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06080146 (2)0 Z a LL U U 0 F U CITY OF CUPERTINO U O y < $ — �* ^�'�''*`• t" "''``' "�•R �IWOR 41�. 'bUILDINGrDIVISION PERMIT r CUN'Y'RAC`� - g BUILDING ADDRESS: DRAEGER CONSTRUCTION INC 11111 NO, 06080146 11103 CANYON VISTA DR OW NER'S NAME: PQ09T L3UEDATb RANCHO DEEP CLIFF HOA 605 COMMERCIAL AT NE: - SANITARY NO. CONTROL N0. (408)536-0420 ARCHITECTIENGINEEA: BUILDING PERMITINFO BLDG ELECT PLUMB MoECH T l� E tt LICENSED CONTRACIORI DECLARATION lob Description I hereby aDirm that I am licensed under previsions of Chapter 9 (commcncing with Sceuan 7OlU) ofDiNdon J of the Budnruand Profeasiam Code,arW my license is I. full force andeffect. 3 TO 4" OF TILE, FELT & BATS. INSTALL NE jj?REMOVE lsss Lia to ANTI -POUNDING, FELT & BATS. ROOF REPAIR. Daucamovor ARCHITECTS DECLARATION I mbernand my Peen shall he used as public nxnNa Licensed Professional OWNER -BUILDER DECLARATION I hereby .,lure Not I =mpg n the COmrutofa License Law for the Business and Profcuumn Cads: My lily Of county following reason. 703 I. s permit t ono, ellen.imPmw,h ere repair which regmiraapermit requires, de, parmil sganyatwctum Fri"miuissmrcpuralso requimthei,mass Law(Ced aemcm 9 Sq. Ft. Floor Area Valuat$A208 fo,Common'U.c. COnuhuman roflaw(sCOO)duer ProfessionsCock) ar (comms cin witPmrnunttodeofDislomofaf eaM Profen Sectiao7000 the Busaged (cat for th ce vi that he ts sump, therefrom and the bsse for the alleged eumptian. Any violation of he is esempt di basis Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant w a civil penally of not more dun five hundred dollars (5300). ON 3 5 6 28029. 0 0 ❑ I, u owner of she property,army, employees with warp as their sale compeua0an, Required Inspections q P will do the work, and On Amctum b Out Intended or Offered for sam(Sm. 70th. Budoeu and proftomm, Code The Conuamof Lohse Law does not apply to an Owner of property who builds a impoven thereon. and who does such mark himsel f m through his Owmemployas, pmvided that such improvements are not mended aro@red for sale. If. however, the toldingar Mproument is old within One year of cmnPletio, the owner builder will have the burden or proving dust M did not build Or Improve for purpose of builder �a �' � ❑ 1, as Owner of the property, am eaclusively con oWiin{ wish licensed cenocmn to construct the pmjea (Sec. 7044. Business and professions Cade:) The COOmwes LI - 'L/A�y9 came Law dam not apply to an owner of property who builds or Improves demon, and who contracts for atwh projects with a senus:mHs) Raemed Farman, to the Contractor's / Lkeme law. I am uempt under See. B k P C for this, moan Owner Dau BUILDING WORKER'S COMPENSATION DECLARATION I hereby eftlrsn under penalty of perjury one of the following decimations: _� U lnamand"I common aCeNfinm of Cmuem m self -Immo for Workefa Compen. sedan, u provided for by Seaton 3700 of the Labor Code, for the Performance of the for which this permit u issued. ww�ork� 9�+Oavc and will maimatn Worker's Compensation Wuran¢, u required by Section ' 3700 of the Lah"Code, for She Performance of de work for which Nu peturk u tuned. My Workee. Compeoudon InsYYnnce ani" and Policy number are: - Came r.S,I'Aff ;,"e Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' (ThLeseNo need not becomFleed if the Permit is Inform hundred dollen (SIW) or lea.) 1 certify the, In the performance of the work for which this permit a issued. I shall not employ anyperson in any munerso ss e become subject to da Workcn' Compcnution Laws of California. Dam ' Applicam NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should became subject m the Worker's Compcuation provisions of de Labor Code, you most r fOMwish amply with such previsions or this Permit shall he dcemed malted. LENDING AGENCY RUCTCONSmisac mmolan agency for she Perfurmanec of 1 homey the thin is m arum s ed (Sm..3n 7, Cin. dw work for which this permit ts issued (Su. 3097, Civ. CJ Lendce: Name Lender's Add. 1 certify that I have mad this application and stage, that the .have I.Immadun Is correct. 1 agora to comply with all city and county ordinances and sue laws -long m building consuactian, and hereby authorim representatives of this city to emer upon the for inspection above-memiened property purposes. (We) agree to save, indemnify and kap harmless the City of Cupertino against w4j liabilities. judgments. cats and expeues which may In my way secom against said City r in Cemsquence of the grmtrng of Nis Permit. 2 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO R u'S I -06 Re -roofs Type of Roof Signature Of ppsandConuaaor Dam HAZARDOUS MATERIALS DISCLOSURE Will the appliam or town building aceupmt store arbandlc heurdous material ss de0ned by the Cupertino Municipal Code. Chapter 9.12, and the Hesish and Safety Code. Secd.255324)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ,afl0" If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or (utere building occupant mm equipment or devices which emu, hamdna air contsminants u dclined by the Bay Area Air Qualuly Management all new materials for inspection. District? ❑Yes I have msl dchvudtwsmaurials req.4vaemeundur Chaper6.95 orlle Califon riaH"lthkSarcty Cade,Sccdom25505,255J3md25534.lundcntaod Omiftha building docs nes, c haw a Uut"d my responsibility to ratify the a"upmt n( Ue myuycmen whit must prionmiuumce nfl Ceruhcam or Ocapaney. Signature of Applicant Date @�t� ti 5s -21- 0 1-, All roof coverings to be Class "B" or better Owner or authodrad agent Dae ap 9 of 10 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35628029.00 DATE ISSUED.......: 08/18/2006 RECEIPT #.........: 35684 REFERENCE ID # ...: 06080146 SITE ADDRESS .....: 11103 CANYON VISTA DR SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: RANCHO DEEP CLIFF HOA ADDRESS ..........: CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 1 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 REC NEW BAL ID UNIT QUANTITY AMOUNT PD -TO -DT THIS ----------------------- 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 CUPEkTINO aO CITY OF CUPERTINO QQ PERMIT APPLICATION FORM N # Fee Description Date: OU Building Address: ` Mailing Address (if different from building address): Owner's N e:V BBOILERI Phone #: a6 Contractor: .DC0 r on Imo. License #: l"1 u I 0 Contact Phone: g25'313-0100 Cupertino Business License#: I I avi 0 Eag da Fax: 21 Building Permit Info: BBOILER5 Boiler> 1.75M Btu Bldg �RODfi Elect ❑ Plumb ❑ M h ❑ Job Description: Ind/Off/Comm/Quasi Residential Lir BCONSTAXBQ Commercial ❑ Sq.Ft. Floor Area: BCONSTAXH Sq.Ft.: Cost of Project: 4, � 2�8 BCONSTAXR Occupancy Group: Type of Construction: BELEC1000 Please check this box if the project is a ELECTRICAL BELEC1001 secon -story addition: ❑ o'ect Size: Standard 2"� Laze ❑ Major ❑ BELEC200 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 IM 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 I BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CUPERTINO CITY OF CUPERTINO 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 BPBACKFI_OW 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn 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 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 J CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 BSPECLAL 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3