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06080135 CITY OF CUPERTINO 4..' d 1'41" ° I BIEiILDING DIVISION PERMIT zCL11tiI'Ta�' � rIna "•. nom"" PERMIT NO. BUILDING ADDRESS: DRAEGER CONSTRUCTION INC 06080135 22435 RANCHO DEEP PERMIT ISSUE DATE OWNER'S NAME: RANCHO DEEP CLIFF HOA 605 COMMER NE: SANITARY NO. CONTROL NO. (408) 536-0420 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 pp LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm But 1 am licensed under previsions Of CWpar 9(commencing mm win Scetien70fiftef Division 3 of Ne Business and Profrssiom Code,and my license is =st,N in full force and affect. f7�ln REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE z jvyDam 2[-2 Comment. ANTI-POUNDING FELT & BATS . ROOF REPAIR. ARCHITECTS DECLARATION i a I undersand my plans shall W used as public recmrdv ?yVI- 'p Licensed Professional .7 OWNER-cm-Pt frDECLARATION a I nosy .(firm Nat I am exempt from the Cssions Co :License yc Law far the .p 0 fonch mquiason.(ermit t 7 onstru31. t.aiuess and owProfessions demolish,or epair y o traclu y $ which requires a e,also re cors,the pike nt for S,hWrmicar repair e y own of prior l(1 its 1nY0oeC,alsa Rgeilea the dpphedrll for Well per111illa rile aSlgned snMmenl that he is licensed Farmers an the provisions of the Comment's Licensc Law(Chapter 9 Sq.Ft. Floor Area ValuaC�20OO ZroF (commencing with Section 7000)of Division 3 of dm Business and Profemions Coeh,)or $ not he IS exempt themfram and da basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the sPPlkdnt W a civil penalty of APN Number Occupancy Type nut more than five hundred dollars($500). 35602034 . 00 1,as ownerof the Pont ar my employees with wages as their Wa compensation, will do the work.and the scum.is not intended or offered far Sale(Sec.7014,Business Required Inspections and Profeasions Code:The Comsano s license Law docs W[apply W an owner of q p propertywhobisIldsviimprovesthereon,andwhodoessuchwork oroff erthrough Ms own employees,provided thmwch improvements mount intended meRercd for Sale.Ir. however,the building or improvement is Wad within one year of completionmen,the owner- builder will M1ave the burden of paving dal W did not build or improve for purpose of w sans). - I T ❑1,as owner of the property,am reclusively mmneting with licensed conuanms to ��� construct La the project(Sec.7094,Business and Pm(noon Code)The Comatmen, cad acne law can not apply je an owner of Property who Wilda o arit.n Nocton,old who contracts Law.for such project with a canaacmr(s)licensed punuam W tW C-ontsectaln L'mmta law. r 1(!'!)� sT /s7 ❑ lam reempt under Sec. ,B&PCfor this mean � � /�{r/ Owner Date '„, 1j{1 WORKER'S COMPENSATION DECLARATION rry 1 hereby affirm under penalty or perjury,one of the following declarations: 1 have and will maintain a Ceniricaa of Consent to self-insum for WorkefsCompcn- aation,n provided for by Section 3700 of da labor Code,for the performance of the work for which this permit is issued. X1 have and will maintain Worker's Compensation Insurance,u required by Section )00 of the[ober Code,for the performance of die work for which Una permit is issued My Wmrkets Compum adan Msun m carrirc: er end Policy number a Cartier. 6+nk-t �yLy`,l Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , (Tors section need not he completed if the permit is formic hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I Shall not employ any person in my mannerso ss to become subject to the Workers'Compensation Laws of California.Dau Applies.[ NOTICE TO APPLICANT:If,mor making this Cenifina of Exemption,you should become subject in the Worker's Compensation prevision of the Labor Code,you most .J O forthwith comply win Such provision or this Permit W deemed rew red. 'Z h CONSTRUCTION LENDING AGENCY (-t 1 hereby afBan that dare its eonauetion miling agency for 1W performance of [�.> the work for which this permit is issued(Sec.3097.Civ,C.) W�Q Lender's Name Q z Lender's Address U Q I certify that I have mad this application and tan that the above information is IJ.H comet.I agree in comply with all city and county ordinances and Sana laws relating to Q[) building consraction.and embyamhome represenativcs ofnis city to roar upon the a ahwc-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against „Fy r/1 liabilities,judgment,casts and expenct which may in any way Secret,Main,said City U^,[ in consequence of the granting of this permit. tti APPLICAN NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �- 'l-I �•,G SOAR EG ATIO q �Grla "66 Re-roofs Sh,riiditrem ppbc RaoS HAZADOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or furore building e.Chapter orand t e HeaMoua material U defined by the Cupertino Municipal Crede.Chapter 9.12,and the Health and Safety 41 Cale.Section 255324d? All roofs shall be inspected prior to any roofing material being installed. ❑Yrs No 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 emit h sedous air comaminnt as defined by the Bay Area Air Quality Managcmcn, all new materials for inspection. District? O Yes Nu I have read the hvmelous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,SeNma 25505,25533 and 25534.1 undersand One if tW building docs not cu have a a that it is my responsibility a nmtil'y the Occupant of the re u'c 1w ' m easure.. a Cc.matemracupancy. Signature of Applicant Date — �$ 'Zl -0 All roof coverings to be Class "B"or better Own-or authoriacd Dom Y ` CITY OF CUPERTINO , 8 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35602034 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35683 REFERENCE ID # . . . : 06080135 SITE ADDRESS . . . . . : 22435 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 d(pQg CUPEYOF PERMIT' APPLICATION FORINT N# o0- Date:C&I1�10� Building Address: �/ Mailln dress (if different from building address): y35 f2oncho cv, Owner's Name: ganch0 n 11 00 Phone#:^M,,2� z3uo Contractor. license# 6Q UtC,C)yInC,. — BD CS9 Contact: Phone:941.313-TWO Cupertino Business Licensee#: worto wSocln Fax: 218q rp Building Permit Info: Bldg R1eC0fff1q Elect ❑ Plumb Mech ❑ Job Description: 3tp " t f� t Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ oject Size: Standard 2 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 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 �. . •, cuPEkTiNo 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 PLLTMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE 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 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 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMEURN 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 aTRTINO CITY OF CUPERTINO CUPPERMIT 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 BSW1M 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 Chane BUILDING 3of3