07100147 CITY OF CUPERTINO ` ' '
BUILDING DIV1510N PERMIT ���� ��Q� ����������� °
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PERMIT NO.
BUfL a �3�� ES �OMESTEAD RD #224 DRAEGEF: CONSTRUCTION INC 07100147 .
PERMIT L55UE DATE
.JER'S NAME:
HOMEOWNERS ASSOCIATION 605 COPIMERCIAL ST � 10/19/2007
SANiTARY NO. CONTROL NO.
PHONE:
ARCHIT'ECI7ENGINEER: BUILDiNG PERMIT INFO
REMV & REPLACE LIKE FOR LIK BLDG ELECf PLUMB MECH
L� � 0 O
i p Q LICENSED CONTRACTOR Decuxar�oN Job Description
� v� � hcrcby a[Grm that I am licenscd umicr provisions of CAaptcr 9(commcncing
; z W wi�h Sccdon 7000) of Division 3 uf ihc Busincsc and Profcssiuns C�, and my liccnsc is
:� y in full force and cffec � .(�
� v� Z Licensc Ciass �M• �
+ �,,, r p Dam � Contractor -� —�-
� r AR HCfECTS DECLARA lON
j a a 1 undcrswnd my plans shall bc uscJ as public records
)yU
' u. F' Licenscd ProCcssional
� y � OWNER-BUILDER DECLARATION
1 t�crcby alTirm �hat I am ezempi Gom ihc Contraccors Liccnsc Law for ehc
� p O following rcason. (Scction 7031.5, Busincss and Profccsians Codc: Any ciiy or county
�^�i which requitcs a pcimit to consuvct, aNcr, impmvc, dcmolish, or repair any sUUCture
priar ui i�s issuancc, also rcquircs ihc applicant for such pertnit io file a signcd sutemcm Valuation
-?< that he is liccnscd pursuant lo thc pmvisions o[ thc Conuacu�r's Li��cnsc Law (Chaptcr 9 ;�q. Ft. Floor Area
r F� (commcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcssions Codc) ar
i�� that he is ezemp� thcrefrom and Ihe bssic [or the allcgcd exemption. Any violauon af
Section 7031.5 by arty applicant for a permit subjecu We applicant to a civil penalty af APN Number Oeeupaney Type
not morc than five hundrcd dollars (SSOOZ
❑ 1, as owncr o[ ttie property, ar my employces with wages u the'v snlc compensation,
wil! do thc work and �he suuctwe is not intenCcd or ofteced for salc (Sec. 7044. Business Required Inspections
and Protessions Cadc: The Conuactor's License Law does not apply to an ownu of
property who builds or improves thercon, and who does such work himself or Uuougd hu
own emplayccs. providcd that such improvemen�s are not in�ended ar allered Cor sala If,
however, the building or improvemen� is sold within one year oC complction, d�e owner-
builder will have the burden oC proving Wa� he did not build ar improvc for purpox of
sakJ.
� I, as owner of the property. am uctusively contcacting wi�h Iiansed contract�s W
construct the penjea (Sec. 7044. Business and ProCessions Cade:) The Coauxwrs Li•
ccnse Law docs not apply to an owner of property who builds or impmves the�eon, and .
w6o convacts tor such projec�s wi�h a conuactor(s) Iicensed pursuant to �he Convactars
r icense Law.
' am ezempt under Sec. , B& P C for this reasoo
..wner Date _.. -.
WORKER'S COMPENSATION DECLARATiON
I hereby affitm under penalty of pc�jury onc of the foUowing declarations:
❑ I h:ve and will maintain a Certifipte ot Conscnt to self-insum Cw Workcrs Compen-
sation, as provided far by Sec[ion 3700 af the Labor Code. for �he performance oC Ux
work for which ihis pertnit is istued.
❑ I have and will maintain Worke�s Compcnsation Insunnce, az mquired by Scction ,
3700 of the Labor Code. Cw the performance af Ux work for which this permit is issued.
My Work r's Compyisaaon Insurancc carticr and Policy numbe I uc t : 'I ' `O �
Cartier. � L �� Policy No.: ��� Z I( 0
CERTIFICAI'E OF EXEMPI'ION FROM WORKERS'
COMPENSATIONiNSURANCE
(7liis secGon nccd noe bc complc�cJ i! the permit is !or onc hundred doltars (5100)
or IcssJ
1 cenify Ihat in thc performancc af Ihc work for which �his pertni� is issucd, I shalt noc
employ any person in any manncr so as to bccomc subject �a the Worlccrs' Compensation
Laws of Califomia. Date
APP�icant
NOTICE TO APPL.ICANT: if, aftcr making ihis Ccnilicatc of Ezcmption, you should
become subject to the Worker's Compensation provisions of ihe labor Cade, you muu
� O (ortAwith comply with such provisions or this pecmit shall bc dccmcd ccvokcQ
z ""' CONSTRUCTION LENDING AGENCY
(. � I hcrcby affirm Wat thcm is a constcucuon Icnding agenry for thc performa�c o( .
a� the work for which this permit is iuucd (Sec. 3097, Civ. C.)
W Q Lendcr's Narnc
a z L.cnder's Address
V � 1 certify �hat 1 havc rcad ihis application and siatc ihat thc a6ovc infocmauon is
w � corrcct. I agree w camply with all city md county ortiinances and state laws rctating w
� U building conswc�ion, and hcreby authomt reprcsen�ativcs of ihis city to cntcr upon �hc
� a abovc-mcnlioncd property for inspccuon purposes.
(Wc) agrce to save, indemnify and kup harmlcss the City o( Cupertino against
N � liabiliti 'udgmcnts, osts and eapenscs which may in any way acrnu against said City
V z ia co cc th ling af Ihis permit.
�+ APPLIC U R ANDS AND WILL COMPLY WITH ALL NON-PO Issued by: Date O-I��G
SOU E ON �
� v Re-roofs �
Signat fApplitanUConuazwr �a� T of Roof
HAZARDOUS MATERIALS DISCLOSURE }��
Wi11 ihc applicant or future building occupant storc or handle ha•rardaus matcrial
Jcfincd by the Cupenino Municipal Cadc. Chap�cr 9.12, and eNe Hcalth and Sa(ay
_� SecUon 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
�y� ❑No
Will thc applicant or Cuturc building occupant usc cyuipmcnt or Jcviccs whicd
If a roof i� installed without first obtaining an inspection, I agree to remove
emit ha•rardous air contaminan�s az dcfincd by the Bay Area Air Quality Managcmcnt all new m aterials for inspecr.ion.
�su����
❑ Ycs ❑ Nu
I havc rcaJ the h ardcws ma�crials rcquircmcnrs undcr Chaptcr 6.95 of �he Cali[or-
nia Hcal ry C , Scctions 15505, 25533 and 25534.1 undcrstv�d that if �hc 6uilding
docs not u n y ha tcnant, �hat it is my responsihility m noufy thc occupant of ihc
rcyuirem ich me� priorw issuance o[ a Ccnifica�c of Occup �r. Signature of Applicant Date
1° '� All roof coverings to be Class "B" or better
Owncr o uthorircd agcnl ��
�.=
� CITY OF CUPERTINO �� � `' �"� � ��
a �
CUPER`TINO PE�IT APPL�[CATION FORM
APN # �� r _ � ^ � � 1 �. Date:
`p �'(
Building Address: Mailing Address (if different from building address):
o I-�oM�S�i�� IZo�� J��r 2z�f
Owner's Name: Phone #:
�
Contractor: License #: �
1� R.q - b�� ��l.s f"�'u1 �"(`c ��J ��! c. . � ��7 (�J � i�
Contact: Phone: y-o3-2'►�t-S6 y� Cupertino Business License#: �
I��o � N�n�4�o �c z— F�: 4 0�3 -5'� b -o�fL . � a `�
Building Permit Info:
Bldg Elect ❑ F'lumb ❑ Mech ❑
Job Description: ��'''`�� � �"�� ''L�l� �� Lt ��L- �+n- �-�'��-
Residential � tL-a � c � � �1 -� � Go� T ��. , Commercial ❑
Sq.Ft. Floor Area: � 3 � S Q Sq.Ft.:
Cost of Project: Occupancy Group:
S �� � —
Type of Construction: Please check this box if th project is a
second-stor addition:
Project Size: Standard ❑ Large ❑ Major ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Bo- ler <= 100,000 Btu MECHANICAL
BBOILER2 Boile -> l 00K to SOOK Btu MECHANICAL
BBOILER3 Boil�;r> SOOK to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS B�iler> 1.75M Btu MECHANICAL
BCONSTAX 1:onstruction Tax BUILDING
BCONSTAX Inc VOff/Comm/Quasi BUILDING
BCONSTAXBQ Co l. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Co�istax - Resi/Mobile BUILDING
BELEC 1000 El�:c 600V <= 1 OOOA ELECTRICAL
BELEC1001 E lec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= ZOOA ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD �;nergy Add Multi BUILDING
BINVESTIGA [nvestigation fee BUILDING
1 of 3
.�
� � ` CITY OF C'UPERTINO
�►n�f pERMIT APPLJ[CATION FORM
CUPER�TINO
Quanti Fee ID ]?ee Descri tion Fee Grou
BMISCELL l�[iscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME Nf;w Comm Electric ELECTRICAL
BNUCOMMM Nev� Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLLTMBING
BOVERTIME In;pection Overtime BUILDING
BPBACKFLOW At�nospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE E�ld Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Ga� Piping System Fee PLUMBING
BPINTERCEP Inc. Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Pla�i Check Repeat Fee BUILDING
BPREPIPE R�� i e Of Fixtures PLUMBING
BPSEWAGE ��ewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lav� n Sprinkler/Backflo PLUMBING
BPSTORM �torm/Rain Water PLUMBING
BpTRAp Kitchen Trap PLUMBING
BPVENT A.t ofDrain & Vent PLUMBING
BPWATER Inst:ilUAlter Water Pi e PLUMBING
BPWHEATER V� ater Heater/Vent PLUMBING
� BPWSVCS M ain Water Service PLUMBING
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 J�ighting Fixtures ELECTRICAL
BREIVIFURN Re location of Furnace MECHANICAL
BREMFURNOV Rel�� Furnace > l OK btu MECHAI�TICAL
BREMHEAT �[eater Installation MECHANICAL
BREMINHOOD In stallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BRE1�rINRAFP Rerr. Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Pow��r Device/A aratus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R�;pair/Alter Heating MECHANICAL
BREMRESAPP Rer.lodel Res Appliance ELECTRICAL
2 of 3
� ;� � � CITY OF C'UPERTINO
CuPE� ��� PERMIT APPL=[CATION FORM
Quantity Fee ID Fee Descri tion Fee Grou
BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR The atrical Lighting Fix ELECTRICAL
BREMVENFAN Ve�it Fan Sin le Duct MECHANICAL
BREMVENSYS VE ntilation S stems MECHANICAL
BSCBLVD `�cb Specific Plan BUILDING
� BSEISMICOM Se: smic Commercial BUILDING
BSEISMICRE ;3eismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimmin Pool BUILDING
BTEMP Tem orary Power ELECTRICAL
BTEMPPERM Tem ora Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Itusiness License BUILDING
ELECTRIC ]�lectrical s foot ELECTRICAL
EPERMITFEE Elf c Permit Issuance ELECTRICAL
MPERMFEE N echanical sq. foot MECHANICAL
MPERMITFEE Me�:h Permit Issuance MECHANICAL
PPERMITFEE Plu�nbin Permit Issue PLUMBING
PPLBG Ph�mbing Fee sq foot PLLTMBING
PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Plannin Lon Ran e Residential PLANNING
3 of 3
CITY OF CUPERTINO
3 ITEMS OF 36 PERMI".' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN ......... 32E�59999.07
DATE ISSUED.......: 10,'19/2007
RECEIPT #.......... BS()00003036
REFERENCE ID # ...: 07:_00147
SITE ADDRESS .....: 22_�30 HOMESTEAD RD #224
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OWNER ............: HOI4EOWNERS ASSOCIATION
ADDRESS ..........: 44�E FIRST ST #1
CITY/STATE/ZIP ...: L0:3 ALTOS, CA 94022
RECEIVED FROM ....: DRi�EGER CONST. INC.
CONTRACTOR .......: DR:�EGER, JOHN EDWARD LIC # 21895
COMPANY ..........: DR�EGER CONSTRUCTION INC
ADDRESS ..........: 60.'> COMMERCIAL ST
CITY/STATE/ZIP ...: SAIJ JOSE, CA 95112
TELEPHONE ........: (4�)8)536
FEE ID UNIT QUANTITY ,�MOUNT 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 FR.AME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
Community Development
' °��, .' 10300 Torre Avenue
, �:
Cupertino CA 95014
� Telephone (408) 777-3228
CIIY OF Fax (408) 777-3333
CUPEt�,TINO
Buildin De artment
JOB ADDRESS: PERMIT # O .� (� O l �
23? a r'l - i G� 7� �Z� �
OWNER'S NAME: � PHONE # o� --�3 fo-o�
GENERAL CONTRACTOR: � �2 t �liT FAX # �{' °�3 -- -�' �, — o �-2�'
I am not using any subcontractors: 1- ° -d 1
Si ture Date
Please check a licable subcontractors and com le followin information:
SUBCONTRACTOR BUSIPJESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
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
J _ j ��(�."o�
Owne /Contra or Si ature Date