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06080162 , ' T$lCITY OF 7 " �:x BUti,DiNL �ISION PERMIT C � : BUILDING ADDRESS: r DRAEGER CONSTRUCTION INC PERMTrNo.06080162 10970 KESTER D OWNER'S NAME: PERMIT ISSUE DATE Allk RANCHO DEEP CLIFF HOA 605 COMMERCIAL 006 E: SANITARY NO, CONTROL NO. (408) 536-0420 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEOCH 00 LICENSED CONTRACTOR'S DECLARATION Job Description m 1 hereby afRrm that 1 am licensed under provisions of Chapter 9(commencing :Z9 with Section 7")of Division 3 of the Basin. it Profession,Code,and in,license la in full fame and encct REMOVE 3 TO 4" OF TILE, FELT 5a BATS. INSTALL NE L1CCnetas` Lim is nctar ANTI-POUNDING, FELT & BATS . ROOF REPAIR. Dale 1,R Cant ARCHITECTS DECLARATION i a a 1 understand my plans shall he used as public records iyUy� G 3 Licenced Professional OWNER-BUILDER DECLARATION ei 1 herchy.11irm that 1 am exempt tram the Contractoex License Law for the e o following maven.(Section IID 1.5,Business and Professions Code:Any city or county 3$ff which requires a permit in construct.slier,improve,demolish,or repair any simulate .zY�+ prior to its Issuance.also requires the applicant for such permit to file a signed statement 6 that be la licensed pursuant in the provisions of the contracts s lJCC.Law(Ch."Cr 9 Sq.Ft. Floor Area Valuati x&2 0 8 Z�Q (commencing with Section 70M)of Division 3 ofthe Business and Profenainns Code)or .. that h<u exempt therefrom and the basis for the alleged exemption.Any violatlen of Section 701.5 by any applicant far a permit subjects the applicmuo a civil penalty of qp Number Occupancy Type cat more d m five hundred dollars($500). 3 5 6 2 8 013 . 0 0 ❑1.as amen of Ne pmperty,or my employers with wages as theirsule compenPCon, will do thework.and the someone lsnmmtended oroResed mrsale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law docs rot apply n, e an owner of 9 P pmpeny who buildsorimpmvuthemon,and who doessuch work himselforthrough his owaemploye.s,provided thatsuch improvements are not Intended centered for sale 11. however,the building or improvement is said within one year of mmplemil.Ira nwner- builder will have the burden of proving that M did not build or improve fm purpose of Pie.). ❑I,P mvmr of the property am asclusivcly convecting with licensed convectors in canstrocn the project(Sec.7044.Business and Profenal...Code:)The Conb¢mrs Li. terse Law data not apply in an owner of property who builds or improves Camara.and who contracts for such pmkch,with a coinractor(s)licensed patient nt in the Contractors License Law. ❑I am exempt under See. .B&P C far this muse. Owner Data WORKERS COMPENSATION DECLARATION 1 hereby alarm under penalty at perjury am:of the following declarations: ham and will maksin a Cenifacare of Came[m self-imm,far Wmkmncra Comp ration,as provided for by Section 3700 of the Labor Code,for W Performance of the work(Or which this permit is issued. Z pave and will mainsin Wrrkch Compensation Insurance,as required by Section 3700.E the labor Cod..f or Need mance of Ne work Err which this permia isissued, ' My Workers Compensation Ins: a caroler and Policy number are: Cartier. Polity NO.: CERTIPC E F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Pction need not be compkn,d if the permit is foram.hundred dollma(5100) or kss) I certify that in the performance of the work for which this Permit is Issued.I shell act employ any person in any rainstorm as to become subject to the Workers'Compensation ' Laws of Califomia.Dan, Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become suacet an the Worker Compensation previsions of the labor Calc.you moat .J O forthwith comply with each provisions or this permit shall be deemed Invoked. ,z—a y CONSTRUCTION LENDING AGENCY [ti I hereby anima that Cert is a combination lending agency for the performance of fZ 7 the work for which this permit Is issued(Sox.3097,Civ.C.) W� Q Lattices Name , z Lenders Address U 0 1 certify that 1 have need this application end stain that the show information Is D. F Cement.I agree in comply with all city and county ordinances and sole laws relating to 0 V building Convection,and hereby auahoria.,msCm.ivesof this city to tour upon the �a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against aF—a h liabilities.judgments.costs and expenses which may in any way acerae ageimtset City V z in consequence of the graining of this permit. s"t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUI-AMONS. Re-roofs Signature of AppliaDen, HAZAR HAZARDOO US MATE RIALSDISCLOSURE Type of Roof Will tree Cupentorfuture buildingk.Chanumrcor bundle Heals ad as defined by Be Cupertino Municipal Cock.Chapter 9.13.and the Health and Safely Code,Scctio (]Nu 2553i(a)? You All roofs shall be inspected prior to any roofing material being installed. ❑ 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 it hazardous air contaminants a dunned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yrs ❑Nu 1 hew mad the hvaNnusmauriats requirements under Chepkr6.95ofthe Califor. nice Health&SafctyC.de,Secuom25505,25533md35534.Iunderwndihatifthc building does not certainly haw a moral,that It is my responsibility to notify the occupant of the requirements which most be met prior to Issuance of accmrcateofOccupancy. Signature of Applicant Date Owncr.rauthonradaccnt Dern I All roof coverings to be Class"Bn or better f CITY OF CUPERTINO 5 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35628013 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT# . . . . . . . . . : 35686 REFERENCE ID # • : 06080162 SITE ADDRESS . . . . . : 10970 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 OEE 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 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 857.. 65 123214 TOTAL RECEIPT 857 . 65 y - CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM O(Q N# ^ 2� "O Date: Ole)111?5 O�D Building Address:_J`(r Mailing Address (if different from building address): I 0q10 r Owner's Na ncho `f -xe /} l� 1 T i4� `f Phone#: � Contractor: T 1 le1't` License# TX � �. �� (v Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg EVLDC A Elect ❑ Plumb ech ❑ Job Description: $1U 'r t i ti L411 I ' Residential k Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ^� Occupancy Group: Type of Construction: IS�LJ Please check this box if the project is a second-sto addition: ❑ oject Size: 'Standard 1;q"� Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL. BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 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 1 of 3 CITY OF CUPERTINO OF cuPEiNo 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 BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS as 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 BPVENT Alt of Drain &Vent PLUMBING BPWATER Instalt/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent 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 BREMFURNOV Relo Furnace> 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 Is 2of3 CITY OF CUPERTINO rYo PERMIT APPLICATION FORM CUPE(�TINO uantity 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 BSWIM 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 Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3