08020139 CITY OF CUPERTINOs�r`:e +' #'
BmcD1NG DIVISION PERMIT CO1�P3T1tAC(N INFORMATION�' MIT NO."
,>�.w .
"RI TyQAD4RT:OMESTEAD RD #210 DRAEGER CONSTRUCTION INC PER
08020139
ER-
S NAME: I'EItMIT SUE DATE
HOMEOWNER' S ASSOCIATION 605 COMMERCIAL ST 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
RMV/RPLC BLCNY CTNG BLDG ELECT PLUMB MECH
C
:oo LICENSED CONTRACTORS DECLARATION Job Description
rd 1 binary afRrm WI 1 am IicevN undsr pruvisiona of Chapter 9(commencing ^^•• ••^` --'� "•••�""
with Section 7M)of Division 3 of Na Busin ser and Profession,Cods,and MY license is
^may in full force andaracs ^
Z_ License Clw/,.--�.-1'I L` Lk.11 v r
3� Dao: /f,._I'LII IfY Connutar 1
r -a _ J(RCHnECrS DECLARATION
�a 0
[understand my pWn Nall ba stand u Public menrN
6
ya�a Licensed Professional
3 OWNER-BUILDER DECLARATIONContra
E I hereby,aRm that 1 I.S.Cxemps from the Cumnat o License taw for the
i❑O following recon.(Saito R131Business and Pmfeaalnm Calc:Any city or county
$ which requires•(emit bpAres; 0.a)ms,nt far such
dsmmit t,nr mpur ed struewm
ZLw pdorbiu issuance,also requimsthe applicant farwch pemina file uitneJ autemam -
xx< Natheisli...d pursuant b tiro provisions of the Contractor's License Law(Chapter 9 Sq.Ft. FIQor Area Valuation
1-� (commencing with Sccsion 7(10[8 MDivision]oflW Businosa roti Profeuiona Cockle,
9 Nu ha u muco pt thertfmer And the bash for the alleged mmmptim.Any Nolsdm of
Station 7031.5 by any applicant for a permit subjects Ne applicam 10 a civil penalty of APN Number Occupancy e
ms mart Nfl.an w hundred dollars($501k.
P Y EYP
❑1,asowneroftieproperty,amywployaswW ngouNe mk campewdon,
will do theworlt and timmucture is nodnanded oroQered forsde(See.7066,Buanry Required Inspections
and Pmfesdo rs Cade:The Communities Licctue Law does rot apply to An awmr e ar 9 P
propenY who Indicts orimpmvea thereon,and who data nub weak himself or through his
awn tmploym,provided that such improvements art not inaaM ora@red for said.H.
however.the building or Improvement a sold within ane year of completion.the owner.
Wada NR have the burden of Moving Ws be did rot Wild or improve far puapme of
um.).
❑1.As owner of da progeny.em exclusively contracting with Iicensed mntercsars to
Maintain thee project(Sec 70x4,Ban..and Profadona Code:)The,Communes U.
an=Law dean not apply to an owner of Property who builds or impaom thtmm,and,
who Control for such projects with a Mtranor(al lireved pursuant in the Contractors
License law.
❑leneaempsunder See ,BIPCforta...
Ow Dam
WORKER'S COMPENSATION DECLARATION
1 hereby&Man under penalty of perjury am of than fallowing declersllona:
❑I ban and will maintain aCeniOwm of Consent to self-insure forWorkers Caciam.
sstion, provided for Section l7W a(Ne labor Code,far NO perfomuce of Ne
wok for
which thin pcmIs in issued
❑1 Mn and will maintain Workers Compensation Intranet,As requind by Section
37W of the tabor Cade,for the performance of the work for which Nis Permit is Issued. '
My Weaker1 C�omPew.rz WuanC`e ndim and Policy number s' !7
Carrier: ✓; c 1 ;: Pollry No.; iJ C) I
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Tits seam sad our W complemd if see prmlt Is forme hundrtd dollen($103)
of lea)
I certify that in to perfomamc of IM work for which this pcmdt W issued.l dtdl not
employ any person in any mature As b become subject in the Workers'Compensation
Lawn of California.Dam
App11Mt
NOTICE TO APPLICANT.If,afer making Nb CertiOam of Exemption,you should
become auhjm in the Workers Campeosation proAsiona of Nc labor Code,you must
O forthwith comply with wen maim
visu or Nm
is peit shall W deemed mvakcd.
r 51CONSTRUCTION LENDING AGENCY
I-t Iheathy a(Rm than Vert as construction lendingagenry,for ire perfuma en of
CYi ti Ne work fur which this pemis is issued(Sec,3097,Civ.C.)
GQ Lender.Name
z Lenders Acidness;
U O I codify Nu I ban mad this application arb sum Nu m,man information W
ppa comm I agree in comply with N city and county aNlnarces and from law missing in
0 building construction,and hcmby authodm mpmenatlwa of Nin eityb enter upon the
{rl Bloat-mentioned property fm inspection Purposes
6, (We)agree to use,indemnify and kap humorless the City of Cupertino against
ww
CA IlabiIiva gmen¢emu and axprn...which may in sty wy accts against Wd City
U"L in to nmet ec of the sting of Nis Permit. t
^' APPLICA ND ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE LA
'0/2,1 ° Re-roofs
S HAZARDnub ser MATERIALS DISCLOSURE Dam Type of Roof
JI the appliMt or future Wilding occupant erre or handle hvardow material
defined by the Cupertino Municipal Cods,Chapter 9.13,and tiro Health and Safety
Section 25532(s)?
E]Yen L/nu
—t' All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or f/mart building oauWnt sae equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hosannas dr comsmina s u defined by sae Bay Area Air Quality Muagcmcnt all new materials for inspection.
District?
❑Yea
[haw mol Ne hvadms materials requirementsm lar Chapter 6.95 of 0e C6lifor-
naHcalth afore ds.Sessions,25505,25533 soul 23!36.1 unJcnund dust dean Wilding
does not cu Jy •unmet Nat Is a my rupomibility to notify Je oceupant of the
mquircmen walk IAnMCLaralaeNceor&Ccnificateof 0�N ,. a Signature of Applicant Date .
ser r u nvadagam Date- All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
ITEM 2 OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659999 .210
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT #. . . . . . . . . : BS000004000
REFERENCE ID # . . . : 08020139
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD #210
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
---------- ------------- ---------- ----------- ---------- ---------- ----------
IDECKWOGD EACH 1. 00 428 . 00 0. 00 428 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 428 . 00 0. 00 428 . 00 0.00
•
Win
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
5 - l C7 o
Building Address:
22030 t/'J t T -Z-L cD
Mailing Address (if different from building address):
Owner's Name: Phone#: 10 o-11 .1 t c.
P20itrc¢T7' rin,rab��.
r1 �v �J. ,JE 5 ASspCi0.T7,0�1 CP350—q 1'7- 9q 11
Contractor: Phone: L+ t36 - Z O q - S 644+
J '414000 t; 3te-O `tZb
C� lEA'vr rmz- � utW11 o� '� L 4
� Fax: 0 Z - S? 6 -o`f 7—
Contractor License#: 67(�7 6 O
• Cupertino Business License#:
Contact: _ L, Phone: L+,o g +4L+U 0 U �C 1�"-''�'`1� CCS Z_ Fax: 4 o S3 6 -a f ZS
Residential Commercial
Job Description: Llr--M0U r,—le-P—c 1014 Cr,— ✓'-.)/,.1 c.o N Co 4'r/4J
'r✓LI''I p�rJ� p f I�Ta L ��451-�
14J l/1 S.
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, lV V-N (-'7
Valuation: Square Footage:
:270 0 '_
• Project Size: StandHdK Laze ❑ 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
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
1BBOILERS 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
1MEETING]HR Application Meeting B
G CITY OF CUPERTINO
• cuPE�iNO 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
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
IFENCE>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
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALUCONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP3 00 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 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B •
(interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<l0 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 sf) B
additional stucco application
D�cku/Ood P,2ek (�&,Odaj
4of5
aCITY OF CUPERTINO
GENERAL BUILDING APPLICATION CATION
FEE SCHEDULE
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
1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
lELCPLNCK 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
1TRAVD0C Travel &Documentation B
1BUSLIC Business License B
•
5 of 5
Community Development
I * 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
tCITY OF Fax(408)777-3333
PEkTINO
Buildin De artment
JOB ADDRESS: PERMIT # .
S2,330 t-10 �sfr��►o VZoAD A- Zl0 OC-0'�(�
OWNER'SNAME: OwIgSQ 1+0 A4 PHONE # 3153 (a-0 t 20
GENERAL CONTRACTOR: DIL&Vaw ter— Goalr T I J L FAX # o _ 53 I& — o Z-5
-
I am not using any subcontractor • 2-21-0
Si Date
Please check applicable subcontractors and completktge following 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
e
L/0-4J
Owner/Contr cto Signature Date