08020133 CITY OF CUPERTINO .:�..t,*.. ,za*S�xxa>
BUILIsINC DIVISION PERMIT OR Il
t � .vartr,,fk•. r.L .j�r6ia, R "a� nc-a'.`'.�� a 7r
hirr NO.
Bu1L.p5,IMT'kMESTEAD RD #216 DRAEGER CONSTRUCTION INC P�08020133
2
0.'S NAME: PERMIT ISSIfEDATE
HOMEOWNER' S ASSOCIATION `1105 COMMERCIAL ST 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITMFO
RMV/RPLC LIKE4L_IKE SDNG & BLDG BLECT PLUMB MECH
3 0 o LICENSED CONTRACTORS DECLARATION O D O
U 1 berebY affirm Nal I am Ihenecd under noviaions of Chapter 9(ournmo hi "'- ---'-" """" """'-' --Job Description
xx with Section 7U(MO of pivblon 3oftha Budnm and Pr fessions Codu,andmylkensuis
^? In full fame and crcm kL / 6 10
j 3 Lkenm Clua V l/ Lk.i
Dam
9 "(�6/rYl t' �ARCNREComiDECLARA ON
I u& my plain Ntll ho umw as public mcnrN
s
Licensed Proficient anal
Zm 3 OWNER-BUILDER m the CoA770N
OO hereby.(firm that I 1 attempt arum the Can i.Coo License taw for tiro
ZOO O following moon.(Sadat 70313,:4 who.and Pronn,dcrons Cole:My dry m county
4� which sequlm n permit to routs.
m4 dtor.tmpmve,demolish,or erepairalighted
g my unownt
Z�^ prior toiu iouance.alw requins dm,ppliwn,forwch permit tofileasigmJ summent
g < that he u licensed pursuant mUx pooviskins of the Conuacmr's l.kenm Law(Chapter 9 Sq.F FFloor Area Valuation
i�g (commencing with Section 7000)of Division 7 of Ne Business and Professions Code)or
- that he is comp,metefrom and As basis for As alleged esempdon.Any violation of
S"tion 7071.5 by arty appli mt far a pcmlt mbj"u the applknt to a dvit penalty of APN Number Occupancy Type
mm fume Nan fivehundred dollars($300).
P Y YP
I,o mwmr of the pmpcny.m my wploym with mrA u dmb mle compenudon,
will do the wars,and to,mucture Is n itimended ma@red faraak(Sec.7044,Business
Ad Proaeasions Cade The Contractors Lteva Law dm not apply 0 A owner of _ Required Inspections
property who buildsorimprom thereon,and who doessuchworkhlmself or through his
Own employee,provided that such Improvements are no,intended moQered for We.B.
however,the building Or improvement is mid within one year ofrompkdon,du owner
Wilder will have tiro burden of proving As,W did NO build or improve ren purpose of
uk,I.
❑1.as awrcr of the property,am exclusively conu=tIng with Ilcensed funs mmis to
construct the project(Sec.7044.Business and Profesamm,Code:)The Contractor'.U.
cense taw dm oa,apply to m owner of property who Wilds or improrn Aco m,and,
who contracts for such projects with a contramor(U licensed purwant to the Contractors
License Law.
❑IamuempturWarsee ,BhPCfmhureom
DA,
WORKER'S COMPENSATION DECLARATION
I hereby afOres under penalty of perjury nm of the following declaradmu:
❑IMwand NlmainuinaCenifiamaf Cansemwselfinsum fa WmkaYs ComRm
Wion,as provided for by Saran 77M of the labor Code,for the performance of As
work for which this permit is issued.
❑1 have and will maintain Warker's Compensation Insurance,a required by Section
7700 of We Labor Code,for me pcRonnmen of he work for which that permit u issued. '
My Work e.Compensation Iwrrce artier and Polity number art:
Cartier. L��i7'�+ Polley No.:7 I W�I ZI-7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
aim,maim coed Out hoemnp mid Ifthe permit Is forme hundred daRan($)00)
nr leu)
I anify me,in the performma of We work for which his Permit u issued,I Nall am
employ any person in my matter an as to beeomo subject in he Workers'Compensation
laws of hlifomla.Due
Applicant
NOTICE TO APPLICANT:If,wier making this Ceninem,of Exemption,you should
become subject to We Workers Compensation previsions of the Latter Code,you in=
.JO foMwith comply with such provisions m sets Permit 0,11 Im tamed revakcd.
z'"" CONSTRUCTION LENDING AGENCY
[-t��+ IWmby affirm that here is a cotwwctim lending agency for the Performance of
the work per which this Permit is issued(Sec.W.Civ.C)
Q Landers Name ,
0 z Lenders Add.
U 0 I cenify that 1 haw read this application and sum that the shove IrdormWm Is
uy^ roncR I agree m comply Wm all City and county aNinancia and state laws relating in
.0 rU^ building couwction,and herebyauthade:repmmnudvu of this city to enter upon the
Gil show-mentioned property a Inspection
pmpema
gy (We gine m sew dcmnify,and kap harmless the City of Cupertino against
ti y liabIlium d m ts.co do, coin,which mayin anyway acme agdut WdCity
U z in eartseq a me ti of this permit �— .r17 f L
APPLIC D STA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date at'C.Q 1
SOU 2/ r0 E
Re-roofs
Slgnu alir DM .
It ADO MATERIALS DISCLOSURE Type of Roof '
Will ted applic tar mhoilding aapan,atammhandlchuaNaw matodd
x dcflmdYa o by the Cup I More
Code.Chapter 9.11,and me Health mw Safety
lira section M532(47M532(47All roofs shall be inspected prior to any roofing material being installed.
❑
Will the appliam fuluro Wilding asupam um equipment a devise Mich If a roof is installed without first obtaining an inspection,.1 agree to remove
..it ha ommiae air conuminsnts as defined by he Bay Area Air Quality Management all new materials for inspection.
Dinri.0
❑Yes No
I have maw me has
materials no,immmumderClupmr6.95afdmCdifor-
niaHealth Safe Code. mZM3,25533and25534.1mJcrmmdthatifthe building
dm mt c rat haw rut
it u my responsibility to notify he acupmt of the
require w her he t 'ortoiasaanccofaCenifpamofOcce ,0 Signature of Applicant .Date
Droner r ren agent 2 Dato" All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
ITEM 7 OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659999 :216
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT #. . . . . . . . . : BS000004000
REFERENCE ID # . . . : 08020133
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD #216
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOMEOWNER'S ASSOCIATION
ADDRESS . . . . . . . . . . : 444 FIRST ST #1
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1DECKWOOD EACH 1 . 00 428.00 0. 00 428 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 428. 00 0. 00 428 . 00 0. 00
0 boa of 33
CITY OF CUPERTINO
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# ✓cp �y Date: Za
_ Z1 -O
Building Address:
22 "tEvrrcko 1z-o UJ(f Zt (o
Mailing Address (if different from building address):
Owner's Name: Phone#:
D 0.4 I Ij t c 104ft IM ,Wry Nein b •�
HOM �ocojc25 Ors c,4Tiv •1 o- ql,7-qa( ( I
Contractor: Phone: �og_ 53(o- oaf Zoo
(0A3L'MU(.T(0j JOG Fax: y.o +U - S? (o -ogzs
Contractor License#: Co 17 (at O
• Cupertino Business License #:
Contact: Phone: t+og ,W g - ri 6
LOki n07(EI_ Fax: 4OS - 53(a-0q7,57
Residential Commercial
Job Description: L ,M0I/IFV W-ato A( r- LIY-(c- Fo'2 LIGE
Siol,04 447 TCI,-? 6 R-4-IL- (A1' l.L 05:- 0-lgnl W4J k
navL�l.So (E SuPro'+-rt- �31��9 . 'a
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N rra
Valuation: -7 00 —
L4Square Footage:
• Project Size: Standard X Large ❑ Major ❑
CITY OF CUPERTINO •
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
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
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3 Installation/relocation of ca 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
IBBOILER5 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
aCF CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWUDuplex New B
IACOUSRESAD SFDWUDuplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY 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
3 of 5
CITY OF CUPERTINO
1*CUPEI�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
1RETS11I0 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high(up to B
50 R
SIDING
1SIDEST/13K Siding, Stone &Brick Veneer B •
interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>lOSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sD B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
4of5
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group ]GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
1 EPERMTTFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK 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
•
5 of 5
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
UTY OF Fax(408)777-3333
-LUPEkTINO
Building Department
JOB ADDRESS: 21 b PERMIT# /
' 1-2-:530 M f- o nh
OWNER'S NAME: M 0 JC-7 S l+0 4 PHONE # 14 01 - T3(,- b'+Z u
GENERAL CONTRACTOR Qpaw ale.— 'C*8JS- v(., FAX # 40S - 57 6 -of Z
I am not using any subcontractors: Z-2-1 -0 $
Sig4ZweA Date
Please check applicable subcontractors and com ete theyollowing information:
SUBCONTRACTOR BUqTNF-qrMAX4E 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
Sheet Rock
Tile
-0 4.
er ntrad nr
ature Date