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06080133 CITY-OF CUPERTINOn �` BUILDINCCIVISION PERMIT lo ,ii . '. � -ziNir 'Ib�Na �a I < , BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT NO.06080133 22385 RANCHO DEEP OWNER'S NAME: PERMIT ISSUE DATE RANCHO DEEP CLIFF HOA 605 COMMERCIAL NE: SANITARY No. 2 CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMIT INFO 'BLDG ELECT PLUMB MECH 0 0 0 0 IOC LICENSED CONTRACTOR'S DECLARATION Job Description U 1 hereby affirm that 1 Am licensed under provisions of Clupscr 9(commencing with Section 7")of Division 3 orthe Businessand Professions Code,and my license is in full force and effect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE License Cls La.11(_176,10 Dam ge-71- OTS —Contractor ANTI-POUNDING, FELT & BATS . ROOF REPAIR. ARCHITECTS DECLARATION i < 1um)craiand my plans shall W used.public records iau s G� Licensed Professional 'ysOWNER,BUILDER DECLARATION 1 hereby AlTirm that I am exempt from the Contrachies License Law for the .p O following mason.(Section 7031.5,Business and Pm(esslons Code:Any city or county 33 r which mquirrs A permit m construct.Alar.improve,demallah,or repair any swctura -¢e prior m its issuance,also requires tin,applicant forsuch permit to file a signed sentiment m that toislicensed pursuanttothe provisions ofNCContractor',License U.(Chapter 9 Sq.Ft. Floor Area Valuatior}208 `FS (commencing with Section 7")of Division S of the Bu¢msmnd Professions Code)in .. that W is 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 APN Number Occupancy Type nos mom than five hundred dollars($500). 35602037 . 00 1,As owner of me property.or my employees with wages As their sole compensation, wall do thewark.and the structure is notinanded ter Ofered forule(See.7814,Business Required Inspections ®d Professions Code:The Contractors Liana Law does not apply to an owner of q P property who builds or im prow thereon,and who dies such work himself or through his own employees,provided thatsueh improvements no,not intended oraQemd forsah.if. however,me building or improvement is sold within one year of rompledon.the owner builder will have the burden or proving drat W did Mt build or improve for purpose of F p®� sale.). ' "' 4 ❑I,as owner of the property,am exclusively contracting with licensed cunmorem to �� cower dap not (gee.7044.Owner Business and property who Wilds Cade:)The Commoner's Lid ave law does not apply b an owner of property who Wilda or improves theman,and whots for such projeca with a mnwaor(e)limited pursuant m the Conuumrs i Licensense UW. E] Imre exempt under Sea .B@PC for this mason �• a � /1'?�t� Owner Date p WORKER'S COMPENSATION DECLARATION ■ 1 hereby aRitm under penally of perjury One of the following declarations: L LNG 405(hare and will maintain a Certificate of Consent to self-Insure far WarkerSCorepem sation,.provided for by Section 3700 of me labra Code,far the perfomsance of the work for which this permit is issued. g-1-have and will maintain Worker's Compensation Insurance,as required by Section 3700 of me labor Cade,for the performance of me work for which this permit is issued. My Workers Compensation Ins cc carrier end Policy number am: Cartier. Polity Naj WO f ... y C RTIFICA EOF EXEMPTION FROMWORKERS' COMPENSATION INSURANCE Mus section aced net he completed if the permit is formic hundred dollars($100) tar less) I certify mot In the performance of the work for which this permit is issued.I shall not employ any person in any mannerso As On became aubjecuo the Warkers'Compensation Laws of California.Dan, Applicant NOTICE TO APPLICANT.It,arm,making mu CAr iOcam of Exemption,you should become subject to the Workers Compensation provisions of me Latour Code,you most Z faMwith comply with such provisions or this permit shall W deemed revoked. Z Q CONSTRUCTION LENDING AGENCY (-w I hereby affirm ren mere is a construction lending agency fm the performance of tai> me we*for which this permit is issued(Ste.3097,Civ.C.) WQ Lenders Name � ice. z LcnderS Address U p I certify mat I have mad this application and sum mat me above information is (; f" correct.I agree to comply with all city and county ordinances and sus laws missing to �U building consuuctmo.and hereby authome representatives Of this city m cmcr upon the above-mentioned property for inspection pugwscs, (We)agree to save,indemnify and keep hartnlass me City of Cupertino against rliabilities.judgmemA.mu and capons.which may in any way acerae egainsuato city p U Z in consequence of me granting or this Permit. �••� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU E6 LATIO 4s-31-o( Re-roofs St 5aturem pplleaa ontraelcr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dn,applicant ter future building occupentstne or handle hrrardous material As dcened by tW Commit..Municipal Code.Chapter 9.12,and the Health and Safely Cale,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑rs _ 24. Will she applicant or future building occupant use equipment ter devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ha>srdoua air contaminants As derined by the Bay Arca Air Quality Management all new materials for inspection. District] _ ❑Yes I have mad the WcaNswaman,rials mquimmenu under Chapar6.95 afthe Califor- iia H.Im&SafetyCade,Secon.25511SM33 it 25534.1undenund Matifine building dws not currently how A tenant.mat it is my ru'resibtlity An moill the aeupmt of the rcyui mentsw' them 'onuissuance ora CeNO.a or Occupancy. Signature of Applicant Dale owner oramthomedasent Dan, All roof coverings to be Class"B" or better CITY OF CUPERTINO 6 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # '1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35602037 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # • • • • . . . . . : 35683 REFERENCE ID # . . . : 06080133 SITE ADDRESS . . . . . : 22385 RANCHO DEEP CLI 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 WE 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 000R i S3 CUPEt�TINO PERMIT APPLICATION FORM WN, ���� b2�11�J� ¢ Date: C&I V&I Ole Building Address: Poncho Mailin ddress (if different from building address): Owner's Nam fZ^n^,^-o W Crlryli l * �� ` Phone#: LP _ 33C0 Contractor: 1lJY ► �� t�/ ^ '�G License #i—1 1 D C39 Contact: Phone:'12-313-0100 Cupertino Business License#: f'� I�Gllrl� �QS1"1G�G1 Fax: ZISq Building Permit Info: Bldg R1?C0fiK7q Elect ❑ Plumb Mech ❑ Job Description: 3ADv "ft Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project:4,,�—I Occupancy Group: Type of Construction: Please check this box if the project is a / second-sto addition: ❑ oject Size: Standard 2 Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL - -- BBOILER2 Boiler> I OOK 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<= IOOOA 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 h CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housin 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 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 Dis osal 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 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 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 A liance ELECTRICAL 2of3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITF'EE 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