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06080134 CITY OF CUPERTINO TIUILDINCrDIVISIONPERMIT IgCC1NT] ,fiR iNFO�tMATi( N. "`' BUILDING ADDRESS: s DRAEGER CONSTRUCTION INC PERMRNO'06080134 22415 RANCHO DEEP CLI DR OWNER'S NAME: PEWry ISSUE DAM RANCHO DEEP CLIFF HOA 605 COMMERCI NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm Nu 1 am licensed under provisions of Chapter 9(Commencing m with Sec11a.7000)afDivision 3 of do,Busuev and Profeasium Code,and my license is eta in fall force andeffnr REMOVE 3 TO 4 " OF TILE, FELT & BATS . INSTALL NE ;q_ Lienn ClasL s le.M��Gld ANTI-POUNDING, FELT & BATS . ROOF REPAIR. I — n Lt. Dam & .aracmr. IQQ-- ARCHITECTS DECLARATION i q'7 6 1 muenmoul my plans shall he used u public mcoNa , U LLo Licensed Professional OWNER-BUILDER DECLARATION 1 hereby.(Toric Nos 11. exempt from Nc Cmumus Co License Law for the o o following mason.permit t 703 Construct Business and improve. acsfan Calc:Any eiry s county v S$Or which requires a permit re requires OC ohm,improve,dcmdlab,fire te a sir arty awmum Or prior mos issuance,also mqo the tite of for ouch permit w iciense Law(Chapter �ZGOat he enemy wit pursuant to the provisions of dte Contractor'a Limnaclaw(Chapter9 Sq. Ft. Floor Area Valuat�p}208 2mFg (commencing with Senion]OW)of Division 3 o IIIc Business and Professinm Cndy7 or l — dost tic Is exempt Nemfmm and On basis for the alleged exception.My violation or Section]03M by A"app0aet for a permit>ubjcm the applicant to a yin penalty at NN Number Occupancy Type and mom Nan five hundred dollars(M). 3 5 6 02035 . 0 0 1,as owner of idle property.or my employees with wages as their sole compensation, and dothewad7,Cade,The mm iacer'sLt.La does a apply.in Required Inspections and sny wh obu Code The ver tncmM1 rad who law don tat apply N an owner is q P progeny who buiidavi improve Neiman and who dream](work himselfed Waugh his awn a however. OC Wig ing.r I that such improvementa arc.year oroffierempl.d.d fm.um., builder,Ne bve the Improvementg oath a thin on yam of completion,Nepose of builder w01 have the burden of pmvinC mos he did not build or improve for purpose of tile.). 1,as owner of the property am exclusively contracting with licemed Conuu:Nrs to construct the project(Sec.7044.Business and Profession Cade:)The Con racmrs Li. came Law does not apply m an owner of progeny who builds or improve Neuron.and who C.momm for such projects with a cont acm(s)Iicemed pursuant N the Comas ohs License law. ❑ I am...in under Sec B A P C far this mann Owner Date WORKER'S COMPENSATION DECLARATION k1 hereby affirm under penalty of perjury one of the fallowing exclmmlon: 1 hive and will maintain.Certificam of Comers m aelf-iamre for Wallach Ca-pen-' salon,as provided for by Section 3700 of the Labor Code,for the performance of dhy wah for which this permit is issued. �hasc and will maintain Warkefs Compensation Insurance,as required by Section 3700 of the labor Code.for W performance of the wark for which this permit is issued. My Worker's Campers atian Iier end Policy number am: Cartier. no ens artPolicy No.::7_i 5I G(),t'-5 2 0 CERTImCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i (Thusccdm need not h....pl.md if she permit is far..hundred dollars($100) less.) j I cattily Nat in the performance of the work far which this perml7 at issued.I shall not employ any person in any mrsocrm as N become subject to the Workeri Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If.after making Nis Ccnifcate of Escapism.you O..Id s become subject In the Workeh Coo chamon provision of Ne labor Cade,you most .J O forthwith Comply with such provision or this permit shall he deemed revoked. 'Z '-' CONSTRUCTION LENDING AGENCY (,14 l hereby affirm Nat Nem is a Convection lending agency for the performance of C> the work for whlcb this permit Is W.d(Sec.3M,Co.C.) (LI A Undeh Name z Lender's Address fJ Q 1 comfy that I have read this application and slam Nat the shove information is F torten.I agree to comply with all eiry and county ordinances and state laws relating 7o I](� building construction,and hereby amhtowc rcprescnusives fthis city,.enter upon the W above-mentioned pmpcny for inspec,ion purposes. a (We)agree to a...indemnify and beep harmless Ne City of Cuponinn against CAliabilities,Judgments,costs and expenses which may in any way accmc againuaid Ciy („)Z in consequence of the granting of thin permit. / r. APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: (,/ur�+JUIN Date SOUR GULATf N . -ria k Re-roofs Signature of ApplicanVConuxyor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hmmdous material as defined by the Cupertino Municipal Cade.Chapter 9.17,and the Health and Safety Code,Section 75532(.)? All roofs shall be inspected prior to an roofing material beinginstalled.pyo Will dte applicant or future building occupant use equipment or devices whicM1 If a roof is installed without first obtaining an inspection,I agree to remove - man.hara,dnua air cmomu mus as defined by[be Bay Area Air Quality M...gcsoml all new materials for inspection. District? ❑Yes Nu I have revel the haoudous materialsmquimmenrs underChapmr6.95of Ne Califor- nia Health h Safely Codc.Section 75505,75533 and 8334.1 understand thmif Ne building . does not cmmntl have a tartan,Nat It is my msponlhili7y o notl'y Ne m'up.,of the w x ormissaamcafaCmtifiute.rCaapancy. Signature of Applicant Date Owner or su@arircd.gem Dan, All roof coverings to be Class "B" or better CITY OF CUPERTINO �m 7 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35602035 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35683 REFERENCE ID # . . . : 06080134 SITE ADDRESS . . . . . : 22415 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 • OW CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORINT Date:�I'�IO�o Building Address: �7� ,1 Mailing dress (if different from building address): 17-12-41 10 nC.�1' 1c Owner's Nam On N O �e N i 4 Ro�. Phone#:40-��_35m Contractor:TY ' O l&rud®n MCI License #: Contact: Phone:'12•313-0100 Cupertino Business License#: H"Iiorio WS1O&I Fax: 2je9 Building Permit Info: Bldg S3"eCC>K4n Elect ❑ Plumb P Mech ❑ Job Description:14mvqt 31M+11 t1 I Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 4"a-I Occupancy Group: Type of Construction: Please check this box if the project is a / second-storyaddition: Elo'ect Size: Standard 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 IM 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 • I of 3 CITY OF CUPERTINO ..a. . aco + PERMIT APPLICATION FORM CUPEII;TINO uanti Fee ID Fee Description Fee Grou • BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New ConamPlumb PLUMBING BOVERTIME Ins�ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 Stonn/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 BREMAIItHAN A/C Units <= 10,000 cfrn 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 BREMREAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & OutletsELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 jaCITY OF CUPERTINO CUPEt�TINO PERMIT APPLICATION FORINT 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 Inspection 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 Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR I Planning Long Range Residential PLANNING ZADDCHG 7 Address Change BUILDING • 3 of 3