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06080139 CITY OF CUPERTINO 1 - DhiNC DIVt9ION PERMIT �, CONTRACTOR INFORMATION z •d+ _ X+"'+R:.b. , BUIL BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITNO.06080139 22456 RANCHO DEEP CLI DR OWNER'S NAME: PERMIT ISSUE DAIS RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST nglipl2onr NE: SANITARY NO. CONTROL NO. (408) 536-0420 ABUILDING PERMIT INFO RCHITECT/ENGINEER: BO EO PLUMB MEOCH �!ap LICENSED CONTRACTOR'S DECLARATION lob Description i d 1 lurchy affirm Net I am Beemed under provisions of Chapter 9(commencing with Section 7")of Division 3 ofthe Basin.sod Pro(essium Code.and my linme u in full force andofr«t. n REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE ;}3',z License lass Licit/17G1 [) •Fc Dam �_cdnlracW, ANTI-POUNDING, FELT & BATS . ROOF REPAIR. A.,loll ane DECLARATION I undcmanJ my plana shall be used as public records ea� °off LicchswJ Professional '•�� OWNER-BUILDER DECLARATION 0 0 1 hcrehy.(Sero on 1 am exempt from the Contras Co License Law for uta O o which re mass&.permit 703 L5.Business and ve der tel Code:Any easy r county 12[! which requires•pamis m conwuct,alcor,improve,dcmoiLN,or repair wY amcture .xi priormis iasuame.also aequimslM.pplicwlfor wch permilx file asigneJ wtemem C IhahheislicensedpersuanuotheprovisionofMeContractor'sLicenxlaw(Chapte,9 Sq.F FFloorArea Valuati$rl 2 0 8 3 $ (commencing with Section 7000)of Division 3 of the Business and Profcasinns Code)or - that he u exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any appiicant for a permit wbjecs dm epplkant m a civil penalty of ge+pyypN}TN�`7umber Occupancy Type not more Nan five hundred dollars(MOO). 3 J O 02054 . 00 ❑I,as owner of to property.or my employees with wages u Noir sole eomPareadan, will do the work,and Be swaure u not intended Cr offemA for aale(Sec.70W,B"— and oared Inspections end Property who Professions Code:umThe rlss trecmrs Licenseand who law uacs not apply lf an owner is �� p propcny who builds provided MonacoI prove wim..1Inch wmk oaoff,o,Nmugh this ��� own cmployru,provided Natwch Improvements ve nos Intended oraRercd for ole If. � ' however,Ne Wilding or improvement u sold within a.year of completion,the owncr- builder will have Ne burden of proving trot he did out Wild or improve for purpose of sale.). ❑L as owner of do property,am escluer,cly contracting with Iiemed conuacmn to construct the projen(Sec.7044.Business and Hofeasisn Code:)The Comnmars U. w hue law don not apply m an owner of propony who seta'or improma lemon.sod, who contracts far such projects with a contractor(s)licensed pursuant to the Conuactar'a it Assss��kk s Lkease law. 1 p {Ys rJ ❑IamexemptundexSet .B&PCfm Nismawn [■��d �WeN9■a Owner Data WORKER'S COMPENSATION DECLARATION 40 1 hereby affirm under penally of perjury ame of But following declandam: I have and will maintain a Certificate of Consent to self-insure fm workers ComNn- .non,as pmvidcd for by Salon 3700 of the labor Code,for But Pe,fonmenec of the work(or which Nis permit is issued. I have and will mannan Workers Compensation Insurance.as required by Section 37W of Ne laEar Code,("a pCoOm ane,of Ne work for which this permit is Issued. My WorkeescampenatanN na Wrier and Paliry number arc: Cartier. Polity Ns,: CERTINCATE OF EXEMPTION FROM-WORK ERS' COMPENSATION INSURANCE mais section need not W completed irthe permit is Fara..hundred&H.($100) or leas) I nnil•v Met in tic Pcrf....of is wort far which Nis permit u round.10.11 sat employ any person in any manner so as in Weomo sobject to Ne Worker''Compensation Laws of California.Date Appltcsnl NOTICE TO APPUCANf.IL after making this Cenificate of Exemption,you should become subject to the Worker's Compensation provisions of tic labor Code,you must .J 0 forthwith comply with such provisions or this permit shall x deemed revoked. Z� CONSTRUCTION LENDING AGENCY (••i thereby alfirtn Nat tem is a convection lending agency for tW Perfurmana of (Yi ^ Ne work for which this permit la issued(Sec.3097,Civ,C.) Q Lenders Name Landers Address U O 1 comfy Nat I have rend this application undulate that the above information is (~ cored.I agree in comply with all city and county ordinances and'este laws relaiag to 0 V Wilding convection,and hereby authorize reprexneatorS of this city to enter upon the - a aWvc mentioned pmpcny for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cuperuos against ito Imbiiites,judgmcnu,cwts and,.pC..which may in any wayaccrocagaimt mid City L)Z in consequence of Ne granting of this permit. ^ APPLICA UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �'�.(<-• 0 RE ATI —"___ %(-P1 Re-roofs St nature torx'Pireanucclorace., Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or future building Occupwtstom echandle haudsus material as defined by is Cupertino Municipal Code.Chapter 9.12,sod Ne W.10 and Safety Code,Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 2No- will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove Cott hvadms air cmtamim us as dcfhncd by Ne Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 1 have rest Ne Ilea icarematerials requirements under Chapter 6.950(the C.lifor. .is Health&SafetyCodc,Some.25505,25533 and 25534.1.Mcnland thahifthe building dam not currently have.tenwl.Net it is my mapomihility to notify the Occupant of Ne resirc nm meIpriarroimaanrcOr.cenineaearOccupancy. Signature Of Applicant Dale ATM, --=-1 S4- - -d� All roof coverings to be Class"B"or better 0 ,he,or t u to nxd.sent Dam CITY OF CUPERTINO I� 2 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35602054 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . • • : 35684 REFERENCE ID # . . • : 06080139 SITE ADDRESS . . . . . : 22456 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 &E 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 0( 06013q aCITW PERMIT APPLICATION FORM CUPEkTINO N# Date: C&I)�25IOLO Building A�reds: V✓nJl'^� Mailin dAress (if different from building address): Deep Owner's Name:�r^ 1,�o }�,,,, O 1'i ,4DA 1 Phone4: �` �Or� Contractor: l%t 1��/lai+ ® TI+vim License n#: y C Contact: Phone:971•313-OMOO Cupertino Business License#: H"OY-10 WSt1 n Fax: 21gq Building Permit Info: Bldg RIeCDR Elect ❑ Plumb Mech ❑ Job Description: Stow, 1 le -PQAYt Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 4"a- Occupancy Group: Type of Construction: Please check this box if the project is a / second-storyaddition: ❑ o ect Size: Standard 2 Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL ti BENERGY Energy BUILDING BENERGYADD Ener y Add Multi BUILDING BINVESTIGA Investigation fee BUILDING • I 1 of 3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quanti 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 PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXT I F 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 rinkler/Backflo 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 BREMFURN Relocation of Fumace 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 Ap2liance 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 A2pliance ELECTRICAL 2of3 CITY OF CUPERTINO CUPEI�TINO INT PERMIT APPLICATION FOR uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs 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 0 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 Mechanical sq. 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