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06080152 CITY OFCUPERTINOX BUILDING DIVISION PERNIIT C®1�iTR'AGI'aR�`INk'URMATION BUILDING ADDRESS: r DRAEGER CONSTRUCTION INC P"""THD'06080152 10873 CANYON VISTA D OWNER'S NAME: PERMIT ISSUE DATE ORANCHO DEEP CLIFF HOA 605 COMMERCIAL ST QR /JR/2006 NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT7ENGINE(.it: BUILDING PERMIT INFO BLDG ELECT OPLUMS MECH op LICENSED CONIRACTOR•S DECLARATION lob Description i u 1 hereby affirm that 1 am licensed under provisions of Chapter 9(mmmancing P with Sectkn 7") Division 3 of the Buaocu and Pmkseiuo Code,and my license is .csN in full to=andeff«t. REMOVE 3 TO 4" OF TILE, FELT & BATS. INSTALL NE Dae License tau/ —Cmnumm acmr G,f'7Gf0 ANTI-POUNDING, FELT & BATS .AROOF REPAIR. t ARCHITECTS DECLARATION 1 understand my plus Mall he used as Public meordm lyU LiconseJ Professional a OWNER-BUILDER DECLARATION t I botchyream .Alium(cc a n 1 em exempt from the Contrmmr'a License law for the ?pO followns mason.permit I7 construct, Boalux, andow.de no Code:Any city Or County which mghisf a pmmit re enmdseL ahaa Improve,demolish,,m opals any statement,Zr�^ pdorms)iC=dista0umqulms pro provisions for Committee mmeasigned nakmcm Valuati$Tl208 G mommankenwJpurmmlmWcprovW000fof the ftilemWhLiceuclaw(Charter tum)m Sq.Ft.Floor Area l�8 list he I,hilcam with Section 7000)of Division r th eal eg a assn std car.MYmns Cama If Nn a ts exempt Ne¢frm and the buts for the alleged eamnpdan.My violadm of Section 7031.5 by any applicant for a permit 51111,1003 tae applicant m a civil penalty of NN Ngtuber Occupancy Type not mom Nan ft.huodmd dollars($5001. 3 5 6 0 2 0 51 . 00 ❑1,uowner mf the properly.oemy employers with ngn uthebr rola eompeumon, will do the wink.and me stmctwe Isnotimumal m offered formula(See7044,11mitrcu Required Inspections and Pmfeaalotu mc Code:The Contors License taw dead rot apply to an owner of q P property who bu Ilds w improve Narcan,end who does such work hunself or through his own employees,pmvided that such improvements an,not trended aroffemd(mrsele.If. ' however,the building or Improvement is mid wB amus year of completion,the owner. builder will haves the bumm of proving that he did m build or Improve for pwpose of N 1` E male.). �'Y v'�i�!® 0 1,u mann a due Property...exclusively consesing whh IlmmsW mnemms m couvuct Um es not (Sec.Iran,neer of rod Profnmou Coda)The Camracmh LI- came who claw don not reply m an owner of property who builds or improv Comm.rod, who convacu for much projects with aeanuactme(a)lianxtl punummthe ContranoYa f] 01 mexempt undo See .B B P C for this memo f'r-• �, Ym p��l!dy)'Jr Owns Dam WORKPR'SCOMPENSATyON DECLARATION Nab �� 1 ha Iave admbym alfim under penally of perjury arc of the fofollowingdeelafadonc hd will maimun a CemOmeof Cwuent mself-imera for Workefs Cout sedan.u pmvided for by Section 3700 of dm Labor Cade,for W performane of me work for which War pumit Is bused ave and will maintain Workces Compensation Insurance,u required by suction 3700 of We liber Coda for the perfwmmen of We work or which this pemit is issued My WorkcYs Compensation Ines a easier antl Policy resells'am: 714 P.IkyNe.::7,L3JS^21-100S CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE (Thin ecdon need not be complemd if the permit is formoehunJmtl do0a3($100) or lass) 1 aeti(y that in the performance of the work for which this permit is ieucd.I mall not employ any person in my manmerm u in became object to the Workers Compensadon Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Cenircam of Exemption,you Should become subject m the Worker's Compensation provisions of me tabor Code,you mot .J O foMwith comply with such provisions or thra la permit shall be doomed nked. .Z.t` CONSTRUCTION LENDING AGENCY [-t Iamby aRvm must them iso consuctimn lending agency for the perfommm of a.�. the work for which this permit la iuund(Sec.3097,CN.C.) 14 Q Lett Name Cl.a z Lemmei Addoss U Q I certify that I have mad this application and sac that the above information Is V. E" correct.I agme m comply with all city and county aminancas and sue laws slating to C) building eonswction,and hereby aumoum representatives of Nis city to enmr upon the Q shove-memiun00 property fur inspection purports. E„t (Wc)agse m Island and keep armless to City of Cupertino against rat liabilidea,JudpmcnuI . sland expense which may in my way amus against said City V Z in consequence of to granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Re-roofs Sigamse orApplicarvanComagetor Dee HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicant or future Wilding weupantamee or handle hendous material u Inroad by the Cupertino Municipal Code.Chapter 9.13,and dte Hnith and Safety Carlo,Section 35533(,)7 All roofs shall be inspected prior to any roofing material being installed. ❑ors h7>'>o'-- Will mus applicant or Boum building occupant um equipmmt or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove emit hunumm s air comtaminsm3 a de0oed by dte Bay Ams Air Quality Maogcment all new materials for inspection. Dierict7 OYo I haw mad the huamtws msmrialasequieo rmt;under Ch ipter6.95 of the Califon nix Health&Saety Cmdc,Sectiou33305,35533 and 35534.1 umkrstm l muatlfdte building does not cmmnd hoe a tenon t it k my respoolbilily W notify to occupant of the w mb mutt ce of a Cerucmc of Occupancy. _ Signature of Applicant Date Gwoet.to thmnac ,g Da 1 All roof coverings to be Class "B"or better CITY OF CUPERTINO 5 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35602051 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # • . . . . . . . . : 35685 REFERENCE ID # . . . : 06080152, SITE ADDRESS . . . . . : -10873 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 &E 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 _. CITY OF CUPERTINO r PERMIT APPLICATION FORM �O�`�� CUPEI�TINO -0 -0 d QA. V. N# 3J1 - a O -o5l Da O CJ leiOLD Building Address: Mailing Address (if different from building address): 0873 6 M ViM VC Owner's e: I Phone #:,�� '30 Contractor: License#: T�rG1Yl Ir Y- k. 1-1LP10 ContactPhone:1-313-U00 Cupertino Business License#: GIYI 0 zasl q Fax: ZI Building Permit Info: Bldg R`9pW4J Elect ❑ Plumb ❑ M h ❑ Job Description: �/P, .�b -E1� Residential Y Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: t� .419-0? 9-0Q Occupancy Group: Type of Construction: �J Please check this box if the project is a second-story addition: ❑ o'ect Size: Standard Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB01LERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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 3 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 BNUCOMMP New Comm Plumb PLUMBING BOVERTWE 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 Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Stonn/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 c$n MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT 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 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 CITY OF CUPERTINO ,;he' cuPErriNo PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd1 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 BSPECLAL 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 Addfess Chane BUILDING • 3 of 3 F TY OF•CUPERTINQ BUILDING DIVISION PERMITESSPEahrtrvo.ING ADDR : DRAEGER CONSTRUCTION INC 06O8O151 10 8 3 PERMTISUEDATE RS NAME: RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST ./IRnnr, NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHIIECTIENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description i 1 henby affirm that I wast licensed under provisions of Chapter 9(commoMing P with Section 7O1M)oMinirbm 3 of the Business and Pmfessiom Code,and my license ba in full to= effect. l 1 REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE jq4 u.mmm as, CI.ontractor ANTI-POUNDING, FELT & BATS. ROOF REPAIR. is,q Dak 2 CSDECL 7W ARCNITECI'S DECLARATION i�< 1 undersunJ my plain shall be used as public recrNs r jy 'a� Licenced Professional•H3 OWNER-BUILDER DECLARATION <I 1 Wnhy alTum that I am exempt from the Co0aael0ei License law for the .C o fallowing Moron.(Section 7031.5.Business and Professions Cale:My city m county 3 e g which nquins a permit to comrseL alter.haprove.demurkh.art repair any Pruaum •Zi priormitsissuance.alsorequiresOeapplicatsforsuchpermittofileasignedPatemcm Valuat(p < mat he k licensed P.M.L to Me provisions Of the commences ucenm law(Chapter 9 Sq.Ft.Floor Area 4 2 0 8 `fd $ Mornmencing wish Section 7000)of Division 3 of the Business and Proresslom Code)m Out he is exempt a mefrom and the Was rte the alleged exemption.Any violation of Section 7031.5 by any applicant far a permit abjeeu dst applleanuo a civil penalty of APN Number Occupancy Type not mom urn 0ve hundred dollars(SSW), 35628006 . 00 0 1,as owner of the property,or my employ.with wga as Neo mk eampemaden, will do the work.and lha ammusre knot intended Or offered far sale(Sm.7044,Basircv Required Inspections and prorC{dramnLI4 on,Code:The CAmes mY d.Law set apply as an Owner of 9 P pmpeny wed Wilda m improvathermn,aM sourd..whwork hb w fo through hu awn employees,proridd that such impronmenu are an,bnkeded oo@red for sale 11. however,Ne Wilding or Improvement is old within arc year of completion,me owner- Wisher wnerWilder will have IW burden of proving dal W did Out Wild or Improve for purpose of ❑1,a..of the prepany.am ealmively contra las with licensed mnuaun be construct the prejea(Sec.7044,Bmbmas and Pmksalam Coda:)The COMITM art Li- mose who c few dao not apply ja m owner or property who Wilds or improver merean,and, �'�� whonse Lm u for solo Projecu with a ecn0amartU Ilamed pursuant m the Conuaeah �� 0 I ms law. ❑1 oro exempt undo Sec. .B k P C for Nis noon Owner Data r WORKER'S COMPENSATION DECLARATION l�rfv ry 2 yys�6,v I hereby offirm under penalty of perjury one of dte following declvG alima: L✓I�Mon. ne and will fairy .tion jance37W of do Labor Code.to for Workers Comperee BUILDING�I r �ass saran,u Provided for by Senlon J700 0(Oe tuber CMe,fm the perrormena of the L ��I�a work for which this Permit is issued. (/yam_ ave and will maintain Workers Compems0an Insurance,as required by Senior 37M of the labor Code,far the performance of the work for which mis permit is ismod. My Workeea Compematian Imus ce artier an Policy number ice: �•— Cartier Polity No.: �y ERTI"CATE F EXEMP17ONP7(OMWORKERS' COMPENSATION INSURANCE (TTuscadan nead not W campleed if the lermh is toren.hundred dollars(g100 or less) I coolly mot In the performance of the work for which this permit Is bound,l stroll not employ any permn in any mannerso as to become subject o led Warkeri Compensation Laws of California.DAM Applicant NOTICE TO APPLICANT:If,after making this CertiECala of Exemption.you should become subjen m the Worker's Comte ration provisions of ted labor Once,you muss .J O forthwith comply with such provision or Utk permit shall be danced revoked. 'ti'h CONSTRUCTION LENDING AGENCY [—t I hereby affirm Out tem is a construction lending agency for the performance of l� the work for which this permit Is issued(Sec.3097,Civ.C.) W� Q danders Name z Lenders Address U Q 1 arIfy that I have need this application and sate that the abort Informal..Is LU correct.I agree 0 comply with all city and county ordinances and state laws misting to O V building consrmion,and herby authonn representatives of this city to caner upon the r GU above-menuuned pmperty for inspccum purposes. G (Wc)agree to save,indemnify and keep harmless Ow City of CupcurO eg.Imt sFr cn habiiides,judgmem,cora and expenses which may In my way acme against said City U Z in consequence of the serving of this Permit. �/L•C; G� DERSTANDS D WILL COMPLY WI TN ALL NON-POINT Issued by: Date S OU ZCE BEG n .— `I' Re-roofs Sign ncof App tan uanc Vale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Oe applicant or future building eccupent Port or handle hmallous material as de0ned by the Cupertino Municipal Code.Chapter 9.12 and the Heal.and Safety codc'Section 255324)?❑Ya All roofs shall be inspected prior to any roofing material being installed. Will the applicant or rutun Wilding occupant use mubpment m dcvl.which If a roof is installed without first obtaining an inspection,I agree to remove emit hmzrdnm aircanumimnts a defined by the Bay Ana Air Quality Management all new materials for inspection. D rict7 0Ya I have read the haaardommattaftssequirsmcrm unlarChapter695 of Oe Caifor nu HaIM&Salmy Cad,Son o=25505.25533od25534.1.,Jcm Odifde Wilding d.net M a Immo that it u my responsibility an miry am Occupant or ala ne ui ata arroisseanccer.CcMr.wofOccupwwY. Signature of Applicant Date Owner oro mar dagem Date All roof coverings to be Class"B"or better CITY OF CUPERTINO 4 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: B1k: Lot : APN . . . . . . . . : 35628006 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35685 REFERENCE ID # . . . : 06080151 SITE ADDRESS . . . . . : 10893 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 WE 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