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06080153 CITY OF CUPERTINO BUILDING DIVISION PERMIT C0 17CxA '�'a Yrr 'o .Tho r fi: BUILDING ADDRESS: w DRAEGER CONSTRUCTION INC PE,LMrr NO'06080153 10922 CANYON VISTA DR - OWNER'S NAME: PERbffI LSSl1E OATS RANCHO DEEP CLIFF HOA 605 COMMERCIAL NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG 1� EIS PLUMB MECH l� 00 LICENSED CONTRACTOR'S DECLARATION Job Description i 1 hereby affirm Nn I am licensed under provisions of Chapter 9(commencing P with Section 1000)ofDivialon 3 of the Budnas and Professions Code.AM my Iiceme is in full force And affect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE ;M: Lia7;3 Lic.1 <�>Sfn ANTI-POUNDING M Do. Tcontractor , FELT & BATS . ROOF REPAIR. ARCHITECTS DECLARATION i 1 understand my pito shall M mad As public=arm ?yV '0 Licensed Professional ey OWNER-BUILDER DECLARATION CormaON <i 1 hereby.(Sm that 11. accept from Um Camrecmra :Any Low y. for Ne e0ofollowing uiresa(Sadao700IA.Badness sod Potations Calc:Anycity termunry j$ which its requires a permit re enrm thol,alcor.Improve,h mama t or repair ed arunum z�^ that w i"i eased f atm rcquima mM applicant for sucCom a Commences License sew(Chtomem Valuatil$pl 2 0 8 Nat he I.licensed pursuant w the Provisions of the Conuactors License Law(Chapter 9 Sq.Ft.Floor Area 5 9 (commencing with Section 700M of Division 3 of dee Business and Profession Code)or .. that he is exempt therefrom and the basis for Ne alleged eaempdon.Any violation of Section 7031.5 by any applicant for a permit objects We applicant w a civil penalty ofN Number Occupancy Type not more Wan five hundred doltsrs($500). 3M28026 . 00 O I,As owoer of dm pmpary.or my wpigces with wages As chair rte compenadoo• will do We work,oil den anaeture is not manned Or offered for ask(Sec.7W,Best^•• Required Inspections and Prefesdom ac Code:The Conuwra Liana Law dom not apply w an mann,of 9 P Property who bulidsor improves du mon,and whodoesauchwork himalfrlhrough his Pg�� lu nerployee,pmN or Improvement vent improvements Me not inmMedroOened fur We R. �'��g ownemployees. dee building or Mpmvemont u aid within one year of cameffem el the owrr- ljliya builder will have Wes burden of provina that he did not build r improve for purpose of FU ale.). ❑1.a owner of the pmperty.am exclusively cmoaming with licensed conuacson in cmnsmct dm project(Sec.7044•Business and Professions Code:)The Coewctoh U- come Law does not apply W an owner of property who builds orimpmves Ihercen,and ✓, -!r i i,m7 who contracts for such pmXcts with a conwctor(O licensed pursuant In the CYnmatora License Law. BUILLANG C3lamaemptuoder Set ,B&PCfr Wamawn Owner Data WORKER'S COMPENSATION OECLSRATION LII be, afihm under peaky of perjury mm of dee following datstWans: and will maintain a Certificate of Convent w alRlnsum for WorkeraCanpen- atimn,an provided fn,by Sadan 3700 of the Lahr Cade•for the Performane,of the work for which this permit is bussed. ave and will maintain Work s's Compensation Insurance,u required by Section 3700of the Mbar Code.for the penfamance of dee work for which this permit Is turd. My Workers Comperadmn hssvrarc artier and Policy number one: Carden m+n) Polley NO.:��L`(1!727el CERTIFICATt IF PEX F NFROM WORKERS' COMPENSATION INSURANCE (This shim need an,W completed If nth permit ts from hundred do0ata($100) or less) 1 certify that in the performance of the work for which this pemlt Is lased.I shall not employ any person In any mannerm as to became abject W Um WOrkerf COmpensatimn Laws Of California.Dam Applicant NOTICE TO APPLICANT:If.after making 004 Cunifiaw of Exemption,you should become subject in the WmherS Compensation provisions of We Lahr Code,you mot vJ z forthwith comply wide such provisions Or this permit shall W doomed rtweked. ,zh O CONSTRUCTION LENDING AGENCY Er I herby arm wt deme Ie a com m;fim lending ages,,far the perfomma of a > ca work for which woo Permit is issued(Sec.3097,Civ.C.) W O Lender:None ]z Lenders Address U Q 1 certify this,I have read this application and soon mad be above information is LI,P: coma l cgme,to comply wins all city and county odinamma and state Isar mhtins w O V building construction,and hereby authorim representmiw or this cayw enter upon the W shave-nmmioned propcny for im,cum purposes. (We)agree to ave,indemnify and keep harmless We City of Cupertino again: y liabilities.judgments.cru and apercus which may In any way acme against said City V z in cmnsequonce or dee granting alibis permit. 'L, C� �-h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 LAM O Re-roofs Si arta pp rwRDataHAZA HAZARDOUS S MATERIALS DISCLOSURE Type of Roof WIII dee a Coper r run=building e.Chapter tuort or handle hvutlmmd Safety al a defined by Un Cupeninm Municipal Cade.Chapwr 9.11.and Uma Health and Salety Code.sada 15532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future building occupant pa equipment or devices welch If a roof is installed without first obtaining an inspection,I agree to remove emit hoaNna air conumiants a defiad by the Bay Ana Air Quality Management all new materials for inspection. DimrieO oyes �Idm I have mal dee haarmau matorialsrequimmewunJer Chapter S95 ofdee Califor. nia Hahb&Safety Cade.Sccvox,25305,25533 And!25534,1 understood demifthe Wilding dons not C..Iijy bew a uman Nat h h my.'Oubillmy m oOdfy deo occupant of dee mql n maeemneatoarOcmmaay. Signature of Applicant Date Owner 0n,tulhorimd agent D,a All roof coverings to be Class°B"or better CITY OF CUPERTINO 6 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35628026 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35685 REFERENCE ID # . . . : 06080153 SITE ADDRESS . . . . . : 10922 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 , 206 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 171 . 53 0 . 00 171 . 53 0 . 00 • Zn CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM Q log -- N# d2�//� —0?0 Dat . O� '� OW Building Adiras nn , /`� Mailing Address (if different from building address): Owner's N eVV: f�l� V Phone#: 016 4 — 3,3Do Contractor: License#: UrGt r on Irc. Conwo Contact: Phone:g25.313-0100 Cupertino Business License#: an C) Eag I da Fax: 2109 S Building Permit Info: Bldg E��COfi Elect ❑ Plumb ❑ M h ❑ Job Description: Ve, Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: L 41 �Q Occupancy Group: Type of Construction: D 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 BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler>500K to IM Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAX13Q 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 0 170 CITY OF CUPERTINO COPE F PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMNIM 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 BPEdTERCEP 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 BREMAIRHAN A/C Units <= 10,000 din 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 Mise 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 HeatinMECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 2of3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Mecb 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 • 3 of 3