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07100082 CITY OF CUPERTINO ' ' BUILDING DIViS'tON PERMIT C��T�A �:TQ�Z. ���}��TIOI� Y � , ;: :. ,... , . • . . . . ,:. PERMIT NO. BUILD � u � n ��� ss HOMESTEAD RD UNIT #211 DR.AEGEF: CONSTRUCTION INC 07100082 � pERM1T LSSUE DATE OWNER'S NAME: . HOMEOWNER ASSOCIATION 605 COPiMERCIAL ST 1 2 7 SANITARY NO. CONTROL NO. JE: BU(LDING PERMITiNFO ARCHITECI7ENGINEER: REMV & REPLACE WATER DAMAGE BLDG ELECT PLUMB MECH � � � � i p � LICENSED CON7RACfOR'S DECLARATION ry �, T _ � DeSCTlpt10❑ : V� I hcreby aCfirtn that I am liccnscd undcr provisions oC Chap�cr 9(cammcncing ^—^�' _^ _ ^^ '..^ , : z� with Sccuon 7000) of Division 3 of thc Busincsc and Profcssions Codc, and my license is �< a in full Corce and eff ��� Q j� i Licensc Clu L�. � � v : F p Datc O� Coniractor ! a ARCHiTEC['S DECLARATION J V 7� 6 I undcrswnJ my plans shall Ac uscd as public rceorde I >yU ' w y Liccnscd Prvfessional : � < OWNER-BUILDER DECLARATION 7 VJ"I I hcrcby alTirm Uia� 1 am cxcmpt (rum ihc Contraaors l.iccnsc Law or the � p o (ollowing reason. (Sccuon 7(131.5, Busincss and Profcssions Ca1c: Any city or rnunry �,°, � which rcquires a pertnit to cnnswct, altcr, improve, dcmolixh, or repair any s�cuctucc �' y prior u� i�s issuance, alsu requircs the applicant for such permit W file a signed sta�emrnt �; Ft. Floor Area Valuation - Z < lhat hc is liccnscd pursuanl lo thc provisions of thc Contracwr's Lic�cnsc Law (Chapter 9 • r t s -� $(commencing wiih Section 7000) o( Division 3 of Ihe Business and Professions Code) or y�.. that he is uemp� therc�rom and �Ae basis Cor the allcgrA exemption. Any violatian of Section 7031.5 by arry applicant for a permit subjccu Uu applicant ta a civil pwlry af ppN Number Occupancy Type not morc chan fivc hundred dollars (5500). ❑[. as owncr o[ tl�e property. or my employces with wages u their sole compa�saGon. will do thc wuck. and �he stcunure is not intended or ofLered farsale (Sec.7044. Bnsi�s Required Inspections and Professions Code: 77�e Conuacwr's License Law dors not apply w an ownec of property who builds a improves thereon, and who does such work himulf or tAroa�h his own employces, providcd thai such improvements are not inrended or oliered for sale. I[, however, the buildiog or improvemml is sold wiNin one year o[ compledon. �6e owntr- buitder will have Uu burden of proving Ihat he did not buiW or improve (ar purpose of salcJ• � I, as ownet af the property am ezclusively convacting with licensed conuactors W conswct the projen (Sec. 7044. Business and Profcssions Code:) The Coauxto�s Li- ccnse Iaw docs not apply �o an owner of propeny who builds or impmves therean. and . who contcacu for such projec�t wi�h a convactor(s) licensed pursuant to the Conuactors License Law. � i am uempt under See . B& P C fw this masoa Owncr Date _ . - WORKEIYS COMPENSATION DECLARATION I hereby affirm under penalty o[ perjury one of the foltowing declaratioas: v 1 hsoe and will maimain a Cenificatc o( Conscnt lo self-insurc for Workcrs Canpen- sation, u provided for by Section 3700 of [he Laboc Code, for the performance of We woric [or which Ihis pertnit is issucd. ❑ 1 have and will maintain Workefs Compensatian Insurance, u rcquired by Scction . 3700 of Uu Labor Cade, Cor thc pedormance af the work (or w6ich this pertni� is �ssued• My Work� A s Compensadon Insu carticr and Policy n�um h O � Cartier. w�+�'�J v�' • Poliry No.: I' •�' �'v CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATlON iNSURANCE (This section necd noc bc complcud if the permit is ku onc hundred dollars (5100) . ar IcssJ I cenify tha� in thc perfom�ance of thc work for which �his pertnit is issucd. l slull not employ any person in any manncr so az to bccomc subjcet to the Workcrs' Campensatia� Laws of Calitomia. Datc Applicant NOTICE TO APPLICAM: If, attcr making this CcrtiCicatc of EucmpGon, you shauki become subject a �he Worker's Compensation provisions of the Lahor Code, you must �`,� forthwith comply wi�h such provisions o� this pecmil shall be decmed �evoked. z O CONSfRUCf10N LENDING AGENCY (.~-� ►�-. I hcreby aftirm ihat thcro is a consuuction knding agcnry lbr thc perCwmancc uf � p�., � thc wexk Cur which �his permit is issued (Scc. 3097. Civ. C.) , W A Lendcr's Namc � z Lender's Address 1 certiCy iha� 1 have rcad this application and sutc tha� thc abovc infamatiun is � O cortcct. I agrce to comply with all city and county ortlinances and sute laws relaung �o � U building conswction, and hcrcby authori�e ccprescnutivcs of this city to cntcr u{xm thc � w abovc-mcntioncd property for inspccuon pur�wses. a (Wc) agrce �o sav cmnify and keep harmless the Ciiy of Cupertino against �,E � liabilities, ju m �s, c ts an xpenscs which may in any way accruc against said City U z in consequc �u�g ���5 a����. Date � f � ci � � APPLICA AND AND WILL COMPLY WITH ALL NON-POINT Issued by SOUR ONS. � U �- � O_ Re-roofs :� Signaturc o pplicanUCon r �� T of R oof HAZARDO MATERIALS DISCLOSURE YP Will the applicant or future building occupant store ar handlc harardous marcrial az dcfincd 6y the Cupenino Municipal Codc. Chaplcr 9.12. and thc Hcalth and Safety co� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Y� � - �II thc applicant or futurc building occupant usc cyuipmcnt or dcviccs which If a roof is installed without first obtaining an inspection, I agree to remove emii harardous air conumina� dcfincd by �he Bay Arca Air Quality Managcment all new rr aterials for inspeccion. Districc? � ❑ Yes ❑ Nu 1 havc reaJ the a�ardous matcrials requiremcncs undcr Chaptcr 6.95 af �hc Califor- nia Hcalih & y C , Sccuons 25505.25533 and 25534.1 uncicrstand that iC ihc buildinB docs not cu n ha tcnan4 �hat il 'u my rcsponsibility w noufy thc a:cupant of ihe reyuire h st prior to issu�nce of� crtifi a of Occu`A - Q l Signature of Applieant Date ��� �"° All roof coverings to be Class "B" or better Owncr or authorizcd agcnt Datc . � �� i o c� � �� �. CITY OF (.UPERTINO - �� �F pERMIT APFLICATION FORM CUPEI�TiNO APN # �o� �0 � - 1 � �� ,�� Date: �� , � � � Building Address: Mailing Address (if different from building address): 2 �J !� M�S�r � I� o� 7 �J�t � r z t t Owner's Name: I Phone #: OM�OtJN� A-sSoG�41��r� � �— `�< —`� Contractor: License #: �. � r� f�o �s f�-� c,T v� 1�r c, . l� ��� i� Contact: Phone: SI a3 -Z o 5-�� 44 Cupertino Business License#: L0� � I�,1PJ��1'�.�lic 2� Fax: � n u - 53 � ��o4?x' � � � �' � Building Permit Info: QE M o J� 4�y ��pl� �E W�TjE'2 o a Ma C� E e �- I G E ��p 2 L-1 � I�- pa �.r ��. s �� � �� q� ti �K.c, .� �� c� A r, � l�e� . r;� v�,��- �, Bldg Elect ❑ l'lumb ❑ Mech ❑ Job escription: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Gr u �, �bo— �-�. Type of Construction: Please check this box if t� project is a �t� second-stor addition: Project Size: Standard� Large ❑ Maior ❑ . Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER ��ther Appliances MECHANICAL BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler > 1.75M Btu MECHANICAL BCONSTAX ��onstruction Tax BUILDING BCONSTAX In�i/Off/Comin/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co zstax — Resi/Mobile BUILDING BELEC 1000 El �c 600V <= 1 OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD �;nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 _ �. �,, CITY OF CUPERTINO � ��n F PERMIT APPL [CATION FORM CUPER�TINO Quanti Fee ID Fee Descri tion Fee Grou BMISCELL T7iscellaneous Fee BUILDING BMITIGATC Corr m. Housing Mit. Fee BUILDING BNUCOMME N�w Comm Electric ELECTRICAL BNUCOMMM Nev� Comm Mechanical MECHANICAL BNUCOMMP r ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBAGKFLOW At nospheric Vacuum PLLJMBING BPCESSPOOL Cesspool PLLTMBING BPERMFEE I�ld Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Ga:; Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLLTMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP P1a1 Check Repeat Fee BUILDING BPREPIPE R� i e Of Fixtures PLUMBING BPSEWAGE :�ewa e Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lav��n Sprinkler/Backflo PLLTMBING BPSTORM ��torm/�Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Inst:ilVAlter Water Pi e PLUMBING BPWHEATER V� ater Heater/Vent PLUMBING BPWSVCS M ain Water Service PLLJMBING BREINSPECT JZeinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI .�ppliance Install MECHANICAL BREMBUSWAY F_emodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re �ocation of Furnace MECHANICAL BREMFURNOV Rel�� Furnace > l OK btu MECHANICAL BREMHEAT �[eater Installation MECHANICAL BREMINHOOD In �tallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREn�INRAPP Rerr. Non-Res Appliance ELECTRICAL BREMPOLE Po le/Platform Fixture ELECTRICAL BREMPOWER Powcr Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re:pair/Alter Heating MECHANICAL BREMRESAPP Reniodel Res Appliance ELECTRICAL 2 of 3 � � := CITY OF CUPERTINO ��n � pERMIT APPLICATION FORM cuP�� �r�o Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Reniodel Signs, Mar uee ELECTRICAL BREMTHEATR Th :atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Sin le Duct MECHANICAL BREMVENSYS V entilation S stems MECHANICAL BSCBLVD 3cb Specific Plan BUILDING BSEISMICOM Se ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ;ipecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP 7'emporary Power ELECTRICAL BTEMPPERM Ten� orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE TZechanical sq. foot MECHANICAL MPERMITFEE Mf�ch Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin ; LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin�; Lon Ran e Residential PLANNING � of 3 CITY OF CUPERTINO ` 2 ITEMS OF 4 PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B11:: Lot: APN ......... 32i>5999.00 DATE ISSUED.......: 10,'09/2007 RECEIPT #.........: BS�)00002948 REFERENCE ID # ...: 07:_00082 SITE ADDRESS .....: 22:330 HOMESTEAD RD UNIT #211 SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OVJNER . . . .. . .. .. .. : HOI�EOVJNER ASSOCIATION ADDRESS ..........: 22:330 HOMESTEAD RD UNIT 211 CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014 RECEIVED FROM ....: DR�EGER CONSTRUCT CONTRACTOR .......: DR�EGER, JOHN EDWARD LIC # 21895 COMPANY ..........: DR�EGER CON5TRUCTION INC ADDRESS ..........: 60i COMMERCIAL ST CITY/STATE/ZIP ...: SA:J JOSE, CA 95112 TELEPHONE ........: (4)8)536-0420 FEE ID UNIT QUANTITY .�NlOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 7,800.00 147.96 0.00 147.96 0.00 BSEISMICRE VALUATION 7,800.00 0.80 0.00 0.80 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 148.76 0.00 148.76 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL