09050085 7-7777777777777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � � � '
BUILDING ADDRESS: PERMIT NO.
10113 PARTM4 PT, DRAFGE
PERMrr ISSUE DATE
OWNER'S NAME:
SA CONTROL NO.
�N :
BUILDING PERMIT INFO
ARCHITECr/ENGINEER: BLDG ELECT PLUMB MECH
SIDINC STUCCO REPAIR
y p c LICENSED CONTRACTOR'S DECLARATION Job Description
U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
O u with Section 7000)of 'vision 3 of the Business and Professions Codeannd my license is
LU
y in full force and eff 1 4
v�Z
Date
CI Contractor
t- Dam
CHrrECCS DECLARATION r
UI understand my pl s shall be used as public records
1.0 l'- Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
n^g which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
C that he is licensed pursuant to ore provisions of the Contractor's Licensc Law(Chapter 9 Sq.Ft.Floor Area
Y t- (commencing with Section 7000)of Division 3 of Uc Business and Professions Code)or
y that he is 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 APN Number Occupancy Type
not more than five hundred dollars(5500).
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Workees Compen-
-don,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
❑I have and will maintain Workefs Compensation Insurance,as required by Section
3700 of the Lab Code,for Ole rforrnance of the work for which this permit is issued.
M Workees �+ ns on I trier and PoI(ry1number am: 1 L
Cartier. Policy No:> C, `
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not be completed if the permit is for ono hundred dollars($100)
or less)
I certify that in the performance or the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z''' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
(S,> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z
Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
VL►" cormcL I agree to comply with all city and county ordinances and state laws relating to
E" building construction,and hereby authorize representatives of this city to enter upon the
U ahove-mentioned property for inspection purposes
E (We)agree to save,indemnify and keep harmless the City of Cupertino against
r�!n liabilities judgments,costs and expenses which may in anyway accrue against said City
U Z in consequence of the granting of this permit. Date
t-" A C U ANDS AN COMPLY WITH ALL ON- OINT Issued b):
OU EG NS.
Q C-:1 Jam- U Re-roofs
gnature P Applicant/Contractor Date
HAZARDOUrMATERIALS DISCLOSURE Type of l1.0of
Will the applicant or future building occupant Store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and tc Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes °
he applicant orf um building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
Will t
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
strict?
❑Yes IKPN.
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cook:,Sections 25505 25533 and 25534.1 understand that if the building
d not curie a tenant,tha is y responsibility to notify the Occup of the
q irc nus h' mustbcmelpri rto; r nrallircate°ra v Signature:of Applicant Date
All roof coverings to be Class" '`or better
tonr authorized agent ato
n
�u s
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lMTM - I
Ctx ertino .Vil-lage
Parish Place 10202
_02._0..1
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10194
8 N Nn
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0192
~, 10121 10123
Swimming PQOI `i ul b4
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013'l10182
1013310173417�' 10141 ___--_--
w ' rn 10172
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1Q101 10143 10171 __ .._.
Parish PIace 10164
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May 15,2009
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City of Cupertino Building Department j
10300 Torre Avenue -
Cupertino,CA 95014-3202
Re: Building Permits for the Cupertino Village Homeowners Association
i
10101 - 10251 Parish Place, Cupertino. CA j
Authorization for Draeger Construction,Inc.to obtain Permits on our behalf i
To Whom It May Concern:
The Board of Directors of the Cupertino Village Homeowners Association hereby authorizes
Draeger Construction,Inc.,605 Commercial c treet, San Jose, Ca 95112,to obtain permits for
miscellaneous remedial repairs to be performed in the common areas of our complex as i
referenced above.
Should you have any questions,please do not hesitate to contact me.
I
Ve truly yours,
Diana Johnson
Association Manager (Aq
Cupertino Village HOA
i
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o
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
J APN# Date:
I �p4 0�
Bu'ldress �
Mailin Address (if different fro buildiAg address):
>-on NCA-V N A
's r Name: Phone#:
O er
o' V%i m CT �4�` S
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter,from HOA
Contractor: Phone:
Dia Fax: �� ' J 3
Contrac r License
Cupertino Business License#:
Contact: �'� -��.U� Phone:
Fax:
Residential Commercial ❑
Job De��r�ipt
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type: _
I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B
X 6-
Valuation: A f?T
Square Footage:
Project Size: Ex rens❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable,include in plan set&the sheet index.
Points Achieved:
For help,contact Build it Green at www.builditgreen.org
Revised 02/05/09
CITY OF CUPERTINO
CUPS T INO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
ij7 Dn 1STUCOAP Stucco Applications (up to 400 so B
additiona stucco application
1 WINREP Replacerr ent windows/sliding glass B
door ea 3 windows
1 WINMEWSTR New WinJow-structural shear B `
wall/masonry( includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
IPLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/1\4/P) B
when not over counter) hourl -stind alone
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
IBSEISMICR Seismic F_esidential B
1BSEISMICO Seismic Commercial B
1TRAVD0C Travel&Documentation B
1BUSLIC Business License B
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CITY OF CUPERTINO
Cox° GENERAL BUILDING APPLICATION
cuPE�TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
IPARTICOMM Partition nterior Commercial B 1PARTICOMM
1PARTIR Partition _nterior Residential B 1PARTIR<=30
RETAINING
WALUCONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high(up to 50 `) B
1 RETSP I0 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1 RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft)
SIDING
ISIDEST/BK Siding, Stone&Brick Veneer B
interior/exterior
1 1 SIDEOTHER Siding al. other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structura
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage hacks 0-8' high (up to 100 so B
1 SRACKS>8 Storage hacks over 8' high (up to 100 B
st
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