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06080154 CITY OF CUPERTINO %BUILDINCDIVISION PERMIT .CLI C'.T12ACTC)RI1�II'l?XtM.AT'Ifi3N ': Bull ADDRESS: a DRA GER CONSTRUCTION INC PERMTr No.06080154 10902 CANYON VISTA D OWNER'S NAME: PERMIT ISSUE DATE RANCHO DEEP CLIFF HOA 605 COMMERCIAL S 6 NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCH=fENGINEER: BUILDING PERMIT INFO BO ELECT PLUMB MEOCH 00 LICENSED CONTRACTOR'S DECLARATION Job DOSCTIphOn i 5 1 hereby aRbm Jus I em limnsed under provisions of Chapter 9(eommencing . with Scotian 7000)ol'DlvWon 5 of the Bumnessand Prof"a neons Code.and my license is i� I.fullfortaandeffect. REMOVE 3 TO 4" OF TILE, FELT & BATS'. INSTALL NE Lieenu iLy Lie.R ANTI-POUNDING, FELT & BATS . ROOF REPAIR. Da¢ q Contn"tor ARCHITECTS DECLARATION i 1 understood my plans ahall he used u public records i .0 Licensed Professional v, OWNER-GUILDER DECLARATION aI hemhy.(Seen that 1 1. exempt from the Contractor',fa :Any c Law for Na a o following mason(Semler 7U3IA,Business and Professions Codc:Any shy or county $ which mqulrea a Terme to dre requires construct,aloe Improve,demolish permit i ri mash any awcwre 111K IXor W ire issuance.IM..'1. thasphossO far sucCO-01 emit rofrleasigue(Clufucm Valual h1208 -ZQ (c meisllcrosud Sectio 7000)of Division3 haCo"uxtorinkrtnuLsorChaprm9 Sq.Ft.Floor Area �$ thammendngwiNgmtirom andth buts for rth alhe lusinesseged and Professions Code)or .. Nat he I.aumpt therefrom end the barb for the alleged excmpJen.My violation of ppN N b Section 7071.5 by any Applicant for a permit subjects be applicant w a civil Penalty of 3 5 62 8��L SC. 00 0 0 Occupancy Type cwt more than ave bundmd dallan ISS(101. ❑1,ss owner of the property,ar my employees with wages u their sole compensation, will Pr Newark,and the he Cortisnot Intended Law offered Unlike in an Business and Profnsdork Code:The Canuxuh License law ed U not apply m w owner sof s property who builds mlmprow thermn,and wWdmswhwork himud(ar Waugh his ownempl"yces,provided that such improvements tee not Intended oro@red for de If. ANED however,Ne building m improvement is veld within one year of completion.the owner. builder will haw the burden of proving that he did not build or Improve for purpose of sti ❑I,As now of the pmpeny,am exclusively contacting with Iicmued ronuwmn 10 came La the es not (Sean an liminess and ray who buionsld, Cade:)T7te C"ouamans I.I. ry „sv�� wens"law does such m w owner"f property who Wilds rs initiatives on metheman.And, S■V■$9■ who contracts far such projetts with a contramar(O licensed pervert mJ�e Conuactola License law. ❑lamexemptunder See .Bk PCfor Ntsreamn Owner Data WORKERS COMPENSATION DECLARATION 1 hereby aRimu under penalty of perjury ane of the following declemlonc ave and will maintain a CeNfiwmof Commit soelf-insole far Warkses Coni cation,As provided for by Section 77M of the Labor Cade.for Na performance of the work for which Nis permit is issued. R,0 tend will maintain Worimex Compensation Irtsunnce,u required by Section O of Ne Labor Code,per the performance alike work farwhich this permit is issued. My Worker's Compenwtir"n haw ce eartiar end Palicy number art: Carier..54s tf r1 Lin' e•' paltry No.: CERTIFICATE OFEXEMPnON FROM W R COMPENSATION INSURANCE (Ibis section moil not bo completed if the permit Is foram hundred dollen(5100) or less.) 1 certify that In the performance of the work for which this permit Is issued.I shall not employ any parson In any mamorm As At become subjeeuo Ne W"rhn'Compensation Laws of califorola.Data Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject In the Worker's Compensation provisions of the labor CMc,you must .,O forthwith comply with such provisions,or this permit shall be deemed revoked. zN CONSTRUCTION LENDING AGENCY Ih"rehy AM.that Nem Iso constmminn kndinjagenry far Ne perfermanceuf a the work fur which this permit is issued(Sec.3097,Civ.C.) QLendae:Name z Lenders Add. U Q 1 cati fy that 1 hay"lead this application and sum that the above information b U, F Correct.I agree in comply WIN all city and county ordi men and sank lam relating in 0U abbuilding construction,and hereby authorb,tCmCSenmiws of Nis city to enter upon the rU above-mentioned property for ins,ecuun purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against tih liabilities,judgments,costs and expenses which may in my my acrnu against said City / ()az+ iAnPPLnxgAecofthe limiting DS RIND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO .RE6B67�0lL,_ _ St 5 I -O Re-roofs Sipa—um orWcamuCordennor r Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof WilltheBic Cupertino fMuni buildingeeeupwt coram and le thh Incautious material As defined by W Cupertino Munirilul Code.Chapter 9.11,and the HruIN atld Safety Code.Section 15531(a)7 �. All roofs shall be inspected prior to any roofing material being installed. ❑Yen Will Ne applicant or future Wilding Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove WAR hanrdans All conuminwu As defined by Ne Bay Area Air Quality Management all new materials for inspection. District? ❑Yea QlT I haw mad Ne haa4tdrusmaCda1s mquiremcros unde,CMpur f.95"f Ne Califm. niaHcaWrh SafetyCade.Smti"ns15505,15533.d2553C.IundersundthmifW building Jena not Connolly haw a Count.that It is my n sponsibility w notify the aacupont of the Must WfiA prior to issuance of a Certificate of Occupancy. Signature of Applicant Date _ o r.1-Mlionzed agent Date All roof coverings to be Class"B"or better CITY OF CUPERTINO �m 7 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35628028 . 00 DATE ISSUED. . . . . . . :. 08/18/2006 RECEIPT # . . . . . . . . . : 35685 REFERENCE ID # • : 06080154 SITE ADDRESS . . . . . : 10902 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 SEE 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 • Zma, CITY OF CUPERTINO ( M(4 CUPERTINO PERMIT APPLICATION FORM 691 C1 I ,,- 062 7 N # Date: _ a8 -oa OU Ie OW Building Address: Mailing Address (if di erent from building address): o D Wi m Owner's N e: I Phone#: Contractor: t1V License#: IDT Y- pn Ire. t-Ill I 0 Contact; a,, �1 Phone:C125.3►3-0100 Cupertino Business License#: �.n 0 OE Ido Fax: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mjjh ❑ Job Description: \1e sto 14 i , Residential [ErCommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: 1� 4, 2b8 Type of Construction: Please check this box if the project is a secon -story addition: ❑ o'ect Size: Standard Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI 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 CUP EI�TINO 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 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 BREMARUiAN 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 R air/Alter H ating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUPER,TINO 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 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 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 • 3of3