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06080149 (2) CITY OF CUPERTINO LUf1:D"�!i'DIVISION PERMIT 7dC�irlr,TRACTQR INFOI.LMATIrQN BUILDINGADDRESS: DRAEGER CONSTRUCTION INC PERMITNO.06080149 CANYON VISTA OWNER'S AME: PERMIT ISSUE DAIS RANCHO DEEP CLIFF HOA 605 COMMERCIAL NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 'ices LICENSED CONTRACTOR'S DECLARATION Job Description �s C 1 hereby affirm We,1 am licensed umkr provisions of Chapter 9(commencing U with Section 7")of Division 3 of We,Business and Profescimu Code,and my liccnuu mfullrorteandeffecl. REMOVE 3 TO 4" OF TILE, FELT & BATS. INSTALL NE iqz Li"">< ass Cour Ci�7LI� ANTI-POUNDING, FELT & BATS . ROOF REPAIR. Dated ARCHITECTS Can DELL Iq- ARCHITECTS DECLARATION i a 1 undcrsund my plain shill he used as public rtrnNs my 1 G In Licensed Pmfessianel Oat I am exempt from DECLARATION p 3 1 Maso alarm e" I a1.excmpl from I po Contractors c:Any c Lew for the i C o following mason.permit t 7113 LS Business and Profdo nm Codc:Any oily or county j29 which acquires ro pinned la cones We elms Mpmw,dcmoRsh,or repair ed structure i< PH.,to its issuance,also acquires the applicant for such penniuo Tile asigaJ summer � •s that he is licensed pursuant to We provisional of WeConlmctor'sLkcnxLaw(Chapter 9 Sq.F FFloorArea Valuat' d,2(]8 a (commencing with Section 90(0)or Division Sar the Business and Professions Code)or my.. Nal he u exempt Wmcfmm and the basis for the alleged exemption.Any violation of Scotch 703M by any.ppliant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type em ram man five hundred dansn(M). 35628041 . 00 ❑Lasownmof red We someone is contain r wine wagussthelrtalc70mpensadess will dao¢work,andth That Ciurzoer,,Lard Or offered folie apply to an4.Business Required Inspections and Professions Cade:That ves Womrs License Law dao not apply lf an ower is q P properlywhos,provided Waimthereon,and who d -1 Milwo al Orri lfud Wr smi his own employees,provided Waimea Improwmants in cot inmMW arpictiod for me.IL however,We building or Improvement u said within one year of Improv for We assn builder will have We burden of proving that be did net beiW or improve for purpose of sale.). 1,as owner M We propeny,am oula tively...inning with Ilmrued comnctmc in constrvet the pmjm(Sec.70x4,Business and Professions Cade)The COMMIM'a Li- oneem Law dins not apply in an owner of properly who builds or ierpmses thereon.and, who contracts for such projects wide a conmacmr(s)licensed pursuant m We Conwcmri License Law. ❑1 am esemp,Was,Sec. ,B k P C for Oureason Owner Data 40 WORKERS COMPENSATION DECLARATION 1 herby af0rm under peaid., of perjury one of the following daclandums: Aar and will meinlsin a Cenifiau of Consent o self-insum for WmkeesCompen- cation,as provided for by Section 37M of the Lobar Cade,for the performance of We work for which this permit is issued. ave and will maintain Work's Compensation Insurance,as acquired by Section W of the lahm Code for cite performance of tM work for which this Nortil isissued. My Workers Compensation Insure cc artier end Policy number me: Canio:54 Polley No.:7I?IS n79 CERTIFIG FEtcxm.nGnN FROM WORKERS' COMPENSATION INSURANCE (This section mcd not kcomplemd if me Permit is fmone hundred dollen($100) nr less.) I cctufy that in We performance of me work for which this permit is issued,1 shall not employ any penin in any manrom as to bccomc subject to the Workeri Compenodon Laws of California.Data Applicant NOTICE TO APPLICANT:It.afar making this Certificate of Exemption,you should become subject in We Worker's Compensation previsions or me Lebo Code.you much .JO formwith comply with such pmvirions m this permit shall he deemed revoked. Z� CONSTRUCTION LENDING AGENCY 'Tr 1hemhy.M.Nal Wert is a constructina lending Bgenry to,We perfmmena of C We work fur which this permit u issued(Sec.3097.Civ.C.) Alenders Name .7 z Landers Add. V Q 1 certify that I have rad Wis application and cam that We above information is U. F comet.I agree to comply with all city and county ordinances and suite laws relating to Q(_) building construction,and hereby euthoria repmsentatives of this eitym emerupnn the res o ahmcmcntiuned pmperty for inspection pugmses. (Wo agree to we,indemnify and kap harmless the City of Cupcnino against H� IIaluilda,judgmean,casts and experso which may in my my scenic against said Cily V Z in consequence or the flooding of this permit. n Z� u••u APPLICA DERST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date k^ SOU REGUL TI -51 -6 Re-roofs Signaum of ApplicanVConlraaar Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant More or handle haoodous material as dolned by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safely Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. QYa 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 until.haon nes air cMlaminMU o derined by the Bay Arta Air Quality Management all new materials for inspection. District? ❑Ya ON. 1 have mM We baamdom materials requirements under Chepmr6.95Of dee Califon one Hcal"Safcty Coda,Sections 25505,25533 and 25534.1 understand Waifde building does nota how a mnant,jdaut it is my mspomibility to an We accuput of We require tswhm muM naissuancc Ofa Cenifmam of Occopanry. Signature of Applicant Date ✓ owner Or aul ornsd agent Dam All roof coverings to be Class "B" or better d: CITY OF CUPERTINO �m 2 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 35628041 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT 4 . . . . . . . . . : 35685 REFERENCE ID # . . . 06080149 SITE ADDRESS . . . . . : 11023 CANYON VISTA 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 SEE 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 • Iwo `> ' CITY OF CUPERTINO a f4q CUPEI �TINO PERMIT APPLICATION FORM �r II)qV3 � Ca. fKe -a -011) N ate: OB 115 OLD Buildi#ng Address: Mailing Address (if different from building address): 3 viSlol Owner's Ne: Phone#: � X106 - Contractor: License#: Dg r on 1y-C. conwo Contact; � ,{ Phone:g25'313-OiOO Cupertino Business License#: a0 O ti astt[Q Fax: 2) Building Permit Info: Bldg ErPZOi Elect ❑ Plumb ❑ Mjjh ❑ Job Description: \1e 3"b Residential r'Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 4, Occupancy Group: � 208 Type of Construction: Please check this box if the project is a second-story addition: oject Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 } ' CITY OF CUPERTINO . cuPE�TiNo PERMIT APPLICATION FORM uanti 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 BPFIXTURE Pb1g 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 Reins 'ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 din 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2 of 3 CITY OF CUPERTINO 0 of PERMIT APPLICATION FORINT CUPEkTINO F-Q-uantity 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 I 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 Aim PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3