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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 • 1 of • 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 2 of 3 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 3 of 3