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03050126 CITY OF CUPERTINO "'"" " `'• BUILDING DIVISION PERMIT ,CONTRA.CTUR IN1''O1tMATION; BuELDINGADDRESS: DRAEGER CONSTRUCTION INC PERMITNO03050126 22385 RANCHO DEEP CL D OWNER'S NAME: PERMIT ISSUE DATE DEHART RENA F 605 COMMERCIAL S 03 NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 goo LICENSED CONTRACTOR'S DECLARATION lb Description pi I hereby affirm W de (co f I em licensed unr,rovi.m.of Cheptcr 9 ommencing P with Section 70110)of DMMon 3 areas,Businces and Profrssioru Codc.end my liccns,is in fell force tndeneet. REPAIR DECK j0Z License Clan Lle.0 E Dee Contractor L Eyq' ARCHITECTS DECLARATION I2 I understood my p Wu Mall W used u public reenacts ' n i� Dttu D i C/ Z8 (�3 Liccosctl Professional y Oat I am exempt from DECLARATION <S I Wmhy.(sere that I em exempt form 0e Convenors License Lew for the 00 following moron.(section 7(131.5, I,amus and Profosiluu Code:Any city Of aunty $f<s which myWms a e.also m cnoswm,cher,improve,h Permit i or reachmy tatemure Q -21n that he its imunce,also to res prevision of for f the Comma or'to file a signed(Chapter < (commencingwidpuection 0the M)ofDivioos 3ofthe nutemr'anic.nseLaw xesCodmr9 Sq.Ft. Floor Area Valuation. S❑B that he exempt hedlore and the hasison3 nflWeged ex,and Pr.Any naCmlO)of 3� this he b exempt therefrom end the buts for the alleged exemption.Any violation of Section e more Nm rwnvApplicator aidolWo(iSWrmR subjects the applicant to a civil penalty of or Occupancy Type ❑L m owner of the pmpeny.m my emplay.os wish wages u Noir mle mmpenudon, will do the work,and the structure is not intended or offered forage(Sec.7044,Business Required Inspections end Profrsalau Code:The Camrmil Liumm Lew dors Out apply to m e owner of q P Property who build,chop ews themm,mul whadoesauchwoA himself.,Waugh his own employees,provided that such improvements see not intended oro@red formic.If, however,the building or improvement is old within ane year.(compledan,the owner. builder will have the burden of proving that he did not Wild or Improve fm purpose of .[a I. ❑I,As owner of the property.em ueluilvely..rennin,with licensed eonmemn u construct Its,pmkct(Sec.7044,Budnem and Professions Cade:)The Co eracmr,Li. cense Law does not apply to an owner of property who Wilds or Improves thereon,and who controls for on projects with a emommor(s)licensed removal o the ConuectoM1 License Law. ❑I am exempt under Sec. ,B Ar P C for this... Owner Dam WORKERS COMPENSATION DECLARATION 1 homey affirm under penalty of perjury ane of the following declensional: I ham and will maintain a Ccninae of Consent m self-losure fm W.r ccs Campem sation,As provided for by Section 3100 of the Labor Code,for the performance of the work for which this Permit is iuved. ❑I ham and will maintain Woroes Compensation Insurance.as mquired by Section 37M of Ne Labor Code,for the parformmce of the work for which this pe,mii is issued. My Worker,Compensation Insurance carrier and Policy number art: Carrier. Policy No, _ CERTIFICATE OF FXEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section need not Inc completed if the Permit is fmone hundred dollen(SIM) or lcsa.) 1 cenify that in the pmfunnaneO of the work for which Thu Permit or issued.I shell not employ enypersan in any manner An As to became subject o the Wmkcn'CompcnaaWn Iswa of Califomin.Date Applicant NOTICE TO APPLICANT:If.after making this Cen ilae of Exemption,you Mould become subject in the Worker's Compensation provisions of the Labor Code,you most .JO forthwith amply with such provisions or this Permit mail Its deemed emoted. Z M CONSTRUCTION LENDING AGENCY [r t+ I hereby alarm Nat there IsacomtoCert lending agency for the Performance of E 7 the work for which this permit I,issued(Sec.3097,Cih,C.) Bll Q Lender,Name n1. z t<ader,Address U Q I certlfy that 1 have road this application and ata¢that the above Information is V.U comxt 1 agree to comply with all city ale county ordinances and sen¢law,relating to C) building convection,and hereby mlhorimrepreenmive,of thi,city to Offer upon the r� shone-mentione4 property for Inspection purposes 4 (We)agars t.on,indemnify and kap harmless the City of Cupertino against ti Iiabiliuos,judgments,costs and expenses which may In any way Ace=atimmat mid City UZ in conegmnce of the granting or this permit. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of AppliuData HAZARDOUS MATERIALS tMom DISCLOSURE Type Of Roof V411I dm applicant or future W ilding occupant atom or handle hmalloua mamriil u dcRned by Ore Cupenuo Municipal Code.Chapter 9.13,and Irk Health and Safety otic.Section 355R(q/ ❑Ye, r-1 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hanrdnu,air contaminants As ecfiued by the Bay Area Air Quality Management all new materials for inspection. vict1 ❑Yea ❑No 1 have mad the hemfdon.=risk raquiremenu under Chapter 6.95 ofthe Califor. I=ni. Health k Safety Code,Smvu,35505.35533 entl 25534.1 understand this ifthc Wilding not currently have a tenant,that it is my responsibility us redly the aceupant of the requirements;which must to met prior it)iuuance of a Cenificam of Occupancy. Signature Of Applicant Date Owner or wthonvcd,sent Date All roof coverings to be Class"B" or better CITY OF CUPERTINO ,t BUILDING DIVISION PFRMI4 CONTRACTOR INFIQR, MAT . BUILDING ADDRESS: PERMIT NO. DRAEGER CONSTRUCTION INC 03050126 AM PERMIT ISSUE DATA 605 COMMERCIAL ST 05/27/2003 (408) 536-0420 SANITARY N0. CONTROL N0. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ] 0 0 0 0 '.IDO LICENSED CONTRACTOR'S DECLARATION Job Description i 1 hereby affirm that I am 1,menud undo mvt.men.n. of Chapter 9(mmmcneug w< with Section 90nB)or Division 3 of 0.Busines it Professions Code.and my license is in,, ,Cfteme d rut. ��G Le - I G l O REPAIR DECK C ; Z Lic Clnsa PIN�►L�D 1„o Da - U Co tree f-e c E-v- $ ARCHITECI-S DEC TION Ca I undcmund my plana shall W used ca pilluic recorda OCT 2 2 2003 eWU a 5u Licensed Professional OWNER-BUILDER DECLARATION <F 1 hereby affirm Nat 1 am exempt from the Contractor's License Law for the BUILDING OO following mason.(Section 7031.5.Business and Professions Code:Any city or county S§E which requires a Permit a construct,slur,impmw,demolish,or repair any structure PLorevel in Her m is issuance,also requires the applicant foraeh Pmmit mile a signed gis that he is licensed pursuant to the provisions of the Contraceri License law(Chapter 9 Sq.Ft.Floor Area $BVa�Otlon $ (commencing with Susion7")of Division 3 of the Business and Pmfcuions Cude)or o0 it that he Is exempt Ncrtfmm and Ne buts for the alleged aempumi.Any vlolmOn of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 'p. Occupancy not more Nan five hundred doll..(5500). 3 5A%16 ero 0 T�P e ❑I,aowner oRhe property,or my employees with wegesuu¢ir sole compcnsssion, will do the wark.aens dissentient.lsnoNorewedoraffered Waste(S .7144.Business an101 - FOUNDA'R�a�fed Inspections d Professions Conse ck:The Contractor,LiceLaw dints nos apply to.n owner of property who build,or improves thereon,and whodoessah work himselfar through his 102 - PIERS own employees,provided that such improvements are not intended or offered for ale.If. however,On building or improvement is aid within one year of completion,the owner- 103 — UFER Wilder will how the burden of proving Nat be did nos Wild or improve for purpose of 10 4 - REBAR sale.). ❑1.as owner of the property,am exclusively contracting with licensed amnctara to 105 - ANCHOR BOLTS saasvactweproject(Sm.704d.Business.adPrafessionsCode:)The conumwrsu- 106 - SEWER & WATER Genu law sea not apply in an owner of property who Wild,or improves thereon,and, who contracts for such pmjcm with a conuamr(U licensed pursuant he the Com actor, 202 - UNDERFLOOR PLUMBING License Law. 203 - UNDERFLOOR MECHANICAL ❑lam exempt under Sm. ,B&P C for this reason Owner Data 204 - UNDERFLOOR FRAME WORKERS COMPENSArION DECLARATION 205 - UNDERFLOOR INSULATION I hereby affirm under Penalty of perjury am of the fallowing dmlantiom: 301 - ROUGH PLUMBING I haw and will maintain.Cand I teofConsenuoem6in,wemrWwr ri ComKn- 302 — TUB & OR SHOWER ,anon,as provided for by Section 37x0 of the labor Code,for On performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation Insurance,m required by Section 304 - ROUGH ELECTRICAL 3700 of the Labor Cade,for the performance otlhe work for which this pmmlt is issued. 305 — FRAME T My Worker.CnmpmadimvlIInsurancen a Policy number are. Ca . t-. Y$Y:' X_ ., rT l Policy No.: �-V(1/! Y 00 J 306 - HOLDOWNS CERTIFICATEOFE):EMPTIONFROM WORKERS'„_1a,�� 307 - INSULATION COMPENSATION INSURANCE n 1,re.? 308 - SHEETROCK or less.)Crus udionnmtl not W completed if she psrmlt is An one hundred dollars(SIW) 309 - EXTERIOR LATH 1 missy duet in thc perform.of the work for which this Permit is issmd,l shall not 310 - INTERIOR LATH employany person many meaner u as in We..subject o dm WmIsra Campmradon - 311 — SCRATCH COAT Laws of califomia.Dau Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.theWorr'Compensation Nisvisinnu the Labor Code, redhmulm 501 - FINAL ELECTRICAL ENERGY became subject m the Worker'.If.Cor melon on provisions to the lahnr CMe,y ZO forthwith comply with suchprnvisinns0m or Oil 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY Fr y. I Womy Aft that then Is.mnswctinn lending agency for the Performance of C� the work for which this permit is issued(Sm.3M.Civ.C.) 504 - FINAL BUILDING ENERGY W q Leaders Name 505 - FINAL ELECTRICAL 7Z LnaerIconify 506 - GAS TEST [)Q 1 eat=the 1 plyhavemud Ni,city and county and,u¢Net On show ws relating is cortCek l agrm m comply with ell elry.na county oNinantts and sou laws relating to 507 - FINAL PLUMBING construction.ilding consction.and hereby attendee representatives of this city to enter upon she��"U shove-mentioiled Property for inspection Purposes FINA MECHAN CAL G 4Dain)agree to adess save,indemnify and keep hamthe City of Cupcnino against 5 9 FIN C.r V) liabilities,Judgments,costs and expenses which may in any way accrue against sonit City U 7 in emuequcnec of the granting of this Permit. S 1 — G F7 APpPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bY5 _ Date SO�Rf]E REGULATIONS. lI!!// /!Sus�� Re-roofs Sign Applin a nUContrutor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant more car handle broto nes material as defend by IM Cupertino Municipal Code,Chapter 9.11,and the Bettis end Safety Code.s y2553z(a)? ❑ . All roofs shall be inspected prior to any roofing material being installed. Yo 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 Intel hmardous air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection. District? ` ❑Yes �Nu 1 have mad the hvaNtws meuriaismquimmenta under CheP¢r695 of tiro Califor- niaHalth&Safety Code,S dom25505,25533ua12553a.iundersundth ifthe Wilding it.nal currently haw•tenant,Nat is u my!expansibility to ratify de aruPat of dm quncomms which mug to met prior to issuance of a Cenificam Occapacy. _ Signature of Applicant Date sae-u uthariud egcnl Doc All roof coverings to be Class"B" or better Rancho [hep Cliff # 3 Sr- 0O2130301 t y c 4 e '1 "" f .. r 4 � ht,1 �.p�€'Sa 1 d,Ti a A'\ 02/14/2003 10:17:52 AM afflu C*Y OF CUPERTINO o 3 12-14 CITY OF PERMIT APPLICATION FORM CUPEkTINO N # i Date: Building Address: 2 Owner's Name: ] JQ hone# Gontractor: 11�� License#: ✓red tf C �� St�cC, 'o�/ 4,r%to Z(8%S Contact: Cupertino Business License#: /.G.ffWVO� Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job escription- Residential mme ci 1 Sq.Ft. Floor Area: $ Sq.Ft.: Cost of Project: Occupa y Gro IL Type of Constructio Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING ' BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX lnd/Off/Comm/ uasi 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3" . ��..� �Y OF CUPERTINO CITY PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg 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 Ston-n/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/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 Fumace> 1 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 2 of 3 alor CITY OF CUPERTA Cu coc PRi�vO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Inectiion 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3