06080147 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA.C*"TC1R`INFC.1IiNT.ATIQN �'
BUILDING ADDRESS: s DRAEGER CONSTRUCTION INC P"""N""06080147
11033 CANYON VISTA D
OWNER'S NAME: PERMIT ISSUE!DATE
Alk RANCHO DEEP CLIFF HOA 605 COWjKB9TAL
Tr NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECf/ENGIy03ER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
;0o LICENSED CONTRACTOR'S DECLARATION Job Description
bis 1 hmeby,firm that 1 am licensed under provisions of Chapter 9(comm r clog
with Section 70M).(Division 3 of the Ban.and Pro@amm Code.W my Iicena u
! pa in fanfame and effeet. LT n REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE
z Lim Clea Lk.,
g' canlrxwr ANTI-POUNDING, FELT & BATS . ROOF REPAIR.
ARCHITECTS DECLARATION
i 1 understand my Plans shell he.,ad a public mend,
j�
c Licensed Professional
OWNER-BUILDER DECLARATION
)n q I hereby.(Sect that 1 1. exempt from the Conlon C, Any c Law for Ne
0 4 fallowing mater.Permit
i 701.5.L5,B ties. and Pro.dem li Code:Any city an mmny
e3
which mquimm• .alsorecares da, ellen Mprow,h Nnniiti or repair my edswment
h
Her,W islmmo,d ponsumquims theapplkant for Co permit mole atlgnedwmment Valuati$p4208
< Nat Acis licenced puwant 7 0)of Division
of Nc Communes (Chapter Sq.FC Floor Area
�D
(commencing wiNSeeurom and
Win far
of Wtheegeit assumpta sand ion.My
At Code)err
5 9 Net io V es1.5 b Ia"applicant
li and Ne basin it the alleged ppliCUon.MY l XMILn of ppb
Section Com by hay out Commfor a permit objects Ne applinnuo Is Civil prohitY Of 3 5 6 2 Number
8042 . 00
Occupancy Type
not mom Nan Rve hundred doll (f5W).
0 1,as owner of the property,or my employe"with wages as their Sale eompanssdon, .
.111 do the wart.and the structure is nota mided maimed fanhle(Sec.7014,B.I. Required Inspections
and Proration Code "The Contractors Liam,Law data not apply N an owner of q P
property who Wilds or Improv"Herron,and who does such wmk himself m through his
owt employean,provided that such improw:menu u,not intended oroRemd for sale If,
however, that mime of provinghaldwlNinaroyid of cdmpledon,dee owner- �'- ■����
buildve will have Ne hmdcaro improvement
1 that he did rat bund of hatemon far Purposebe Own of - ,�+e.■
am.l.
0 I,a owner of the property,am meluuvely contracting wide licensed cum sron m
rom mal Ne project(see.7014,Business and Prafesdom Code:)The Communities U-
C..Law it= at apply m an owner a property who builds or improv"Cmman.said, awls �,rt 9100who correct,for such prokcta ln
with a canctO Sem N
or( emed personal e Contractors
Lk".Law.
0 I am eaearpl end"Sec. .B A P C fm Nis.soon pppppp �t r"TNG
�i�
Owner Date UILY
WORKER'S COMPENSATION DECLARATION
1 hereby sin=under Nulty of perjury,one of dee following declaellorte
-1 Aave and will maintain•CudO"m ute of Canin self-imus,fa warbler,Camper
arms,a provided fer by Section 3700 of Ne labor Cade,fm Ne p"fonnsom of Om
work for which this pmmit is issued.
C).frave and will maintain Wmters Compensation Irsursnce,as requited by Section
3700 of me labor Code,fns,Ne performance of tee wort for which this permit is Issued.
My Workers Cempemauan Imuran c"aim and Palley number art:
Came'.!�Ab Policy Na.:
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mmian recd net bccomplemil If the permit Is formic hundred dall(SIM)
airless)
I certify Char in me performance of the wart for which this Permit is lattice.I slWl not -
employ any person in my mmneru as m became subject in tiro Worbl"i Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If..net making this Certificate of Eumption.you should
become subject m Ne Wmlcr's Compensation provisions of the lab"Cade you must
.J Q forthwith comply with such provisians m this permit shall be domed mvokcd.
.Zi r~N. CONSTRUCTION LENDING AGENCY
[-a I hammy alio"Nat Nam te a eomtrualan lending agency far the perfurmem:n of
a dee work fur which this pmmit m issued(See.3097,CN.C.)
QLenders Name '
z Lenders Address
V 0 1 Certify that 1 have read this application and sum that the above infroarmuvn is
U,f comm.l agree to comply with all city ual county ominamu end sem laws mining to
O V building construction,and hereby suthern representative of this Cirymermrupoo the
i•'0. ahove-mcnooncd pmNrty for impaction purposes.
(~ (We),,me m ave,indemnify end keep hnm4ss Ne City of Cupertino ageimt
fq liabilid",judgmcats,costs and telecasts which may in any way same ageimt aid City J
V Z in consequence of the grunting of this permit. ,� G
r• APPLICANT LINDE��,(IITANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sOU E -AT, S. _
IIPPP�� ' ) -0 -Re-roofs
SR[�mrc n
, nAZZARDOUS MATERIALS DISCLOSURE Dem
HAType of Roof
Will the applicant or future Wilding occupant mom or hurdle humanities material
as dellned by No Cupertino Municipal Code.chapter 9.13.and Ne H"Ith and Safety
Code.section 355334)7 All roofs shall be inspected prior to any roofing material being installed.
41 0Y" t}Me_
Will ft applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
mak h.m..air contaminants as defumd by the Bay Area Air Quality Managemem all new materials for inspection.
District?
O Yes 0No
I have mud the haardaius materials requirements underC'hapmr 6.95 of the Califor.
.in Health @ SiretyCorle,Secuans35505,31533 end 31534.1 undcrsmnd thnif the Wilding
dam not currently ban a wrens that II u my maponsibility to nodry th,occupant of Ne
rc`{ui'mme}''""�"�"'�°`� aim,anwwaafaccrdfleaeoraeap,m:y. Signature of Applicant Date
-TH^�(�/�G_''f� ^ 5-:2) -04 All roof coverings to be Class"B"or better
Niel,ar.uPRm20,saa Dam
CITY OF CUPERTINO
�n 10 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . 1 : 35628042 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . . : 35684
REFERENCE ID # . . . : 06080147
SITE ADDRESS. . . . . : 11033 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 .
METHOD OF PAYMENT AMOUNT NUMBER
---- ------------- ------------ ------------------
CHECK 1715 . 30 123214
TOTAL RECEIPT 1715 . 30
•
alcl -
CITY OF CUPERTINOCUNO PERMIT APPLICATION FORM
011 SPo I/o
N# Date:
S Ica Ol0
Building Address: , Mailing Address (if different from building address):
llo�3 V/i
Owner's Nam Phone#:
Contractor: License #:
DCLIQ042 conwo
Contact Phone:g7a•313-LAw Cupertino Business License#:
Gly1 Q el l do Fax: ZI
Building Permit Info:
Bldg Rrk0 Elect ❑ Plumb ❑ Mjjh ❑
Job Description: e 1
Residential [Er Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 1:4 .41 ,10B Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑ '
o'ect Size: Standard 2`� Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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 > 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 -
cuPERT iNo PERMIT APPLICATION FORM
Quantity 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 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 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 Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise 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
CITY OF CUPERTINO !
CUPERTINO PERMIT APPLICATION FORM
FQuanlily Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Li ting 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
BSPECUL 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 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