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06080159 (2) CITY OF CUPERTINO *° +� - vBUI LDING DIVISION PERMIT ;; ONTRACTQRINkION �ORMAT ' BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMTTNO-06080159 10920 K TER OR OWNER'S NAME: PERMIT ISSUE DAM RANCHO DEEP CLIFF HOA 605 COMMERCIAL ST 08/18/2006 E: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGO ELECTO PLUMB MECHO Rap LICENSED CONTRACTOR'S DECLARATION lob Description i U cI Iertby afllrm Nm li at 1 acensns ed under provisioof Came.,9(cem mencing with Section 700(0 of Division Sof the Business and Profession,Code,and my Been.is in full fame and elf act. / REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE {�Z Licence us Lm.N (OI 7G J Dame—Camncmr ANTI-POUNDING, FELT & BATS . ROOF REPAIR. ARCHrIELTS DECLARATION 1. 1 unconnected my plans shall W used u public rtcardr IyU oG Licensed Pmreuional y 3 OWNER-BURDERDECLARATION I refuse.(Tien,that 11. exempt from the Convectors Any taw for the ;00 fallowing rearm.(Semite]031.5,Business and von.de am Cole:Any city or county e$ which mquimunpeemit recnnmmc4 alter,improve.demolish.Perlia ore a siganyned ommon a-` priors its also momGuiR the istme;o far sucContractor's icese Law(Chap.9 e (that he commescceauftsScom7 )ofDisiscm3ordoB. cmr'moce�law(ChapuT9 Sq.Ft. Floor Area Valuat IY208 l� thammenrinawiNSauous and of basis for of Jmoged eon endon.M vi Cade)tion of $ that he V exempt thuefrom and the buss far the alleged exemption.My violation of Section 7031.5 by arty applicant for a permit subjects the applicant in a civil penalty ofN Number Occupancy Type net mart than five hundred dallas($500). 3F628018 . 00 ❑I,uawrmlallied property,army employees with wages u their salecompenuuon, wiilda Jrework.andthesMomis.(imm.dodoronem fonale(Sec.]OH,Bumnem Required Inspections and Profession,Code:The Canhaemrs U.law does act apply m e ns an owner of 9 P property who builthimimpmw Nncon.and wh.doessuchwark anemia,through his awn amplayco,provided that such improvements art not intended oroRered forsale If, however.the building or improvement is sold within arse yev of(mmPleGan,the owna- builder will have Be burden of proving that he did not build or improve for purpose of sale.). ❑1,u owner of the Property,am uelumvely contenting with Ileemed eanrranma te censuucl Ne project(Sec.7044,Business aM Rafessiom Code:)The Contnemh V. rue Raw docs not apply to an owner of property who builds or improv Jxreon,and, who contracts for such projects with a conuactar(s)licensed parsuant to the Contracmra L4wme law. [:]I am exempt under Sec .B&P C far this rtuan OwnerDam 41 WORKER'S COMPENSATION DECLARATION 1 hereby air=under parody of perjury one of the following dceoratiom: tem and will maintain aCenifram of Consent m selr-ineum fa WmiersCompen- sauan,as provided for by Saturn 3100 of Jct tabor Code,for Jse performance of the work for which this permit is iMu . ave and will maintain Worker Compensation Insurance,as required by Section ]00 of the labor Code,far the performance of d wary for which Nis permit u issued. ' My Work�effsC�ompensstioo Wurapce anis end Policy number are: Carrier �rrwc� Fis.a.-1 Policy No.:?131S49 tZY.O QS CER i6m OF..MON FROM WORKERS' COMPENSATION INSURANCE (Thusecunn need aotMcamplead If the permit Iarmone,hundred dollars($IN) or leas.) I certify Nat in the performance of the work for which this permit is issued.I shall net employ any person in any manner an as to became subject In the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making This Certificate of Exemption,you should become subject in the Workers Compensation provisions of the Labor Cod%you mum O forthwith comply with such provisions or to permit shall be dcemed revoked. Z� CONSTRUCTION LENDING AGENCY (•'tom I battery alfum that there isacomuumien lendingagenty l'or the performance of ani ti the work,fur which Wi Permit t Wood(Sec.309],Civ.C.) UJLenders Name , Z lenders Addrea V 0 1 certify Nu 1 have read this application and sem that the above information is Iy (~ comet l agree in comply with all city and county ordinances and sore laws relating to pU building construction,and hereby authonrn representatives or this city to enter upon the Cid above-mentioned property for inspection purposes. 4 (We)agree I.ave,indemnify and keep harmless the City of Cupertino against fA Iiabiliue,judgencnLLcmtendexpemrs which may in aa ywayaucagaimsaid City U Z in consequence of the granting of this permit. t•. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date a SOMum of plica tONS. �� SL I '�� Re-roofs Si nuurt of AppliaHAZARMOU Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will theCoan on future spilling oaupat r 9.1 ar handle Menelaus material as dented the Cudeed by pertino Municipal Cade.Chapter 9.12,and the Health and Safety Cade,Secdon255320)? All roofs shall be inspected prior to any roofing material being installed. ❑Yee F3pu Will the appliaat ar future building medical use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit havardaus it,contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Ya 'EPft— I have read the haardum mamrlat requirement under Chapter 6.95 of that Calif.,. no Health&Safety Code.Sutvom 25505,25533 and 35534.1 unJemmnd that if the building Jags eat curtently have•m that h u my nuryomihilfy to notify the accupent of Ne rtgn hm ambo pnarmisstranaafaccoramanxcopenay. Signature of Applicant Date t a I n Owner eAll roof coverings to be Class"B"or better nutharivcd agent Data' CITY OF CUPERTINO 2 of 5 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35628018 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT # . . . . . . . . . : 35686 REFERENCE ID # • . • : 06080159 SITE ADDRESS . . . . . : 10920 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 0EE 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 c r PERMIT APPLICATION ORM 0(0050N CUPERTINO N# r„y n �O Date: 0,e) 11q� Buildin Ad ress: 1(� U� Mailing Address (if different from building address): r Owner's NTG� I l Phone #: .�IC�C� 1111 , /tL� �� Contractor: License#: yr eXCOOMACt l°C.-. ul-I(0 ! C) C-301 Contact: Phone: Cupertino Business License#: Fax: { Building Permit Info: Bldg �tZCOF'1 Elect ❑ Plumb ech ❑ Job Description: �'TO - I Residential k Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ^� Occupancy Group: Type of Construction: L�LJ Please check this box if the project is a second-story addition: ❑ o'ect Size: Standard B� 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> 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<= 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 r CUPo rwo PERMIT APPLICATION FORM QuantityFee 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 cfrn MECHANICAL BREMAIltHAN 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 2of3 CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM Quantity 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 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