09050096 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
s;
PERMIT NO.
BUILDING ADDRESS:
10172 C QN S T PERMIT ISSUE DATE
OWNER'S NAME:
SA CONTROL NO.
SNE:
408 536—
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
o p Z LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Di''on 3 of the Business and Professiog Code, d my license is SIDING STUCCO REPAIR
a y in full force and effect. cp
DjgAZ License Conic-tractor
M Date
ARCHiTEl 1'S DECLA O l
aF7 I understand my plans shalt le used as public roto
5yV C/
C y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
no following reason.(Section 7031.5,Business and Professions Co:Any city or county
y^ alter.improve,demolish,or repair any structure which requires a permit to construct
prior to its issuance.also requires the applicant for such permit to file a signed statement jq Ft,Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
%F (commencing with Section 7000)of Division 3 of the Business and Professions Co)tar
a� that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500) 316440---3 . 00
❑1,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 Co: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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractoes 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
1 hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to sell'443ure for Worker's Compen-
.aon,as provided for by Section 3700 of the Labor Co,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's mpensatpn Insu na carrier and Polity number
Carrier. 99 Polity No.:
ERTIFICATE F EXEMPTION FROM W RKERS'
COMPENSATION INSURANCE
(This section teed not be completed if the permit is for one hundred dollars($100)
or less)
I certify that in the performance of 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'Compensadon
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
,J`Z, forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[~.h I hereby affirm that them is a constructinn lending agency for the performance of
p!> the work for which this permit is issued(Sec.3097.Civ.C.)
W QLendces Name
I54 Lender's Address
U 0 1 certify that I have read this application and state that the above information is
conccL 1 agme to comply with all city and county ordinances and state laws relating to
Q Vbuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
a (We)agme to save,indemnify and keep harmless the City of Cupertino against
.to liabilities judgments,costs and expenses which may in any way accrue against said City
U Z inconsequence of the mndng of this permit. Date
.. AP CA STANDS AND L COMPLY WITH ALL NON-POIN7 Issued b3:
U EG TIONS.
5 Re-roofs
S' nater fApplicant/Contractor Date T Of 1:00f
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Co.Chapter 9.12,and the Health and Safety
Co,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will
a roof is installed without first obtaining an inspection, agree to remove
ll the applicant or future building occupant use equipment or devices which
hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
vitt?
❑Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 75505.25533 and 25534.1 understand that if the building
docs no u nlly have a tenan.that it responsibility to notify the occupant of Date
requ' n hi be met prior issuan of a ficatc of Occu�try�/q 9Signaturt:of Applicant
/ All roof coverings to be Class" or better
0. r th d agent Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Bl1.: Lot :
APN 31E44033 . 00
DATE ISSUED. . . . . . . : 05/ 19/2009
RECEIPT #. . . . . . . . . : BS000007750
REFERENCE ID # • • . : 09050096
SITE ADDRESS . . . . . : 10:.72 PARISH PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SALLAN DONALD R ET AL
ADDRESS . . . . . . . . . . : 940 GRANITE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1101
RECEIVED FROM . . . . : DRAEGER CONST
CONTRACTOR . . . . . . . : DP6EGER, JOHN EDWARD LIC # 21895
COMPANY DRAEGER CONSTRUCTION INC
ADDRESS 6015 COMMERCIAL ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE (4 )8) 536-0420
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 975. 00 1 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 975 . 00 0 .50 0 . 00 0. 50 0 . 00
1SIDEOTHER SQ FEET 1. 00 367. 00 0. 00 367. 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 368 .50 0. 00 368 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 368 .50 142001
---------------
TOTAL RECEIPT 368 .50
(A 0*5 009
CITY OF CUPERTINO
CUPEkTI O GENERAL BUILDING
PERMIT APPLICATION FORM
J APN#2 (f , j q o � 5 c) O SW/ 01
/Date: ` 01
Building Address:
v Pyr,<U- Pldc-,O—
Mailing
Address f diffrt,from b ilding add / S. V(p
Owner's Na e: Phone#:
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter from HOA
Contractor: Phone: tlff-- _
Ua Fax:
Contrac r License
Cupertino Business License#:
Contact: �'� L -��. (3 e", Phone: A
Fax:
Residential Commercial ❑
--�St� ct o
Job De t � V
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ II/111 B, IV-HT,V-B
SW4- F6-
Valuation: JIQ T Square Footage:
Project Size: Express❑ Standard ❑ Large :1 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.builditgr,-en.org
Revised 02/05/09
CITY OF CUPERTINO
� ; GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf B
0. additionz 1 stucco application
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-structural shear B
walUmas Jnr includes plan ck fee
IEPERMITFEE Electrica. Permit Fee E
1MPERMITFEE Mechani gal Permit Fee M
1PPERMITFEE Plumbing;Permit Fee P
IELCPLNCK Stand Al)ne Electric Pln Ck(hourly) E
1MECPLNCK Stand Al)ne Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Al)ne Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourl -st?nd alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic 1Zesidential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel& Documentation B
1BUSLIC Business License B
5 of 5
CITY OF CUPERTINO
Ui�� 0 GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1PARTICOMM Partition I iterior Commercial B 1PARTICOMM
1PARTIR Partition IZterior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN Standard(up to 50 ft) B
1RETSP310 Special D,-sign, 3-10' high(up to 50 `) B
IRETSP10 Special D,-sign, over 10' high(up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib allover 10' high(up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone&Brick Veneer B
interior/F xterior
_ 1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight :ess than 10 sf B
1 SKYL>10SF Skylight;treater than 10 sf or B
structural
1STAIRS Stairs-fiat flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Lacks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Packs over 8' high (up to 100 B
st
4 of 5
Cupertino .Village
Parish Place
.... ._._.. .:_...... 10202
-10201
-- o c ci . ` , -1 •� -___ ,w.._,. 10194
0
w N N o 10193 __. ..
_.► ,s w w ,1 , a 7 0.192
10191 — -
10121 10123f -
m 10184
0]10103
Swimming Poolo10182�' -1013310174
01017 3 10141 .-� a 10-172
1043 10171
_]
Parish PIace 10164
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May 15,2009 i
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City of Cupertino Building Department I
10300 Torre Avenue
Cupertino,CA 95014-3202
Re: Building Permits for the Cupertino Village Homeowners Association
10101 — 10251 Parish Place,Cupertino, CA
Authorization for Draeger Constructior.,Inc.to obtain Permits on our behalf
To Whom It May Concern:
The Board of Directors of the Cupertino Villa€e Homeowners Association hereby authorizes
Draeger Construction,Inc.,605 Commercial "treet, San Jose,Ca 95112,to obtain permits for
miscellaneous remedial repairs to be performed in the common areas of our complex as
referenced above.
Should you have any questions,please do not ILesitate to contact me.
I
Ve truly yours,
l� C.
Diana Johnson
Association Manager (Il�r en+
Cupertino Village HOA
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