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06080158 CITY,OF CUPERTINO - '� BUiLDINO DIVISION PERMIT ` O1 T]l2AC,'faR INIFORMATIUI± BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITN0.06080158 10900 KESTER DR OWNER'S NAME: PERMIT ISSUE DATE RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST na /ig/2nois NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMRINFO BLOC ELECT PLUMB Mn opo LICENSED CONTRACTOR'S DECLARATION Job Description V 1 hereby affirm that 1 am liwmcd under provisions of Chapter 9(eommcncing i with Section 7")ofDivision 3 of the Business and Professions Code,and my license ie ray in full force and effect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE LIZ Limm.Class Lic.A 17LIO Dam Q� o�Codirector ANTI-POUNDING, FELT & BATS . ROOF REPAIR. E ARCHITECrS DECLARATION m 1 undemund my plans shall be used u public records Jy0 1,G t; Limmed Pralmsgonal y S OWNER-BUILDER DECLARATION I berehy affvm that I am exempt from the Contractors License Law for the t pec following..an.(Suction 703 1.3,Business and Professions Code:Any city or merely K m 9 which requires a pcmtit be..naw.,,eller.improve,demolish,or repair any smaamre O'w prior m its issuance.also requires the applicant forsuch Permit to file a signed sencronl SeNu at be is licensedpurmanotmprovisionsoftheConmuluelLicm¢eLaw(Chapter9 Sq.Ft:Floor Area Valuat"208 set-$ (commencing with Section 7000)MDivision Jof the Businnys and Professions Code)or .. that he u exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A3IIN Number Occupancy Type not more than firs hundred dollen(5500). 35 28020 . 00 ❑1,as owner of the property,ar my employees with wages as their sole compeneadon, will do the work.end the structure 6 rusuirumdedor offered for..].(Sm.704/,Business Required Inspections and Professions Code The Contmcmr's Limm a Law deny mat apply m an owner of 9 P property who builds on ina mvm thereon,and who does such work himselfor thmugh his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is said within one year of completion.the owner. builder will have the burden of proving that he did not build or Improve for purpose of ask.). 1,as owner of the property was exclusively contracting with licensed contractors he construct the pmject(See.70".Bmineue and Professions Cade:)The Contractor's Li. come law darn not apply m an owner of property who builds or improves thereon,and who contracts for such projects with a mosranar(s):mmard pursuant he the Cmaracmfs Licetse Law. ❑I do exempt under Sec ,B&P C far this reason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby aBimt under penally of perjury ane of the following duclantimu: 1 bare and will maintain.Cerdfirnm of Cement to self-infuse far Workers Compact. bad,as provided for by Section 3730 of the Labor Cade,for the performance of the were for which this permit is headed. have and will maintain Workers Compemstion Insurance.as required by Section W of dte labor Code,for the performance of the were for which this permit is issued. My Worker's Compensation lmu cc carrier and Policy number are: Carrier Poliry No.: C RTIFICATE 0 EXEMPTION FROM WORKERS COMPENSATION INSURANCE (rho section need not be completed if the permit Is foram hundred dollar(Sial) or lest) 1 certify that in the performance of the work for which Nis permit Is gssum.I shall not employ anypen ns in any maonerso u m become subject to the Warkcrs''Compemadon Lowe of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject in the Worker's Compuneadon provisions of this labor Code,you must .J O forthwith comply with such pmviaians or this Permit shall be domed revoked. „zsy CONSTRUCTION LENDING AGENCY (ti I hereby aRnm thathere is a cotutrucdon lendinga,do,l'or theperfmmance of rt > the work for which this permit u Issued(Sea 3097,Civ.C.) W A Lender's Name z Lenders Address UI certify that I have read this application add stare that the above information is E-" correct.I agree to comply with all city and county oNgmntta and sum laws relating to 0 U building concoction,and hemby xothorim mprmcntativm of this city to enter Olean the _ >^a above-mentmned property fur inspection purposes (We)agree to save,indemnify and kop harmless Ne City of Cupertino against rti liabilitics.judgmcnu,corm and expenses which tory in any way....,.last said City V`z in consequence of the granting of this permit. ^' APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date 5E R TIONS. 1 -- 5r-e l -0 Re-roofs Si reafAppl..11Cantractar Data Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will dre applicant or future Wilding ooupantsmm orhandle hmardous material as dented by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code.Secdon 25533(47 All roofs shall be inspected prior to any roofing material being installed. ❑Yesy3Ne— Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove omit harardaus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. DuadcQ ❑Yes No ' I have mad an,hadeand.materials tequitemunm dndmChap e,6.95 of the Califor- nia Health&Softly Cadc.Scctians25505,25533and25534.1unduntandthdifthc Wilding; does nm cu vs.<7 Nat a is my amponsihilay m Only the occupant of the re mmmt.ewbmhre uoismagoafacaurreamofOccupancy. Signature of Applicant Date $..2 -� All roof coverings to be Class "B"or better O r or suthariaed agent Data CITY OF CUPERTINO 1 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35628020 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35686 REFERENCE ID # . . . : 06080158 SITE ADDRESS . . . . . : 10900 KESTER 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 9EE 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 • CITY OF CUPERTINO pp�15� C F PERMIT APPLICATION FORM C� w CUPEkTINO N# /'n-1h Date: Building A ress: �1J Mailing Address (if different from building address): r Phone #: Owner's N Co Contractor: License#: yr er (.D►-1(0 1 O C39 Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg 'piElect ❑ Plumb ech ❑ JobDescription: tj Residential E Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 'lJD6 Occupancy Group: Type of Construction: Please check this box if the project is a second-storyaddition: ❑ o'ect Size: Standard 'O� Laze ❑ Major ❑ Quantity Fee 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 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 • I of3 CITY OF CUPERTINO CUPEI�TINO 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 BPBACKFL OW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENI' 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 BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREWURNOV 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 2of3 ( ' CITY OF CUPERTINO cuPErZTnvo. PERMIT APPLICATION FORM Ouantitv 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 BSW W Swimming 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 Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3