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06080136 CITY OF CUPERTINO �UI0 Nk"DIVISION PERMIT rC�NTRA.GTORANFORMATION w".'..�nb?e"�3,r.,.z :^�.�",eu°�i ,. BUILDING ADDRESS: a DRAEGER CONSTRUCTION INC PERMIT HO.06080136 22455 RANCHO DEE OWNER'S NAME: PERMIT ISSUE DATE RANCHO DEEP CLIFF HOA 605 COMMERCIAL NE: SANITARY N0, CONTROL NO. '.. (408) 536-0420 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Op LICENSED CONTRACTOR'S DECLARATION lob Description UM F 1 hereby affirm that I am Ikcnxd under provisions of Chapter 9(commencing lei wish Scnion]gID)ofDiviaion.7of dm Husinw and Profusium Codc.and my liaveis ;ate inrultforce and crfect. REMOVE 3 TO 4 " OF TILE, FELT & BATS . INSTALL NE Licenx aas-T��`N"" (nl� I Q ANTI-POUNDING, FELT & BATS . ROOF REPAIR. qq Dames? Contractor i sQ'W ARCHI I ht.t'4 DECLARATION i 2 7 I ts ularam d my plans shall he used as public menrds ly{ 0u.t; Licenxd Profesanal a 3 OWN EMh.creR-BUILDER DE Ce Contractor's 1 Wrthy a(s c Not 11. ,Bumps from the Conon;Co License Law per 1W 1 O o following massa.(Section](131.5,Business and w.d.oro Code:Any city or county f$E which requires a Permit m cnnswct.alms imPrsrvn,dcmulish.nr¢Pair any swcmre �! Zto prior la its issuance,also requires she applicant for such permit in file a signed statement 3 G that heolicensed pursuant wtheprovisionsorNeConoacmr'sluxnxLaw(Chmucr9 Sq.Ft.Floor Area ValuaCt�11208 2 (commencing wish Section 7000)ofDi%nshm 3 of the Basin.and Pmfeuimu Code)tar $ N at be Is eaempt therefrom and the basis for the alleged exempdan.Any violation of Section]031.5 by any applicant for a Permit subjects she applicant to a civil Penalty of APN Number Occupancy Type not mom Man rive hundred delta,$(5508). E 3$602033 . 0 0 1,as owner of hen property,or my employees wish wages u their auto compensadon, Is��aaa� will doshe ftwiM..and Coal:: swctureisher'sUded or altereddocs 1applyke .TON,Baamaa ISIQ_Cttp and Ra(eWotu Code:The ssmaactor'i License law dans rot apply lf an Dana of �Ias���W plata gay, propertyaha Wilds arimprovesch improvements who danauhwork oroffsrthrougb Ito own employers,provided this web impmsemenu am not intended mplool ed for sale.r. however.she building assimpm Fearing sold within one year of completion,purpose semen buildu will Marc tha When of proving dot be did tat Wild or improve for puryox of t NIcJ' ❑1,as owner of the property.am wlusively communing with licensed rnnaanon mconso arose a desoject ot (Sea.s an wnerof satiny who ars,Wilds Cade:)The Coahemen.Lid �� . cove law ctsf not apply e m owner of property who Wilds or imProvas thereon,and, ,a� who contracts for such projects with a cansrumdO Ilennxd pursuant w the Canoac(oi s �T�QNkM�pp License law. ❑lam escmpt undo Sm .B&PC(or mu ma.on ' Owmr Dat" WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarmiom: 1 h w mamba.and will maa Cenifiwm of Co..[to relbinsu a for Worker's Cmarm- sation.as provided for by Section 3700 of me labor Code,for the Performance of tbe ' work for which this Pewit is issued. 1 bow and will maintain Worker Compensation Imuran.,as required by Section 3700 of the Labor Code,for me performance of f wank for which this permit u issued. My Worker's ComPensatian lnsuran Cartier and Policy number am: ' Carver.S'trn}P (IMf� Policy No.:71.I K_A')2 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu sectine need nm he completed if be pewit is faronc tunical dollen($100) or less.) 1 certify met in me Performance of me work for which this Pewit is broad.1 shall not employ any person in any manner an as b become subject to tM Workcri Compensadan Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Certificate of Facmption,you should became subject no the Worker's Compensation provisions of shc labor Code.you must .J ,2,r formwim comply wim such provisions or this permit shall be deemed revakcd. Z QC CONSTRUCTION LENDING AGENCY 'rt thereby al dot them is a construction lending agency for the Performance of �t the.,it for which this Permit is issued(Sec.3897.Civ.C.) QLender's Name , Z) z Lender's Addrw J C) I certify mat I have tend this application and sum shat the above information is IL Fcoven.l agree in comply with all city and county on inances m l suis laws relm ag I. building consouction,and hereby authove mp escoutives or this city to enter upon the Whow Mentioned property for insicetan purposes. .i C (We)agree to save,indemni ry and keep harmless ate City of Cuparino against tF—t rA liabilities,judgments,cut%and expenses which may in any way a w.agalnsteaid City U,z in consequence of the granting of this Permit. p APPLICA R VNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE - Re-roofs Sig urn ofnpplicanUConoacmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(mart building occupant atom of handle haasrdous materia as defined by the Cupertino Municipal Code.Chapter 9.12.and she Health and Safety Code,Section 23532(.)1 0 No All roofs shall be inspected prior to any roofing material being installed. 41 ❑Yes Will the applicant or future Wilding occupant use equipment or dcvicas which If a roof is installed without first obtaining an inspection,I agree to remove emit nonporous air contaminants as dcOned by me Bay Ames Air Quality Management all new materials for inspection. District? [3 Yes I have mal the ecowd mannamrials requirements under Chepmr 6.95 of the Califon ria Hcalshk5afmyCadc,Sections 25505,25533 and 25534.1 undcaund muif tW building does not currently how a tens t It is my responsibility m notify the occupant of me r n 0ca�eapaaey' Signature of Applicant Date oar araomo >< Dam All roof coverings to be Class "B"or better i' CITY OF CUPERTINO �n 9 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35602033 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35683 REFERENCE ID # • : 06080136 SITE ADDRESS 22455 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 �EE 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 • [Q CITY OF CUPERTINO �� CUPEI�F PERMIT APPLICATION FORM .a //�� . N# 3'l�' VZ Date: Building Address: Mailin dress (if different from building address): 2 5� r2(,nch(D CNS Owner's Name�� „�� n�� r nr � Phone #: 4C � P�3300 Contractor:vvvegff 1 opgzi ojoyr 'nG. Licensci ' (D C39 Contact: . W Phone:92 -313-=D Cupertino Business License#: f'Ih� n(-) �C1S'Yj6n Fax: '1 J8q Building Permit Info: Bldg S3'1eCXDW7q Elect ❑ Plumb Mech ❑ Job Description:IWOel, 3tp u Qt-VA lc� Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: . Cost of Project:-44- Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ o'ect Size: Standard L7 Large ❑ 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 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 <= 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 1 of 3 Q CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. HousinE 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 . Cessliool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINIBRCEP ;-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 Ei 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 . WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAnu-IAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT • Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREN FURNOV 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 Appliance ELECTRICAL 2of3 aC10F CITY OF CUPERTINO cuPERMIT 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 Inspection 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 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 Change BUILDING • 3 of 3