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
•
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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
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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
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