06080158 (2) CITY,OF CUPERTINO -
'� BUiLDINO DIVISION PERMIT ` O1 T]l2AC,'faR INIFORMATIUI±
BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITN0.06080158
10900 KESTER DR
OWNER'S NAME: PERMIT ISSUE DATE
RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST na /ig/2nois
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMRINFO
BLOC ELECT PLUMB Mn
opo LICENSED CONTRACTOR'S DECLARATION Job Description
V 1 hereby affirm that 1 am liwmcd under provisions of Chapter 9(eommcncing
i with Section 7")ofDivision 3 of the Business and Professions Code,and my license ie
ray in full force and effect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE
LIZ Limm.Class Lic.A 17LIO
Dam Q� o�Codirector ANTI-POUNDING, FELT & BATS . ROOF REPAIR.
E ARCHITECrS DECLARATION
m 1 undemund my plans shall be used u public records
Jy0
1,G t; Limmed Pralmsgonal
y S OWNER-BUILDER DECLARATION
I berehy affvm that I am exempt from the Contractors License Law for the
t pec following..an.(Suction 703 1.3,Business and Professions Code:Any city or merely
K m 9 which requires a pcmtit be..naw.,,eller.improve,demolish,or repair any smaamre
O'w prior m its issuance.also requires the applicant forsuch Permit to file a signed sencronl
SeNu
at be is licensedpurmanotmprovisionsoftheConmuluelLicm¢eLaw(Chapter9 Sq.Ft:Floor Area Valuat"208
set-$ (commencing with Section 7000)MDivision Jof the Businnys and Professions Code)or
..
that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A3IIN Number Occupancy Type
not more than firs hundred dollen(5500). 35 28020 . 00
❑1,as owner of the property,ar my employees with wages as their sole compeneadon,
will do the work.end the structure 6 rusuirumdedor offered for..].(Sm.704/,Business Required Inspections
and Professions Code The Contmcmr's Limm a Law deny mat apply m an owner of 9 P
property who builds on ina mvm thereon,and who does such work himselfor thmugh his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is said within one year of completion.the owner.
builder will have the burden of proving that he did not build or Improve for purpose of
ask.).
1,as owner of the property was exclusively contracting with licensed contractors he
construct the pmject(See.70".Bmineue and Professions Cade:)The Contractor's Li.
come law darn not apply m an owner of property who builds or improves thereon,and
who contracts for such projects with a mosranar(s):mmard pursuant he the Cmaracmfs
Licetse Law.
❑I do exempt under Sec ,B&P C far this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aBimt under penally of perjury ane of the following duclantimu:
1 bare and will maintain.Cerdfirnm of Cement to self-infuse far Workers Compact.
bad,as provided for by Section 3730 of the Labor Cade,for the performance of the
were for which this permit is headed.
have and will maintain Workers Compemstion Insurance.as required by Section
W of dte labor Code,for the performance of the were for which this permit is issued.
My Worker's Compensation lmu cc carrier and Policy number are:
Carrier Poliry No.:
C RTIFICATE 0 EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(rho section need not be completed if the permit Is foram hundred dollar(Sial)
or lest)
1 certify that in the performance of the work for which Nis permit Is gssum.I shall not
employ anypen ns in any maonerso u m become subject to the Warkcrs''Compemadon
Lowe of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Worker's Compuneadon provisions of this labor Code,you must
.J O forthwith comply with such pmviaians or this Permit shall be domed revoked.
„zsy CONSTRUCTION LENDING AGENCY
(ti I hereby aRnm thathere is a cotutrucdon lendinga,do,l'or theperfmmance of
rt > the work for which this permit u Issued(Sea 3097,Civ.C.)
W A Lender's Name
z Lenders Address
UI certify that I have read this application add stare that the above information is
E-" correct.I agree to comply with all city and county oNgmntta and sum laws relating to
0 U building concoction,and hemby xothorim mprmcntativm of this city to enter Olean the _
>^a above-mentmned property fur inspection purposes
(We)agree to save,indemnify and kop harmless Ne City of Cupertino against
rti liabilitics.judgmcnu,corm and expenses which tory in any way....,.last said City
V`z in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
5E R TIONS.
1 -- 5r-e l -0 Re-roofs
Si reafAppl..11Cantractar Data Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will dre applicant or future Wilding ooupantsmm orhandle hmardous material
as dented by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Secdon 25533(47 All roofs shall be inspected prior to any roofing material being installed.
❑Yesy3Ne—
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
omit harardaus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DuadcQ
❑Yes No '
I have mad an,hadeand.materials tequitemunm dndmChap e,6.95 of the Califor-
nia Health&Softly Cadc.Scctians25505,25533and25534.1unduntandthdifthc Wilding;
does nm cu vs.<7
Nat a is my amponsihilay m Only the occupant of the
re mmmt.ewbmhre uoismagoafacaurreamofOccupancy. Signature of Applicant Date
$..2 -� All roof coverings to be Class "B"or better
O r or suthariaed agent Data
CITY OF CUPERTINO
1 of 5 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35628020 . 00
DATE ISSUED. . . . . . . : 08/18/2006
RECEIPT # . . . . . . . . . : 35686
REFERENCE ID # . . . : 06080158
SITE ADDRESS . . . . . : 10900 KESTER 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
9EE 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
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CITY OF CUPERTINO pp�15�
C F PERMIT APPLICATION FORM C� w
CUPEkTINO
N# /'n-1h Date:
Building A ress: �1J Mailing Address (if different from building address):
r
Phone #:
Owner's N Co
Contractor: License#:
yr er (.D►-1(0 1 O C39
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg 'piElect ❑ Plumb ech ❑
JobDescription: tj
Residential E Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 'lJD6 Occupancy Group:
Type of Construction: Please check this box if the project is a
second-storyaddition: ❑
o'ect Size: Standard 'O� Laze ❑ 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
BBOILERS 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
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CITY OF CUPERTINO
CUPEI�TINO 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
BPBACKFL OW 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
BPVENI' 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
BREWURNOV Relo Fumace> 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
cuPErZTnvo. PERMIT APPLICATION FORM
Ouantitv Fee ID Fee Description Fee Group
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
BSW W 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
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