08020136 CITY OF CG
BUI LDING DIVIS10 N PERMIT CCINTRAGTOR�INF'Q A'C`ION `.
BQaTTSSTEsfiOMESTEAD RD #214 DRAEGER CONSTRUCTION INC Pou,08020136
ER'S NAME. PERMIT ISSUEDATE
HOMEOWNER' S ASSOCIATION 605 COMMERCIAL ST 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
RMV/RPLC BLCNY COATNG BO o PLO 0
30o LICENSED CONTRAC OR'S DFALARATION Sob Descri on
I hereby anion that 1 am lacowd under Provitimu of OUPmr 9(commencing _ _..-._ .�� .._.__,... p .
with Seniors]01111)of Dlvirion lo(Ne BuJnw and Profwiuu Cado,end my licenm u
n�N
In full forte and off 0
�fdZ License Caw
Dam Conlr�_ Contr
E 1- actor
ARCHr1Ecrs DECLARATION
I understood my plans MW W used a publlc rooms
�d
good Uccused Profeumul
5 OWNER BUILDER mDECLARATION
COO hemhy.ffirts(Soret that I em exempt from the ContrProfessions
Co License Law for the
COO
which me masoa(Section]0313,Bassinets andrte ve. oli Cade:My city m count'
which magus u a e.atm to c sun lion alcor.ImPmsu hPerdemolish,or repair any sutmen,
uctom
_ 0 war heor toiucense C0.almntut we lion o for such Permit torile a cense Laed w(Chom em
pp G Notal is licensed purmantm we provisions of we Contractor's License LawlChapmr9 Sq,Ft.Floor Area Valuation
C59 (commencing with Section 7000)of Division 3 of the Busittw and Protestations Code)or
— that be is eumpt tWmfrom and Ne basis for the alleged eumption.Any violation of
Section 7031.5 by any applicant for a pump subjects the applicant to a civil porosity of APN Number Occupancy
,rot more than five hundred dallua ISMP y Type
Cl
I,uawner ortle property,ar my wploym with mgnu Nov mmcmnpewUdn,
will do we wadgmd Umswctumlsnotimm�sedoroReeedfmum(Sec.70/s,Buinw Required Inspections
and Pmfeuians Cade:The Conuecmfs Licuue don hot donot appy m an owner of q P
Interparty who buildsorimproses U¢rcon,and who does such warkhimvSf or through his
own employees.provided thatsuch Improvements art not intended oroffertd for We.If. '
however,the building or imp mvemart t is sold within Lae year of completion,we owur-
builder will nave the When of proving that he did wt hold or improve for purpose of
sale.).
❑1,as awmr.[,I.property arm exclusively concocting with licensed e n ownara he
construct Ute project(Sec.706x.Business and Rafessions Code:)The Cmcaemr's U.
ecw law dors not apply m an owner of property who builds or improv Norton,and.
who coatrmu far ouch projects;with a contnnm(s)licensed pursust to the Concmtue.
Lkeue law.
❑I me exempt under See ,B h P C for this named
user Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aRimt under penalty of perjury one of dm folmwing decimations:
❑I haft and will munW a s CerUBam of Covent to self-Iuvm far Workce C=Wn-
satlaa,as provided for by Section 3700 of the Labor Cade,for we performance of the
wart for which this pc nsh is issued.
❑1 beve and will maintain Worker's Compensation Ivuranm,as required by Section
3700 of Ne labor Code.for the performance of Ne wart for which this permit is Vuued. '
My Workte Compentation lI•wj=corner and Policy number me .S
Cooler•. tea/ -1 a"w Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ttls section need no loccomplemd If the permit Is forone hundred dollars(SIM)
or teas.)
1 comfy that in the performance or the work for which Nts permit is housed,I shall net _ -
employ any Woman in my manrer m as to become subject to the Wartuar Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Ccn llcow of Exemption,you should
hecome subject M the Workers Compensation provisions of Ne Latter Code,you more
.J O forthwith comply with such provlalom or this permit shall W doomed rtwked.
,z., CONSTRUCTION LENDING AGENCY
'rs rN. 1 hemhy alrion Nat Nem I....do.rending agumy for the ned'umout.of
a> the work for which this permit Is issued(Ser.3097,Civ.C.)
W�Q Lerodees Name
.7. z lessees Addmsa
U O 1 codify that I have read this application and state Nu the above information is
correx.I agree to comply with JI city and county on iro noes and sum lam relating to
buildingconstruction,and hereby sulsodm reprnenudv of this city to cmerupnn Ne-
Lk7 above-mentioned property for inspection purposes.
p1, (We)agree to mw,indemnify and keep homeless the City of Cupertino against
y Ilabilitin,Judg u,cosn and vea which may in my way acrnm against said City
U z in conxgmnce Ne tiny is normiL y,
" APPLICANT D AN S D WILL CO PLV WITH ALL NON-POINT Issued b Date
SOURCER LA O
�g''Z ° Re-roofs
Si{ urto pp can Dam
x urns il Ls DISCLOSURE Type of Roof
WilluseepCRcmist,Muni ipal C pantatort .sundae Health
nd Saety
defined by we Cupertino Municipal Code.Chapter 9.11.and Use HuIN and Safety
.Section 155324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
WIII the applicant or(atom Wilding=upon,use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
leaft hexanes.air cmumim us as dc0ud by the Bay Amro Air Quality Management all new materials for inspection.
Di,hhx7
❑Yes /1,110
I have mwi Nebmarduu enamrielsmyuimmenuundet hapmr6.95 ofthe Califon
me Health SalctyC 'oat U503,15533aW 15534.1 undctwnd Uor it Ue Wilding
does,rete tl he a anti Uw it u my mapouibiliy m ratify the
oceupmt of Ue
mquimmc w mm pdormiuumce eta CcmtlOceuo ave very. Signature of Applicant Date
owns nth sada Date.
All roof cover ngs to be Class"B"or better
CITY OF CUPERTINO
ITEM 5 OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659999 .214
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT # . . . . . . . . . : BS000004000
REFERENCE ID # . . . : 08020136
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD #214
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
•
ogoa o � 3�
aloL CITY OF CUPERTINO
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
2-21-045
Building Address:
233 o IFOMt�c JAjt>" 2
Mailing Address (if different from building address):
Owner's Name: Phone#:
t.)0Mi ltJ It efCrc�frY N4Vafet4
►, t� reS ACS 0GWIT c3 5, a —q1,7-9 °t
Contractor: Phone: Lt o eb - 6'3 6 -p e f zo
CpJs�fz i1�T�o�.► �sl C. Fax: .4 to 6 Z S
Contractor License#: (o I ( o
• Cupertino Business License#:
Contact: Phone: +0%S - ZO9 - 5.6`-4
LO II tGtZjn�,jvcz- Fax: 4oe, , 5310-1 4t5;
Residential Commercial
Job Description: 12gr/our--le
epj4CS
(-lr lC—, ForL LOCIC- W ITI-k M,&Jur. C'0eP1>=-jT,t _I
'f-vo-i ar--rAL 4�1W4s .
Building Permit Info:
BldgA Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N 1
Valuation: Square Footage:
Oa —
• Project Size: Standard Large ❑ Major ❑
CITY OF CUPERTINO
CUPE(ZTINO 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 29.31cw
1BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBO11,ER3 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 Btwh 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
aw
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
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-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
IFOUNDREP 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
CUPEf�TINO GENERAL BUILDING APPLICATION •
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
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'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 fl)
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B •
interior/exterior
1 SMEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>1 OSF 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 so 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
A2 Ck
4of5
+D CITY OF CUPERTINO
• CUPEI�TINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES 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
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
IMECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
1STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
ITRAVDOC Travel & Documentation B
1BUSLIC Business License B
• I
5of5
$ , Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
=30 214 2 013
OWNER'S NAME: O X PHONE # Lf 0 S - ri3 (o - a't ZO
GENERAL CONTRACTOR l?,rcfoC—L asT. W L FAX # 0 S _ 5;1 G -o z-
I am not using any subcontractors:--d� Z-21-0 6
Signa a ) Date
Please check applicable subcontractors and complete twfollowing information:
SUBCONTRACTOR BUSINESS NAME 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
. T'
\Jwmer/Contra o Signature Date