06080144 (2) CITY OF CUPERTINO '�'°^ '-
BUILDINCDIVISION PERMIT �£CONTRA.CTQR�IN�QTRMATION
BUILDING ADDRESS: s DR E12 CONSTRUCTION INC PERMIT N006080144
11062 CANYON VISTA DR
PERMIT ISSUE DATE
OWNER'S NAME:
RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST 08/18/2006
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHTIECT/ENGINEER: BUILDING PERMITINPO
'BLDG ELECT PLUMB MECH
�op LICENSED CONTRACTOR'S DECLARATION Job Description
ib 1 hereby affirm that 1 am licensed under providons of Chapter 9(commenting
i� to uSection ll orceandd streeDivision Sof uta Business n
nsend Professions Code.and my licenmu
REMOVE 3 TO 4 " OF TILE FELT & BATS . INSTALL NE
LiemacCass ANTI-POUNDING FELT & BATS . ROOF REPAIR.
Dao: Z— 1�—Contractor r ,
ARCHITECTS DECLARATION
i I understand my plans shall he used as public nom da
a V
o G Licensed Pmressionel
5 Oat I am exempt
DECLARATION
1 Mushy.(Sect that I I.S.exempt favus the Qomlanel License Law for the
:00 following mason.Permit
t 703 LBusiness and profession Code:Any airy s manly
ism o which iUIsu•e,also reconatmcLahaicimprov,k Perlia errerepair my edmmctum
_I< prior m its censed p rsuant a the thovisio s of for amh Permit micense caw(Chapter
s�G that heiscing it pursuantmthe of Divisioof the4 B mores License Law(Chapter9 Sq.Ft. Floor Area Valuated@208
5 $ (eat he is(commencing with Sectionrn and the Division of Ne egad.ad Proon.M Actedns de)or
_ that k u exempt IMmfrom and the bash for be alleged eamption.My violation of
Section 7051.5 by A"applicant for a permit subjects the applkauo a civil penalty of 3 OV 8TIer 0 0 Occupancy Type
not mom than firs hundred dollars(SSW). 5 6 2 8
i azownerof the property car my gmunrces withwage ea Heirmk ca .Butdoom
and dvrsubmsCde:Tim Com is nmlLicensulcol oraw dismed ntapplyade In so
Required Inspections
and property
wh ora Cade:The m themmr's Liaise Law don ret apply lo r or t owner of q P
own emy who b,provided"Inch i m r and who docsaahwork oraffr edthrough his
awn employees,prowled nut such improvements art rot Intended uvRerctl for alter,
builder Veuvebuilding.,timprovement is amid withinrm yearcarimprovefo,Neownm-
sam.).r wi0l�w the buadm of proving that he did int build or improv far puryase of '
sok.).
❑1,as owner of the property am amfi sively contracting with Earned contractors to
Construct the project(Sec.7004,Business and Pretnslan Cotler)The Comrmmr's I.I.
cone law does not apply m an owner or property who builds or improve themun.and,
who contracts for such pro ce s with a eommctor(O llunsed pursuant to nae Consumer
License Law.
❑ Iamescreprundm5ee, .Bh PCRuthurcason
Owner Date
k1
WORKER'S COMPENSATION DECLARATION
ON
hereby affum under penalty of perjury mm of esu following declarmivn:
ham and will maintain a Certificate of Consent m a1f-inuro for wafter comped
action,as provided for by Section 77W of the labor Cade,for the performance of the
work for which this permit is issued.
rT Fhdbe and will maintain Worker Compensation Insurance,u required by Section
761
W of the labor Coda far the performance of the work for which this permit is is u ch
My Workees Compenauo.Inau nee carticr and Policy number are:
Gmer. Poliry No.: 'b In
CERTNFE TE OF EKEMPI70N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he complemd If the permit is force`hundred dollars($1 00)
or less.)
1 certify that in the performame of the work for which this permit is issued,1 shall not ,
employ anyperan in my manor so as b become subject to the Worka s'Compensation
Laws of califomia.Dam
Applicat
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
become subject to the Workeh Compensation provisions of the labor Code,you mum
.J z forthwith comply with such provide.or this permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-� Thereby affirm that Vert is a eonaumtion lending agency for the Performance of
I5i .moi the work for which this permit is Wood(Sec.5097,Civ.C.) '
Q Landow Name
z Lender's Address
U C) I coor,that 1 have mad this application mal ware Net the about information is
W P correct.I agree to comply with all city and county ordinances and some laws rekting to
�Ubuilding construction.and hereby authorize mprescnatives of this city to corupon
enter the
r W shove-memiuned property for inspection pugvus.
F LL (We)agree m save,indemnify ad keep harmless tht City of Cupertino against
In liabilities,judgomms.casts and espouser which may in my way accrue against said City
U Z in consequence of the granting or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO ONS
Re-roofs
Signaaieo ppicant/Coetractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupantmom or handle haurdqus material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health ad Safety
Code.Section 75553(.)? All roofs shall be inspected prior to any roofing material being installed.
❑r tri.-
41
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
emit hvardnus air mdmmimmus as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea _Qilt-
1 have read Ne hanrdwsmaerials mquimmemu under Chapter 6.95 of the Califor- -
maHealth&Safety Code.Somlau 25505.25557 and 75574.1 undersand thmirthe building
does net currently have a tams that it u my responsibility to notify the oaupat of the
q .m It dormiesemmeacerurmaeaoccupancy. Signature of Applicant Date
own¢or amthnrisd asst Dam All roof coverings to be Class"B"or better
I
CITY OF CUPERTINO
n- 7 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1 '
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35628034 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . . : 35684
REFERENCE ID # . . . : 06080144
SITE ADDRESS . . . . . : 11062 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
•EE 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
CUPEkTINO PERMIT APPLICATION FORM
N# Date:
-0 0� Ig Ol0
Building Address: Mailing Address (if different from building address):
o ViStz1
Owner's N Phone#:
Oo—ntractor f W License #:
Contact �}-, �1 Phone:g25'313-010q Cupertino Business License#:
Ily� Ot I�vl Fax: 21
Building Permit Info:
Bldg C<ti�Ofi Elect ❑ Plumb ❑ M h ❑
Job Description: Ve, sto -h'llt,
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: L 41 Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
oject Size: Standard 2"- Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy,Add Multi BUILDING
BE\VESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO -'
CUPEI�TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Grou
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
BOVERTINIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg 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 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
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
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CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
Quantity 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
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
MPER I= 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
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