06080143 CITY OF CUPERTINO
BUILDING DIVISION PE CONTjUOTOWINF,O.R�AT_RON,,,;,
s .py' PERMIT NO.
BUILDING ADDRESS: D ER CONSTRUCTION INC 06080143
11042 CANYON VISTA DR
OWNER'S NAME: PERMrr LSSUEDATE
RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST op /18/9.nnis
NE: SANITARY NO. CONTROL N0.
(408) 536-0420
ARC HITECTIENGINEER: BUILDING PERMIT INFO
BLDG EO PO MO
LICENSED CONTRACTOR'S DECLARATION lob Description
b
+ 1 hereby affirm Nn I are licensed under prevision,of Chapter 9(commencing ZP
with Secfion 7")of Division 3 of No Business sed Profession'Code,and my license Is
nto in full FO=and effect REMOVE 3 TO 4" OF TILE, FELT & BATS. INSTALL NE
;gz Li"— Lle." aj7Gjn Contractor ANTI-POUNDING, FELT & BATS. ROOF REPAIR.
i Da¢ ARCHITECTS DECLARATION
i I understand my plans dull W used as public records
i
u. LiccnaJ Pmfessianal
aD OWNER-BUILDER DECLARATION
I hmacco ,(Roti the 1 am esichn from the Casa Co e:enseMY
Law for the
:00 following moan.(Section 703 oncem Business and approve.
deroll Calc:My oily Or county
1$fit. which requires a permit re rnnMmer.Ater,improve,demolish,of
•Z�ja, pair ny uuauo
priortoitscalrho lieam farmia sWemem
thatWislleensedpurmuant1.JupdwisiamOfthecom"Wtor.,LeonaLaw(Chapta9
Sq.Ft. Floor Area Valuati$I€208
$ (commencing with Section 7000)of Division 3 oftha Bushmaaand Perfection'Code)or
—
that he I'eempt theefMM and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of ppb Nth ber Occupancy Type
not mom dun Ow hundred dollars(SSW). 3 56 2 8 U�6 . 0 0
❑1,as owner Cliffe property,or my employees with wages as Jess ole(ompensation.
will do the work.and due mueturtunet mtetwedoranemdformic,sac.ra.,Bashwa, Required Inspections
aro Profession,CoThe Contractors Lt.Law dao not apply M an owner of 9 P
property who builds a impoveatherson,and who doessuch work humelfor though his
Ownemployeca,provided thatsuch improvements are not Intended orolferoE retain.If.
however,the Wilding or improvement I,old within can you of completion,the Owner-
builder wi0 have the burden of ponying that he did na Wllm in improve for purpose of
sake.).
I,a owner a the property.am eulu'ively contracting with licensed cenuemm to
comtmct the pmjca(Sec.70",Business and Professions Cade:)The Contractors W-
came law does not apply to an owner of popery who Wilda or impmvn theeon,and
who convects for such pmj,m with a contoctods)Headed!pursuant M the COnuanlori' s.
License law. J1.1t1 09 2€Ib1
C]I me uempt undo See .B&P C far this recon
Owner Date BUILDING
WORKER'S COMPENSATION DECLARATION
1 hertby'fiirm under pensRy or perjury one of the following declarmlam:
I have snit will maintain a Ctuniftato of CanenUoelf-Imum I"W-uces Coot
ssdmn,as provided for by Section 3700 of the labor Coda,fa the performwwe of use
work for which this permit is issued.
erl have and will maintain Workers Compensation Insurance,u required by Section
3700 of the Labor Code for the performmce of the work for which this permit is fussed
My Worker,Compensation in Cmc cartiu and Policynumberam:
cmm,;c4a4& PolicyNo.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITusenion reed net W complewJ if Ne permit is!,Tone hundred doll=($100)
car less)
1 certify that In Ne peffamanca of the work for which this Permit Is issued.)shall not
employ any person in any summer an as In become object to the Workers'Campemadon
Laws of Califumia.Date
ApPlicam
NOTICE TO APPLICANT.If.after making this Ccnifiuw of E remit ic.,yen should
become subject to the Workers Compensation provisions of site labor Code.you most
.,0 forthwith comply with such provisions or this permit mall W deemed mmked.
z y CONSTRUCTION LENDING AGENCY
f-a 1 hereby e1Rrm that cert is a communion lending agency for the performance of
IY.> the work for whim woe permit is issued(Sec.3(597.Civ.C.)
W� Lender,Name
M z Lender's Address
V Q I=try that I have mad this application and sum that the above Information is
Is.HCorect.1 agree to comply with all city and county ordinances and state laws relning to
V Wilding consuuctioo.and hereby mduries oes pmeenwdvof this city to enter upnn the
Uahovomemiuned property for inspection purposes.
(We)agree to ave•indemnify and keep harmless the City of Conenmo gaunt
rF-t r4A liabilities,judgments.costs end espemm whim may in my way accma against=it City
U x in comequeme of the Swung of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S��OyyRC O TIONS.
SE N_ 5r-21 'C Re-roofs S-fgn'mum of pp ram/Conu scar Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Je applicantor fuom Wilding Occupant Mort or haemic hu aide-mamrisl
as de i cd by the Cupertino Municipal Cade,Chapter 9.13.and the Harsh and Safety
Cade.Section 15531(e3? All roofs shall be inspected prior to any roofing material being installed.
❑Yea 'Erg.—
Will the applicant or future Wilding Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardou,air cantwimnts as defined by the Bay Ams Air Quality Management all new materials for inspection.
Disrict?
❑Yes 4!rFu
I have mad the hvaoous materials requirements underCWplcrd.95 of the Collor.
nu Health&SafctyCWC,Sectiom 15505,25533 vo25534.1 umkn"thuif he Wilding
does not currently how:a wren.that Is u my respemtbility to notify the Coconut of the
re ==2='
me muttbc armtamncaar,Certificateorocxupmcy. Signature of Applicant Date
Owmror duthorixeJ Cog 'paw-o All roof coverings to be Class"Bn or better
CITY OF CUPERTINO
6 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35628036 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . ,. : 35684
REFERENCE ID # . . . : 06080143
SITE ADDRESS . . . . . : 11042 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
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wo, CITY OF CUPERTINO 143
CUPEf� PERMIT APPLICATION FORM
- -0,35 0 �1•
N# Date:
06 1g OU
Building Address: �` Mailing Address (if different from building address):
a namonzr
Owner's Nam • Phone #:
t —3-390
Contractor: License#:
'Dg r Qn 1CC. LoQU10
Contact Phone:q?5-W3-LAGv Cupertino Business License#:
GLYI 0 Ea Q Fax: 21
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mjjh ❑
Job Description: Ve 3 b " Nlt.,1
Resid( Kcni Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 4/�g Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: El Size: Standard � Laze E) Ma or E]
QuantityFee 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
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
CUPERTINO 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 rhWer/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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLkMIAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace 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 Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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i CITY OF CUPERTINO
cuPEkTF PERMIT APPLICATION FORM
uantity 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 Insection BUILDING
BSWIM Swinuning 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 Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
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