03060071CITY OF CUPERTINO
"°x a^xdt 3 '- ,
NFORMATIO�NN,
BUILDING DIVISION PERNIIT
OWNTRAc�fTQR
.
BUaDINC ADDRESS:
11272 QR
DRAEGER CONSTRUCTION INC
PERMITNo.03060071
OWNER'S NAME:
605 COMMERCIAL ST
rEeMrr 69A/%9/2003
NE:
(408) 536-0420
SANITARY NO. CONTROL NO,
ARCHITECT/EbIGINEER:
BUILDING PERMIT INFO
BO ELECT PLUM B MEOCH
.
LICENSED CONTRACTORS DECLARATION
t I aunder provisions of Chapter 9 (Commencing
1 Itenby affirm Net m limned
Job Descript�t
with Section 7000) of Divldon 3offtnuygce�and Professions Code. and mylicenab
�+
Lfull fo¢dwOtJ�TRcI. ✓
Lieenxe la 'CZL� -
Dam— ^t nvjL
SIDING L��
ARCH LIRA ON
iuntlenund
ORIG.#02100047 EXPIRED QUG 2 7
HALF FEES PAID (06/09/2003) 2oa3
mypWssNll rte used upubit. rremdi
Licensed P.f..i... I
OW NER-BUILDER DECLARATION
BUILDING
I hereby am. that Earn acmpl from the Cantrmtor's Licmnu Lew far the
following honor. (Section 703 1.5, Business and predications Code: Any city of county
which requires a permit to convect, alter, improve, demolish, or repair any structure
prior to its issuance, also requites the applicant for such permit to Glc asigne i mammcnl
Nat m is licensed pontoons an the provisions of she Character's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing wish Secllms 7000) of Division 3 of the Business ane Normal.. Cost) or
that be I. exempt lbe.from and the bais for the alleged exemption. My violation of
APN Number
U0#&Qy TYpe
Section 7031.5 by any applicant fore permit subjects she appllunl to a civil penalty of
not mom than five hundred dollen (5500).
I,aownerof Ind property,or em ployeswishwageutheir vele rompenutian,
-
Required Inspections
I, 7044. 1111111howner of
will dathe wart, and sheat.eta¢bOut
and Profeta Come: The Convuror's License Law Ores ret apply lf owner
rsLieeaerawdort,.1 apply
q, P
t is
progeny who builds orimprow Nereoe,and whodaea such week himalfu through Ms
bis
awn employees. provided that such improvements she rat intended oronemd forst If.
101 — FOUNDATION
however, the building. improvement is sold within ane your of completion. the Owmr-
bullcim will have dm burden Of proving that he did not Wild or Improve for purpose of
102 -. PIERS
nate')'
103 - UFER
0 I, ss Owner of Its, property, am aeluabely contracting with licensed contractors to
REBAR
construct dM project (sec. 7014. Business ad Profestio. Code:) The Gnaacmr's Li.
104 —
cera law does not apply m an owner of property wed Wilda or Improves Nehmen, and
105 - ANCHOR BOLTS
who concocts for such projects wish acomrsc o (s) licensed pursuant N she Contractor's
License Law.
106 - SEWER & WATER
❑ lamaemptumer Sem. ;B&PCfarthisreaon
202 — UNDERFLOOR PLUMBING
Covent Data
203 - UNDERFLOOR MECHANICAL
204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I lumbyamrm under penalty of perjury am of des following tleclantio.:
205 — UNDERFLOOR INSULATION
I have and will maintain Certfbate of Cement to elf-l.um for worker's Compos-
union, u provided fa by Section 37M of the labor Code. fm the porronnamx of the
301 - ROUGH PLUMBING
work ret which this permit is issued. _
302 - TUB & OR SHOWER
0 I have and will maintain Worker's Compensation Insurance. u required by Section
3700 of the labor Codc,for the performance of one week for which this permit is issued.
303 — ROUGH MECHANICAL
My worker'.Campe.adool.. e.t ierad Policyoumberam:
304 — ROUGH ELECTRICAL
Car Or` e1yQyla.:
305 — FRAME
CERTIFI FFXEM QN FROM WORKERS'
COMPENSATION INSURANCE
306 - HOLDOWNS
ffhh so.tha end not hecomplemd if she permit is Earn. hundred radiant
307 - INSULATION
arlma.)
308 - SHEETROCK
1 anify that in Ne performance of the work far which this Permit is issued, I Nall not
employ any person in any manmf so a m become subject retie wokc
rn'Campasation
309 - EXTERIOR LATH
Laws of California. Data
310 - INTERIOR LATH
Appliant
311 - SCRATCH COAT
NOTICE TO APPLICANT: IL after making this Certificate of Exemption. you should
became subject N the Wodeer's Compensation provision, of the Lane, Code, you most
313 — ROOF NAIL
forthwith comply withsuch provisions or this permit Mall he dmmcd revoked.
501 - FINAL ELECTRICAL ENERGY
CONSfRUCT10NLENDINGAGENCY
I hereby storm that Nen iso co.trmdnn kndingagemy for dap mirarmamcar
502 - FINAL PLUMBING ENERGY -
am arwhich Niepermituiumd (See .J097.Ch, CJ
lender's
Undoes Name
503 - FINAL MECHANICAL ENERGY
504 - FINAL BUILDING ENERGY
Lender's Adema
Ianify Elan 1have read ads coup andpatethat is
abovews
505 - FINAL ELECTRICAL
county totaling
ty and cesnd sun hest relating m
bonding I agree N comply with all city
nttlinumnnd
building mnatroction, and hereby wNarin representatives of abs city mentor upon 0e
ri
— GAS TEST
above-mentioned pmpcny far inspection palpasGl
0 F I
(We) agree to ave, indemnify and keep harmless the City of Cupertino against
Ilabllitia,judgments, costs and exposes which may in any way... against said City
C ICAL 7
in conxegmncc of the Sanding of this Permit.
APPLICANT UNDERSTAN AN ILL COMPLY WITH ALL NON -POINT
Issued by: 5 Date 7
S E REGU 0
Re -roofs 514 INAL PUBLIC WORKS
Type of Roof
' -
sigmaurea le -memter Data
HAZARDOUS MATERIALS DISCLOSURE
Will rite applicant or future Wilding occupant slot of hanele harardou, ata read
a donned by the Cupertino Municipal Code. Gepter 9.12, and the Health and Safety
ale, section 25532ay?
❑Yea
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
wtu IM.ppOmanl ter (ulu c banding occapant use egalpmat or aevtees wmeb
it haruanu air Contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
isvittT
0Y. �o
1 have road the haardrus materiels requirements under Chapter6.95 of thc Califon
nice Health&SefcdyC^dn5ccdo.M505,25533.d25534.1undcmand Nedifdx Wilding
dna not euovntiy how a moa. u my responobilhy m Cory led occupam of ac
mgnirepgtswmen amm�nC atehr mpaey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner
or radon r agent
am
CITY Or
CUPERTINO
CITY OF CUPERTINO
PERMIT APPLICATION FORM
/���7�
RJ � 71
PKPN #
Date:
Fee Group
BAPPLOTHER
Building Address:
'1673 iDr
Owner's Name:
Phone #:
C
/0
Contractor:
License #:
C
Gt
Contact:
Cupertino Business License#:
Boiler > 500K to 1M Btu
MECHANICAL
Building Permit Info:
Bld Elect ElPlumb ElMech ElJob
escription:
Residential Commercial El
q.Ft. Floor Area:
$/Sq.Ft.:
c�
.Gid
Cost of Project:
Occupancy Group:
—i o
BUILDING
e o� nstruction:
Con. Tax for BQ Zone
� Q
BCONSTAXH
i
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
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 > I OOOA
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BEN VESTIGA
Investi ation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1 of 3
Cm o
!'1 IDrDTIkin
CITY OF CUPERTINO
PERMIT APPLICATION FORM
2of3
Quantity Fee ID
Fee Description
Fee Group
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BMNEWSF&2F
New Sf&2F Res Bldgs
MECHANICAL
BNEWMULTI
Multifamily Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BNUMULTI
New Multifamily Res
PLUMBING
BNUSFD
New Single Family Res
BUILDING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
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 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 HeaterNent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10,000 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
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
2of3
CITY OF CUPERTINO
CITY Of PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID
Fee Description
Fee Group
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
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
BSEISMICRE
Seismic Fee Res
BUILDING
BSPECIAL
Special Insection
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
Mechanicals . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
PPLBG
Plumbing F e sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
3 of 3
j4
Pon 2 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36651061.00
DATE ISSUED.......: 06/09/2003
RECEIPT #.........: 22101
REFERENCE ID # ...: 03060071
SITE ADDRESS .....: 11673 SEVEN SPRINGS DR
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OPERATOR: conniew
COPY # : 3
OWNER ............: RAYMOND CHAN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5.128
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
TRT.RPHnNR _____ (4np)rlr-n4?n
MEE ID UNIT QUANTITY
---------------------------------
BENERGY PERMIT FEE 177.00
BPERMFEE VALUATION 12,000.00
BSEISMICRE VALUATION 12,000.00
TOTAL PERMIT :
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
J
AMOUNT
-----
374.65
374.65
AMOUNT PD -TO -DT THIS REC
26.55 0.00 26.55
88.50 0.00 88.50
0.60 0.00 0.60
115.65 0.00 115.65
NUMBER
------------------
101940
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