06080142 CITY OF CUPERTINO a a •ei .z.ai;a �• d. ' as „� -�.� `
BUILDING DSYISION PERMIT *�CC1AiRA.GfTOItI1 `.,f1�tMA7'I
a ,>34;. hYf nTsh w' £a j`b• a•.,t. A
BUILDING ADDRESS: x DRAEGER CONSTRUCTION INC P�MITND'06080142
11022 CANYON VISTA D
OWNER'S NAME: PERMRISSUEDATE
RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST ng/ia/2nne
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
in
0 0
CC LICENSED CONTRACTOR'S DECLARATION Job Description
i uF I hareby affirm Chat 1 am liceued under p ovienu s of ehapmr 9(commencing
til wlVt Section 7IXX))of Division Sof she Butlrw and Prol"Iuu Code,aM my licensees
to infull facer and effect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE
,qan
z Damm - Conte �ei�relQ ANTI-POUNDING, FELT & BATS . ROOF REPAIR.
if Dam —'� I — Contractor
ARCHIIECrS uNblic DECLARATION
I untlenund my plans Nall be used u W blit mcorth
iyU
.Gr' Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm(cc the 11. exempt Business n do lam nes Co Llanee Law far the
.a O following mason. mint,l 7031.5, ,arca. and improve.
adoll Cada:Any easy or cauuty
re
5$ which requires
n permit re construct,alms Improve,d Permit,or rele pair signed
ig any tatnelum
Pdarniutssuame,minnt WIM to applicant for techrcrmiuofiense La (Chaps ens ValuatiOd 208
that
menlicensed cigwit Sewam 7010)of Division
of the Canumand cuc Law(C Code)
Sq.Ft.Floor Area
S�$
(commencing wish Section 7000)the
Dristan r the
the Businesscousin d oe.ProAn Vi Cade)of
Net he Le sump+th.efmm and dm buLe fa the alleged eumption.Any violation of
Section 7031.5 by In)•applicant for a permit subjccu the 11PPlkant 70 a civil Panally 01 WrsN Number Occupancy Type
our mom than live hundred dollars If500). 3 628038 . 00
'
1,uowerofthepmp".mmywploymwlmwgesuthebmlecompe don,
will do thework,and thesmctum Le mtimmvded aRcre
ad for We(Sec.7044,Buda•• Required Inspections
and Profeasiam Calc mm
The Coacrs Liaise 70 m IAw does ant apply —or q p
property who bis TMs a ire prows th.mn,and woo doessuch were himself or through his
own employees.Provided thataneh improvement,are not mounted ar.fla ed for role.U.
however.the building or improvement's mid within can year of completion.the owner.
builder MB have the burden of proving dist he did sous build or Improve for purpose of
salla.).
1,Is awns of the property,am exGmively consisting with licensed conmctom b
conamuct the project(Sec.7044,Business and Professions Cade:)The Comnctah
Law Li-
,.I w does act apply 0 an own.of property who belittler Improve thereon,and
who La ufonneh projects wit aronmemr(a)Ilanad punuemm to ConvanoYe FINAL
��
who co tract. 4
❑I ore uempt under See .B h P C far this moon
Own" Dau
1 hereby armRunder penalty of perjury,not of dm following d"IarWoade ��"e `a f•�
am Indwillfmaintain e Can3700of ComesrCin l .for fa rfakera Coofft
andwork....ad
f as which
gd fa DY 5"tion 3700 a(dm IAbor Cade.for ds peefonnana of tits �,� i I
work for which Nie permit is used. L
Pl-+have and will maiman Workers Compensation Instance,u required by Section
3700 of to Labor Code,for the peRarmeme of the wads for which this permit is iaaued
My Workers Comparison ]Inw nes artier Ind Policy numberan:
Cartier: Policy No.:
CEIMFIGATE OF EXEMPTION FROM WORKERS•
COMPENSATION INSURANCE
(Thin section mad nothe completed If the permit is foram hundred dollan(SIM)
artless.)
1¢nifty that In the performance of tho work for which this permit Le issued.I star not
employ any perm.in my mamcrm u in beam e.subject in the Work.i Companudmn
Iowa of California.Das
Applicant
NOTICE TO APPLICANT:IL after making this C)ni0can of Exemption,you should
bccome subject 70 the Workers Compensation Provisions of the Labor Codc,you most
'.7 z faMwi,h comply wit tech provisiau or this point,shall be doemed revoked.
ti O CONSTRUCTION LENDING AGENCY
F I hereby artmm that Nem is a construction lending agency C"the performmcc of
Di 7 the work(Ler which this permit is Leaned(Sec.3097.Civ,C.)
aQ lender's Name
.7. z Lender's Addmu
C.)Q I unify that I have teed this application and soon thin No above information is
Ty f~ correct.I agree 0 comply with all city and county ordinances and state laws miming to
0 building Convection,and herby audodm mpresenstives of this city in enter upon the
r W shove mentioned pmpeny for inspection Purposes.
F+y (We)agree to eve,indemnify and kup harmless the City of Cupertino agaiut
(n liabilities,judgencataxoau and expenw which may in my way accrue agalas,said City
U z in consequence of the getting of this permit.
p••' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S1�
C_]1$ Re-roofs
St{n ere of AppticaMCreuref r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dmo applicant or future building occurred ams or Media transitions manrial
as de0ncd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cade,Section 55532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yee I f15N.41
Will the applicant or future building occupant use equipmrnt"devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h"ardaus air conummemst;In deBoed by the Bay Ana Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have read the huooNsls materials requirenmrsurdef Chipnr6.95.1 the Calif.,.
.isHealth;Sak,yC.&.Sadau25305,25533 uu125534.l umknmd dutifde building
dna not currently have a unana that it is my responsibility so ratify do oompmt of the
reqs ,comet uiuuanceofacertifcamofOccupancy. Signature of Applicant Date
— 7I All roof coverings to be Class"B"or better
Owner Ler amhorircd nice, Dan
CITY OF CUPERTINO
.m 5 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35628038 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . . : 35684
REFERENCE ID # . . . : 06080142
SITE ADDRESS . . . . . : 11022 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
06E 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
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zgv,� , CITY OF CUPERTINO aI
CUPEIiiTINO PERMIT APPLICATION FORM
7N# Date:
3:54 -a - ® 0 18 ou
Building Address: Mailing Address (if different from building address):
�/�aa ViStZt
Owner's N Phone#:
a66 -3
Contractor: License#:
'Dg Y- on Irc. conwo
Contact Phone:q?.5-313-(AGn Cupertino Business License#:
I an Q Zag 1 CICI Fax: 21
Building Permit Info:
Bldg Elect ❑ Plumb ❑ M h ❑
Job Description: \fe, 3'b +
Residential YCommercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: L 4/�Q Occupancy Group:
Type of Construction: D Please check this box if the project is a
secon -story addition: ❑
o'ect Size: Standard 2`� Laze ❑ Major❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M 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
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 . . • .
CUPERPERMIT 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
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 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 clip MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace 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 Repair/Alter H ating MECHANICAL
BREMRESAPP Remodel Res Ap liance ELECTRICAL
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CITY OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM
9uantity 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 Change BUILDING
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