
-ate-off a
JFPN# 3 — a2-D41q
Date:
Building Addrgss: , /i� Mailing Address (if di ferent from building address):
.1n61,g V
Owner's N �e: Phone#:
-3-300
Contractor: UpLicense#:
1DC0 r n Irk. to 1-1 LP 10
Contact Phone:C125'Z13-OIOC) Cupertino Business License#:
41YI 0 f��CJCI Fax: 2109 S
Building Permit Info:
Bldg ER )0(i Elect ❑ Plumb ❑ Mjjh ❑
Job Description: \1e, 3 b
Residential \naA—s. gw� Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: L 4 9-uQ Occupancy Group:
Type of Construction: D Please check this box if the project is a
second-story addition: ❑
o'ect Size: Standard 2"� Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appfiances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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• CITY OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM
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
BNUCONB P 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
BPIIVTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat 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 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
BREMAIItHAN 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 Furnace> IOK 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
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i CITY OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM
quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Mar_ uee 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 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 I -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 Chane BUILDING
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