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07100148 CIT� OF CU$ERTINO �� ` ` #�. ' BUILDING DIVISION � �E1�1v11T ��"� ��+' ;: > « .. ,, :. , _. _ .,...,: _. .. PERMtT NO BUIL a �3�� ES �pMESTEAD RD #313 DRAEGEF CONSTRUCTION INC 071b0148 . pERMIT LSSUE DATE iVER'S NAME: . HOMEOWNERS ASSOCIATION 605 CONMERCIAL ST 10/19/2007 SANITARY NO. CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITEGT/ENGINEER: R��REF LIKE FOR LIKE B� E� PLU �n� C ipQ LICENSEDCONIRACTOR'SDECLARATION ,.,,,�, ,,,�__� Job Description : V� ( hcrcby afGrm that I am licenscd undcr provisions oC Chaptcr 9(commencing ; Z� wiih Scction 7000) af Division 3 of �hc Busincss and Profcssions Codc, and my liccnsc is �� y in fuli foece and eCtec� l 9 j v� Z Licensc Clas L�. � � - p Datc Conlractor : � � A CHiTECI'S DECLAR ON j� . � a 1 undcrstand my plans shall bc used as public records )aU ' u. y Licensed Pcufcssional : � a OWNER-BUILDER DECLARATION �y� 1 hcrchy atTirm U�et 1 am czempt Cmm ihc Convactar's Liccnsc Law or �hc � p O (ollowing mason. (SccGon 7031.5, Busincss and Professians Calc: Any eiiy ar county u$� which requires a pertnit tu conswct, alter, improvc, dcmolish. or repair any swctmc prior w ils issuancc, alsu rcquires ihc applicant for such permit ta file a signed s�a�emcnt �' q . Ft. Floor Area Valuation �? a ihat hc is liccnscd pursuant �o t h c provisions o f U u C o n u a c t o r' s L i c� c n s c Law (Cha ptcr 9 •' �� (commcncing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssions Codc) or ,�, �� that he is exempt theie(rom and the basis for the aitcgcd exemption. Any violation ot ApN Number Oecupancy Type Section 7031.5 by arry applicant tor a permit subjecu tlu applicant w a civil penalty a[ not more �han five hundned dotlars (SS00� ❑ I, as owncr o( the properry, ar my employces with wages u eheir sale compensadon, willdotheworlc.andthestruduceisnotintendcdoroReredforsalc(Sec. Required Inspections and Professions Code: 'Rie Conuutor's License Law docs iro� aPP�Y � a" �"ncr ot propeny who 6uilds or improves thercon, and who does such work himsel[ or tlwugh his own employces. provided that such improvements are not intended ar ottered Cor sala ![, however. Urc building or improvement is sold wi�hin oa year oC compietion, the owner builder wilt have the burden oC proving 16at he did rot build ar improvc Cor puryox ot salc.). ❑ I. as awner of the property. am uclusively convuting wi�h licensed rnnvactors la construct the projen (Sec. 7044. Business and ProCessians Code:) The Contncwr's Li- cense Caw does not apply to an m�mu of propeny whu builds or improves Iheieon, and . who contracu Cor such pmjects wilh a convactor(s) licensed pursuant to �he Convactors [.icense Law. t am uempt under Sec . B& P C far this rcason �,wnu Date _ . _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty o[ perjury one of the (ollowing �clarations: ❑ i ha+e and will maintain a CertiGcate ot Conscn� to xlf-insure [or Workcfs Compen- satian, as providcd far by Section 3700 of the Labor Code. far the performancc ot the work for which this permi[ is issued. ❑ I have and will maintain Worker's Compensation lnsunnce, u rcquired 6y Section , 3700 of the Labor Code, for the performance of the x�ork (or which �his permit is issued M Worke� Com nsation Insu ce caaier and Policy number_ a�c:, ___ �� Y � �tl 11 1 P.1'/�11 Carrier. � ��"�1 Policy No.: _11.�.L=�=J-- CERTIFICATE OF EXEMPfION FROM WORKERS' COMPENSATION INSURANCE (This secdan necd not bc complctcd if the pc[mit is ku onc hundred dollazs (E100) , or lcss.) I cenify that in thc perCortnancc of thc work for which U�is permi� is issued, l shall �rot e�ploy any person in any manner so az to become subject to du Worlcers' Compensatian Laws of Cali(omia. Datc Applicant NOTICE TO APPUCAM: lf, aftcr making �is Ccrtificatc of Excmption, you should bccame subjcct to thc Workcr's CompcnsaUon provisions of thc Labor Codc. you must � z (arthwith comply with such provisions or this permit shall bc dccmcd revakcd. z � CONSfRUCT10N LENDING AGENCY (.~.� .�-+ I hemby afGrtn Wat there is a consuuction knding agency Cor the performance of � a, � thc wurk Cur which ihis pertnit is issucd (Scc. 3097, Civ. CJ , W A Lendcr's Namc a z L.cnder's Address I cectify �ha� 1 have read this application and suic �hat �he a6ove infoematiun is �� cortect. 1 agece to comply wi�h all city and county oniinances and su�c laws relating to 0 U building conswction, and hc�cby authori�a represcnlativcs of �his ci�y to cnlcr u�mn lhc � W abovc-mcntiuned properly for inspcction purposes. a (Wc) agrce �o save, indemai(y and kccp harmless �hc Ci�y of Cupcnino against "H � liabiliuu, judgmcnts, costs and ezpcnscs which may in any way accruc againsl said City V z in consequencc of granting of Ihis permit. -f1 r/'7 ►�+ APPLIC N ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by. Date � � SOURCE ONS. � ..�� Re-roofs Signawre CA plianUConuacwr e � T of R.00f HAZARDOUS MATERIALS DISCLOSURE YPe Will Ihe applicant or future building acupantuorc or handle harardous matcria! cfincd by 1he Cupertino Municipal Codc. Chap�cr 9.12. and [he Health and SaCety _�a�. Scction 25532(a)? ,�,/� All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs W�'+o . �Il thc applicant or futurc building occupant usc equipmcnt or dcviccs whic6 If a roof is installed without first obtaining an inspection, I agree to remove cmit harardous air contaminan�s az dcfincd by �hc Bay Area Air Qualiry Managcment all new a.aterials for inspec*ion. �su�� ❑ Ycs ° Ihavcrcad e ardcwsmaicrialsrequircmcn�sundcrChap�cr6.95o(d�eCalifor nia Hc & cty , Sectioos 23505, 25533 anc125534. I undcrstand ihaz i[ ihc building docs n i u t1y a a tenant, Ihat it is my responsibility to noafy the occupartt nf ihe rcyui n�s hi be meL Prior to iuuanu of a Cenifica� of �P��r. Signature of Applieant Date ° � All roof coverings to be Class "B" or better Ownc r authorized agcn� Da�c ' ��7C��► �� :�_ - CITY OF C'UPERTINO - ��F� pERMIT APPL=[CATION FORM CUPEI�TINO APN # �, � n �, o � Date: � Building Address: Mailing Address (if different from building address): Z O — 4� 12 • UJt I� Owner's Name: Phone #: ��4 � �a — S3 �o —o`f z c� Contractor: License #: rJQ�otL C.c�� vv I U c, . � l 7(� l O � ontact: Phone: Cupertino Business License#: ¢ (� i l) ��7�,Z Fax: � 0 1 � Building Permit Info: Bldg Elect ❑ I'lumb ❑ Mech ❑ Job Description: �Z�*'to��C= �P1°►C.� l'��t2.% -�'°''�- �'��GC= Residential 3��✓1 � 7 i t1 ��A-t� � 1 • Commercial ❑ Sq.Ft. Floor Area: '�� Q Sq.Ft.: Cost of Project: _. �� Occupancy Group: Type of Construction: Please check this box if t� project is a �c��IZ�ro�-- �I v tS }} K-. S. second-stor addition: Project 5ize: Standard Large ❑ Ma or ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER ��ther Appliances MECHANICAL BBOILERI Bo .ler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boil�r > 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/OfflComm/Quasi BUILDING BCONSTAXBQ Co z. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:istax — Resi/Mobile BUILDING BELEC 1000 El �c 600V <= l 000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD �;nergy Add Multi BUILDING BINVESTIGA [nvestigation fee BUILDING 1 of 3 :�. � .:h � CITY OF C UPERTINO - ��nrv�F pERMIT APPLI:CATION FORM CUPER�Tt�i() Quanti Fee ID l�ee Descri tion Fee Grou BMISCELL N[iscellaneous Fee BUILDING BMITIGATC Comn. Housing Mit. Fee BUILDING BNUCOMME Ne:w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N�w Comm Plumb PLUMBING BOVERTIME In:cpection Overtime BUILDING BPBACKFLOW Atrnospheric Vacuum PLLIMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B ld Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLLTMBING BPLANCHK l'lan Check Fee BUILDING BPLANCKADD Pla-i Check Add Multi BUILDING BPLANCKREP Pla.ii Check Repeat Fee BUILDING BPREPIPE Rf� i e Of Fixtures PLUMBING BPSEWAGE � ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING gpSpRINK Lawn Sprinkler/Backflo PLLTMBING BPSTORM Stonn/Rain Water PLLTMBING BpTRAp Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLIIMBING BPWATER Inst2.lUAlter Water Pi e PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT I:einspection Fee BUILDING BREMACOVER A/C' Unit > 10,000 cfin MECHAI�TICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI ��ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re� ocation of Furnace MECHANICAL BREMFURNOV Relc� Furnace > lOK btu MECHANICAL BREMHEAT �:eater Installation MECHANICAL BREMINHOOD In:�tallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRE1��iNRApp Rem Non-Res Appliance ELECTRICAL BREMPOLE Po!e/Platform Fixture ELECTRICAL BREMPOWER PowE�r Device/A aratus ELECTRICAL BREMRECEPT Rc �:1, Switch & Outlets ELECTRICAL BREMRELOCA R�location of Hood MECHANICAL BREMREPALT RE pair/Alter Heating MECHANICAL BREMRESAPP Reniodel Res Appliance ELECTRICAL 2 of 3 ? � � CITY OF C'UPERTINO �� ^ ��n�F pERMIT APPL:[CATION FORM CUPEl�TINO Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rm�il Signs Add Branch ELECTRICAL BREMSIGNS Rerr.odel Signs, Marquee ELECTRICAL BREMTHEATR The:atrical Lighting Fix ELECTRICAL BREMVENFAN Ve 1t Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD :>cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE 5eismic Fee Res BUILDING BSPECIAL �'�pecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T em orary Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC l3usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE El��c Permit Issuance ELECTRICAL MPERMFEE 1�[echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plu mbin Permit Issue PLUMBING PPLBG Pl ambing Fee s foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING :� of 3 CITY OF CUPERTINO 3 ITEMS OF 36 PERMI7' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 32E59999.08 DATE ISSUED.......: 10�19/2007 RECEIPT #.........: BS(�00003036 REFERENCE ID # ...: 07J.00148 SITE ADDRESS .....: 22; HOMESTEAD RD #313 SUBDIVISION ....... CITY .............. CUI'ERTINO IMPACT AREA ....... OWNER ............: HOPZEOWNERS ASSOCIATION ADDRESS ..........: 44�6 FIRST ST #1 CITY/STATE/ZIP ...: LO:; ALTOS, CA 94022 RECEIVED FROM ....: DR.i�EGER CONST. INC. CONTR.ACTOR .......: DR��EGER, JOHN EDWARD LIC # 21895 COMPANY ..........: DRi�EGER CONSTRUCTION INC ADDRESS ..........: 60.'i COMMERCIAL ST CITY/STATE/ZIP ...: SAI1 JOSE, CA 95112 TELEPHONE ........: (4�)8)536 FEE ID UNIT QUANTITY :�NlOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ------- BENERGY PERMIT FEE 126.36 60.65 0.00 60.65 0.00 BPERMFEE VALUATION 5,800.00 126.36 0.00 126.36 0.00 BSEISMICRE VALUATION 5,800.00 0.60 0.00 0.60 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 187.61 0.00 187.61 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 Community Development `�` �' 10300 Torre Avenue � ' Y;E. . Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�TINO Buildin De artment JOB ADDRESS: PERMIT # �� U � ` �� z 3� l ��s�r��.�� 313 OWNER'S NAME: }-{� o wt K:o ic: �5 � PHONE # � � "� -S 3 � -m �- Z-�o GENERAL CONTRACTOR: t2q(�.lo -' G� aS • I'� L FAX # 4-0 �-�3 6- o� z5" I am not using any subcontractors: �, p_� o� _ o, Si e Date Please check a licable subcontractors and com lete the followin information SUBCONTRACTOR BUSIr1ESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile . I�—��t-o� Owner/ Contracto ign ture Date