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06080147 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRA.C*"TC1R`INFC.1IiNT.ATIQN �' BUILDING ADDRESS: s DRAEGER CONSTRUCTION INC P"""N""06080147 11033 CANYON VISTA D OWNER'S NAME: PERMIT ISSUE!DATE Alk RANCHO DEEP CLIFF HOA 605 COWjKB9TAL Tr NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECf/ENGIy03ER: BUILDING PERMIT INFO BLDGO ELECTO PLUMB MECHO ;0o LICENSED CONTRACTOR'S DECLARATION Job Description bis 1 hmeby,firm that 1 am licensed under provisions of Chapter 9(comm r clog with Section 70M).(Division 3 of the Ban.and Pro@amm Code.W my Iicena u ! pa in fanfame and effeet. LT n REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE z Lim Clea Lk., g' canlrxwr ANTI-POUNDING, FELT & BATS . ROOF REPAIR. ARCHITECTS DECLARATION i 1 understand my Plans shell he.,ad a public mend, j� c Licensed Professional OWNER-BUILDER DECLARATION )n q I hereby.(Sect that 1 1. exempt from the Conlon C, Any c Law for Ne 0 4 fallowing mater.Permit i 701.5.L5,B ties. and Pro.dem li Code:Any city an mmny e3 which mquimm• .alsorecares da, ellen Mprow,h Nnniiti or repair my edswment h Her,W islmmo,d ponsumquims theapplkant for Co permit mole atlgnedwmment Valuati$p4208 < Nat Acis licenced puwant 7 0)of Division of Nc Communes (Chapter Sq.FC Floor Area �D (commencing wiNSeeurom and Win far of Wtheegeit assumpta sand ion.My At Code)err 5 9 Net io V es1.5 b Ia"applicant li and Ne basin it the alleged ppliCUon.MY l XMILn of ppb Section Com by hay out Commfor a permit objects Ne applinnuo Is Civil prohitY Of 3 5 6 2 Number 8042 . 00 Occupancy Type not mom Nan Rve hundred doll (f5W). 0 1,as owner of the property,or my employe"with wages as their Sale eompanssdon, . .111 do the wart.and the structure is nota mided maimed fanhle(Sec.7014,B.I. Required Inspections and Proration Code "The Contractors Liam,Law data not apply N an owner of q P property who Wilds or Improv"Herron,and who does such wmk himself m through his owt employean,provided that such improw:menu u,not intended oroRemd for sale If, however, that mime of provinghaldwlNinaroyid of cdmpledon,dee owner- �'- ■���� buildve will have Ne hmdcaro improvement 1 that he did rat bund of hatemon far Purposebe Own of - ,�+e.■ am.l. 0 I,a owner of the property,am meluuvely contracting wide licensed cum sron m rom mal Ne project(see.7014,Business and Prafesdom Code:)The Communities U- C..Law it= at apply m an owner a property who builds or improv"Cmman.said, awls �,rt 9100who correct,for such prokcta ln with a canctO Sem N or( emed personal e Contractors Lk".Law. 0 I am eaearpl end"Sec. .B A P C fm Nis.soon pppppp �t r"TNG �i� Owner Date UILY WORKER'S COMPENSATION DECLARATION 1 hereby sin=under Nulty of perjury,one of dee following declaellorte -1 Aave and will maintain•CudO"m ute of Canin self-imus,fa warbler,Camper arms,a provided fer by Section 3700 of Ne labor Cade,fm Ne p"fonnsom of Om work for which this pmmit is issued. C).frave and will maintain Wmters Compensation Irsursnce,as requited by Section 3700 of me labor Code,fns,Ne performance of tee wort for which this permit is Issued. My Workers Cempemauan Imuran c"aim and Palley number art: Came'.!�Ab Policy Na.: CERTIFICA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This mmian recd net bccomplemil If the permit Is formic hundred dall(SIM) airless) I certify Char in me performance of the wart for which this Permit is lattice.I slWl not - employ any person in my mmneru as m became subject in tiro Worbl"i Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If..net making this Certificate of Eumption.you should become subject m Ne Wmlcr's Compensation provisions of the lab"Cade you must .J Q forthwith comply with such provisians m this permit shall be domed mvokcd. .Zi r~N. CONSTRUCTION LENDING AGENCY [-a I hammy alio"Nat Nam te a eomtrualan lending agency far the perfurmem:n of a dee work fur which this pmmit m issued(See.3097,CN.C.) QLenders Name ' z Lenders Address V 0 1 Certify that 1 have read this application and sum that the above infroarmuvn is U,f comm.l agree to comply with all city ual county ominamu end sem laws mining to O V building construction,and hereby suthern representative of this Cirymermrupoo the i•'0. ahove-mcnooncd pmNrty for impaction purposes. (~ (We),,me m ave,indemnify end keep hnm4ss Ne City of Cupertino ageimt fq liabilid",judgmcats,costs and telecasts which may in any way same ageimt aid City J V Z in consequence of the grunting of this permit. ,� G r• APPLICANT LINDE��,(IITANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date sOU E -AT, S. _ IIPPP�� ' ) -0 -Re-roofs SR[�mrc n , nAZZARDOUS MATERIALS DISCLOSURE Dem HAType of Roof Will the applicant or future Wilding occupant mom or hurdle humanities material as dellned by No Cupertino Municipal Code.chapter 9.13.and Ne H"Ith and Safety Code.section 355334)7 All roofs shall be inspected prior to any roofing material being installed. 41 0Y" t}Me_ Will ft applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove mak h.m..air contaminants as defumd by the Bay Area Air Quality Managemem all new materials for inspection. District? O Yes 0No I have mud the haardaius materials requirements underC'hapmr 6.95 of the Califor. .in Health @ SiretyCorle,Secuans35505,31533 end 31534.1 undcrsmnd thnif the Wilding dam not currently ban a wrens that II u my maponsibility to nodry th,occupant of Ne rc`{ui'mme}''""�"�"'�°`� aim,anwwaafaccrdfleaeoraeap,m:y. Signature of Applicant Date -TH^�(�/�G_''f� ^ 5-:2) -04 All roof coverings to be Class"B"or better Niel,ar.uPRm20,saa Dam CITY OF CUPERTINO �n 10 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . 1 : 35628042 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35684 REFERENCE ID # . . . : 06080147 SITE ADDRESS. . . . . : 11033 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 . METHOD OF PAYMENT AMOUNT NUMBER ---- ------------- ------------ ------------------ CHECK 1715 . 30 123214 TOTAL RECEIPT 1715 . 30 • alcl - CITY OF CUPERTINOCUNO PERMIT APPLICATION FORM 011 SPo I/o N# Date: S Ica Ol0 Building Address: , Mailing Address (if different from building address): llo�3 V/i Owner's Nam Phone#: Contractor: License #: DCLIQ042 conwo Contact Phone:g7a•313-LAw Cupertino Business License#: Gly1 Q el l do Fax: ZI Building Permit Info: Bldg Rrk0 Elect ❑ Plumb ❑ Mjjh ❑ Job Description: e 1 Residential [Er Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 1:4 .41 ,10B Occupancy Group: Type of Construction: 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 Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK 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 <= IOOOA 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 - cuPERT iNo 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 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 cfm 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> I 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 Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO ! CUPERTINO PERMIT APPLICATION FORM FQuanlily Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Li ting 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 BSPECUL 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 • 3 of 3