08020131 CITY OF CUPERTINO a.;wawrg �,„, „e-o- *�� e _
BUILDING DIVISION PERMIT CU1"�TRACpRTNFf?T.2MA�I ?
BulL�ry�\Sgt4EsPOMESTEAD RD #108 DRAEGER CONSTRUCTION INC P�08020131
ER'S NAMED: - FE'RMn'LdUEDATE
HOMEOWNER' S ASSOCIATION 605 COMMERCIAL ST 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHfTEC(ENGINEER: RMV/RPLC DMGD RAIL WALL SDN BLDG Be1.6CTG PERm.rrUMeD - MECH
�oO LICENSED CONTRACTORS
rp DECLARATION - lob Description
1 Mn7 )of Nal1emlicensedfdic Bu undernd Prooasof Chapter 9 my lictrin Is ^^"`^^ ^-^'• '-••^ p
with Secdon]OfIU)of D9vidon7af Ne Business and Profcaaiam Code.and mylicensu is
N m Inn roma ana =
z aClara O Lm.
Data
g F Demta - Comncmr ✓g t ry
ARx OFLLAR ON
1 understand
he nJ my plena shill used as public seethe
�yU
{ to Ucerwed Professional -
y ,3 OWNER-BUILDER DECLARATION
E I hereby affirm that 1 am exempt from the Conoactm's Licenra Law for the
C O o following meson.(Secdan]0313,Dealt.and Prefectures Code:Any city or county
I$( which requirin a permit in consent,alter.improve,demolish.or repair any structure
-ZP prior at its issuance,aim requires the applicant for such Permit file a signed statement
FFss< thin he is licensed pursuant to the previsions of the Canuecmrs License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yF� (commencing with Section 7000)of Division 3 of the Buninessand PwNuioas Code)or
say - that he u eumpt therefrom and the basis for dm alleged exemption.Any vloladan of
Section 7031.3 by any applicant for a permit subjects Ute applicant to a civil penalty of APN Number O
nut more than five huMred dollars(M3 ccas Pane y TYpe
❑L ss awmr of the P e structure
trucm mY otimaycea wish wags ss dec(Sm.eampmssdon,
will dofinal,and the she CmaIs nuintenioded araw it font a(gee.]094, wnerof
Business
ana property
who
coca:The Can anaxS Union Law ansa oar apply uf ri owner ar Required Inspections
property who buildaar9mpmvv th improvements
vWwho arenamh work himadfn Nrou{h his
own emPloyewiproWded that such improvements arc not intended oro@red In uta If. -
howaveathe Wilding orimprowment is hath within one yeas of c prove for
dee purpose
of
molder will have dee burden of proving Net he diad ter build or improve Ter puryne of
saki.).
❑1,as owner of the property,am exclusively contracting wide licensed comme on to
mnstmet the pmjem(See.7044.Business and Profesaiou Cade:)The CmlmcmrS LI- '
mum law doss out apply to so owner of property who Wilds or improves thereon,and
who contracts for such pmjeau with a cottontails)licensed moment in the Conoacmr's
License Law.
❑I am exempt under See ,B A P C for this rumen
Data
WORKERS COMPENSATION DECLARATION
I hereby affl m under Penally of perjury am of um following dachratiau:
1 haw and will maintain a CenlOcate ofConsenita calf-insure for WorWsCmv,xm-
sasion,in provided for by Section 3700 of dee labor Code,for the Performance of the
work for which Nis permit is issued.
❑1 have road will maintain Worker's Compensation Insurer=,in required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Wor rad Com1'pouado91nsurance artier and Policy number art .ar
Center. o l-b Poliry No.: :jIWO12f70
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7bil section and not be completed if the permit is(none hundred dollart(SIM)
or les.) '.
1 to n fY that in the Performance of use wart for which this Permit is tssmd,I shill not
employ any person in any mannerse u in become subject to use Work&Camperuadm .
Laws of CoNe.m.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of Ne labor Cede.you muss
.J O forthwith comply with such proviaioru or this permit shill be decmaad reeked.
aid.
ceCONSTRUCTION LENDING AGENCY
[-i i+ Ihereby&Mm Nn New is a coeswNnn lending agency for ft Performance of
4Yi
the work for which this Permit ts Issued(See 3097,Civ.C.)
dA lender's Name
D z Lenders Address
V Q 1 certify that 1 have read this application and standout use above infomaduo la
F cOomm.I agree 10 COmPIY with all city and county aNlnrocea and site laws relating to
.OU building construction.and Mrebysudeodm mpresenutives of Nu city m enter upon the
shove-mentioned property for inspection purposes
�y'y (We)agree N save,indemnify and keep harmless Oe,City of Cupertino against
07 Iiabilides, gmenu.car rad ex"which may in any way accrue against mid City
V z in coaseq ce of a gin {of Nis Permll. (( yy
a
ER A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l �'7
if
T7 s. 2 I(� 8
Re-roofs
ver Dam
xAZARDO ATERIALS DISCLOSURE Type of Roof
plicrotar lulu bin Ing ncupantmnearhanllchuardaas material
the Cupertino Me al Code.Chapter 9.13,and On HUWt and Safety
ectim, 3a(a)7 All roofs shall be inspected prior to any roofing material being installed.
No
If a roof is installed without first obtainingan inspection,I agree to remove
pplicant or future building acaupant use equipment ar devices which P g
CMR havandnu air contaminants n defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[D Yes No
a
Ih mad Nehas msmmarials mquiements 'C
ChaPmrd.93ofthe Cilifar-
doesmlOt ainyC 'd=1
does
it my Nd hilit,mJcrsmndthuifuten.of d,
docs oat c nil ha and Net II u my rcaPemihilitY m mtlfY Nc oecupant of tate
mqulmm, h st reetpriortuissuarecofa Ccrdfmate Ocry panty.
w Z l D Signature of Applicant Date
Owns r a on agent o Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
ITEM 9 OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32659999 . 108A
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT # . . . . . . . . . : BS000004000
REFERENCE ID # . . . : 08020131
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD #108
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOMEOWNER'S ASSOCIATION
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : DRAEGER CONSTRUCT
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
FEE ID UNIT QUANTITY AMOUNT - PD-TO-DT THIS REC NEW BAL
---------- ------------ ---------- --------- ---------- --------- ----------
1DECKRAIL EACH 1. 00 428 . 00 0. 00 428. 00 0 . 00
- ---------- ---------- ---------- ----------
TOTAL PERMIT 428 . 00 0. 00 428.00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 3, 852 . 00 #134408
---------------
TOTAL RECEIPT 3, 852 . 00
i
o�oaoi �
Gp. CITY OF CUPERTINO
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
n0�4101c� p�zoY>t'Lf`l' Malo& �
� f0►1 W�2 AVC00l4Tto�
Contractor: Phone: Lt osb - S 3 b —o`f 20
-0V-4i✓ l0V—Z- C""WWGTiov "JC. Fax: —'0'4 Z-5
Contractor License #: &1-7 to I U
• Cupertino Business License#:
Contact: Phone: qo5 _Zpq -S 6 -p`r
Uol1 rcr2dajvle7 Fax: 0 -36—'01'5
Residential Commercial Lj
Job Description: IZIM G V / fG Pj4`r-- ►, A Qp 1(^ 1�a
S'1v1&j 11h-E rPv�zT1, � �►z4�, cE STcI�
Ll�ttc �p �2 L1G1�,
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy�Type:
1 FR, 11FR ❑ 11, 111, V-lHR [:] 11, 111, 1V V-N l `�
Valuation: Square Footage:
• Pro'ect Size: Standard XLarge ❑ major ❑
CITY OF CUPERTINO •
CUPEI,TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1BTEMPPER Temporary Building Permit (good for B.
30 davs)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to &incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
IBBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea •
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to &incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour) •
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
G - CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3of5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50'
1 RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B •
(interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
4 of 5
L� - CITY OF CUPERTINO
CUPEfZF GENERAL BUILDING APPLICATION
16 FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door (ca 8 windows)
1WINMEWSTR New Window-structural shear B
wall/mason includes plan ck fee
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
1BUSLIC Business License B
•
5of5
- - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
l UPEkTINO
Building Department
JOB ADDRESS: lf7— PERMIT #
zam a Of-imsTif;i-,00 ka4q 106 Odo�ai
OWNER'S NAME: N'1 I,/Aj _ 1+0Ar I PHONE # '-fog ,19'3 G —n `N z.b
GENERAL CONTRACTOR: Cp aJ r r f ,FAX #
I am not using any subcontractors: y -Zl —Og
Signa Date
Please check applicable subcontractors and complete Ze fo owin information:
SUBCONTRACTOR BURNES' 4E BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Shee ock
• Til
b7kn
er ontract Sign a Date