06080139 CITY OF CUPERTINO 1 -
DhiNC DIVt9ION PERMIT �, CONTRACTOR INFORMATION z
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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
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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
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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
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