07100146 CITY OF �'UPERTINO < '
, ,
BUILDING DIVISION PERMIT ���'T�2A�;�C)�;:I�����'T���1 ;
aui � rr �� a ��� ES �OMESTEAD RD #312 DRAEGE,R CONSTRTTCTION INC P � R 07100146
itJER'S NAME: PERMITLSSUEDATE
HOMEOWNERS ASSOCIATION 605 CC�MMERCIAL ST 10/19/2007
PHONE: SANiTpRY NO. CONTROL NO.
ARCHITECT/ENGiNEER: BUILDING PERMIT INEO
REMV & REPLACE LIKE FOR LIKE BLDG ELECT PLUMH MECH
0 � � O
+ O p LICENSED CON7RACTOR'S DECLARATION
� v� [ hcrcby afGtm that I am licenscd unJcr provisions of Chaptcr 9(mmmencing Job Description
: z� with Scction 7000) of Division 3 of ihc Busincss and ofcssions Codc, and my liccnse is
'� y in futl force and effect. �.�
i'� ? Licensc Class Lic. #
� F p DaLC � Contraclar — "\.�
� � .�,� ARCHITECI'S DECLARA ON
;� U 1 undcrswnd my plans shall bc used as public records
,a
� o y Licensed Profcssional
� y � OWNER-BUILDER DECLARATION
� Q� 1 hcrcby aCflrm Uiat 1 am exempt Crom ihe Conuactors Liccnsc Law for Ihc
` p O Collowing zuon. (Sccuon 7031.5, Busincss and Profacsions Co�1c: My city or rnunty
��� which �cquires a permit to conswct, altcr, improve, dcmolish, or repair any swcture
_ Z �, prior ui iLS issuancc, alsu rcquires thc applicant Cor such pertnit w filc a signcd sutemcnt
;= o that hc is Iiccnscd pursuant to thc provisions of thc Convacror's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation
� �- $ (commencing wi�h Scction 7000) of Division 3 of Ihc Busincss and Rofcssions Cadc) or
L �.. that he is exempt thcrefrom and Uie basis Cor the altegcd exemplion. Aoy violauon o(
SecGon 7031.5 by a�ry applicant for a pertnic subjccts ihe applicant to a civil penalry of APN Number Oeeupancy Type
not more tMan five hundred doilars (SS00).
❑ I, as ownu ot ttie properry, or my employces with wages az the'v sak compensation,
will do the work, and �6e struduie is not intended or ofTered for sale (Sec. 7044, Business
and Professions Code: The Conuacwr's License Law docs not apply m an owner o( RCC�ll1iCd IIIS�CC�IOi1S
propeny who builds or improves �heccon, and wha does such work himselCor tlwugh his
own employces, providcd �hat such improvemenls are not imended or otfered fw sa1e. IC,
however, the building or improvement is sold within one year of compktion, tde owneo-
builder will have the burden of proving Wa� he did not build or improvc far pmpose of
salc.).
❑ I, as avner of the property, am exclusively contracting wiW licensed convactors w
constn�ct the projen (Sec. 7044. Busineu and ProCessions Code:)'Ibe Ca�uxanr's Li-
ccnse [aw docs wt apply �o an owncr of propeny who builds or improva We�eon, and ,
who contracts Cor such pmjecLt wiih a con�cactor(s) Iicensed pursuant to We Conuacrors
License Law.
I am aempt under Sec. , B dc P C fw �his rcason
, �vner Date
WORKER'S COMPENSATION DECLARATION - � _
1 hereby aflirm under penalty o( petjury one of the follawing declantians:
❑ I hsve and wil! mainiain a CertiGcate of Consent to sel(-insurc for Worker's Compcn- -
sation, u providcd for 6y Section 3700 oC che Labor Co�, for the perfarmancc a( the
work for which this permit is issued.
❑ I havc and wil! main�ain Worker's Compensation Insurana, az�cquired by Scction
3700 of �hc labor Codc, Cor �he performance ot �he work far which �his pem�it is issued. '
My Worke�s Cgm� aGon Insur�nm carricr and Policy numhCi azc� ����� � u �
i�
Carrier. � Poliry No.: E
CERTIFICA'fE OF EXEMP7'IOIV FROM WORKERS'
COMPENSATlON INSURANCE
(This secUon necd not hc camplc�ed if tf� pertni� is !or anc hundred doUars (S 100)
or Icss.)
1 ceni(y �hxt in the pertormancc of thc work fw which U�is pertni� is issucd, 1 shatl no[
employ any person in any manner so as m become subject to the Workers' CompensaGon
Laws of Califomia. Datc
Applicm�
NOTICE TO APPLICANT: If, afmr malcing �his Ccnificatc oC F�ccmption, you should
bccome subject ta thc Workcr's Compcnsation provisions of �c Labor Codc, you must
. O fort6with comply wilh such provisions or lhis permil shal) bc dccmcd mrokcd.
z � CONSTRUC?ION LENDWG AGENCY
(-+ ►-� I hemby affirm ihat ehere is a consuuction lending agency Cor the performance of
F: � ihc wurk for which this permit is issucd (Scc. 3097, Civ. C.)
W� A L.endcr's Namc
= z L.cnder's Address
V � 1 certifY Ihal 1 havc read �his application and su�c ihal Ihc abovc info�mauun is � -
( �"" corrcct. I agrce to tomply with aIl city and counry oniinances and sute laws relating �o
rJ U building conswction, and hemby authori�e reprexnu�ives of �his city to rnter u�mn Nc
� a abovc-mcnuuncd property (or inspccuon purposes. �
(Wc) agree to save, indcmnify and kecp harmless thc City of Cupcnino against
�� liabititia, judgmc , costs and expcnscs which may in any way accnre against said City
U,'� in con ucnce c granting of this pertnit.
�"'� APPL A ERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by: Date �� �`f-rC�
SOU S.
( y l '� , Re-roofs ,�
urc o Appli I/Conuactor Duc
HAZARDOUS MATERIALS DISCLOSURE Type of Rc of
�111hc applicant or futurc building accupant storo or handlc harudous ma�crial
kfincd by Ihc Cupenino Municipal Codc. Chapicr 9.12, and the Hcalth and Safety
�� Scction 25532(a)? All roofs sliall be inspected prior to any roofing material being installed.
❑ Ycs � No
Will the a�licant or futurc building occupant usc cyuipmcnt or dcvices whic6 If a roof is installed without first obtaining an inspection, I agree to remove •
emit hazardous air contaminan�s as dcfncd by Uic Bay Arca Air Qualiry Managemem all new ma:erials for inspec!ion.
a5�����
❑ Ycs � Nu
I havc rcad �he haiardous maicrials rcquircmcnLC undcrChapier695 ollhe CaliCar-
nia Hcalth & Saf y Codc, Scctions 25505, 25533 and 25534_ t undcrstand Uut iCihc building
docs n curtent have a tenan6 Iha[ it is my responsihility m noufy the occupant of Ihe
rcyuirc n wn musi x met prior w issuan« of a Ccni�ca�c af Oc ry Signature o f Appl icant Date
p �
oW ��,,,, ri , ��,,, pa � All roof coverings to be Class "B" or better
- � ��1 � � U I `-� �
� _. �,� CITY OF CUPERTINO
- ���Y�F pERMIT APPLI CATION FORM
CUPER
APN # 3 - �' , � n � • � / Date:
�� ��
Building Address: Vlailing Address (if different from building address):
2Z �� �t= S 7�. lln►� fi� l Z
Owner's Name: Phone #:
0� �o� _ 53 �o — o`t �- o
Contractor: License #:
.I�►Zn-�' c� �� f.� t1S �rotJ � �1 � �O � � � � O
Contact: Phone: `�' �- z'�'�-S� `''`F Cupertino Business License#:
Lov � C J� t� L F ax : 4�� c� � �
Building Permit Info:
Bldg � Elect. ❑ F lumb ❑ Mech ❑
Job Description: � �''� ° � '��° �°� V' �� �o'z � I►��
Residential 13 {�n r►�l Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
13�
Cost of Project: Occupancy Group:
��d�
Type of Construction: Please check this box if t� project is a
� �,�� f ��.�S , second-stor addition:
Project Size: Standard Large ❑ Major ❑
Quantity 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 Boiler> 1.75MBtu MECHANICAL
BCONSTAX ��onstruction Tax BUILDING
BCONSTAX In�UOff/Comm/Quasi BUILDING
BCONSTAXBQ Co 1. 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 <= ZOOA ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD I;nergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
� �� CITY OF CUPERTINO
�;,. .
��n ��"' pERMIT APPLI CATION FORM
CUPEi�TINO
Quanti Fee ID I�ee Descri tion Fee Grou
BMISCELL M iscellaneous Fee BUILDING
BMITIGATC Com�n. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNLJCOMMP N�;w Comm Plumb PLLTMBING
BOVERTIME In:�pection Overtime BUILDING
BPBACKFLOW Atrlospheric Vacuum PLtJMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPF'IXTURE Pbl � Fixture PLUMBING
BPGAS Gas Pi ing System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLLTMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Pla�i Check Add Multi BUILDING
BPLANCKREP Plat� Check Re eat Fee BUILDING
BPREPIPE RE� i e Of Fixtures PLUMBING
BPSEWAGE � ewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn Sprinkler/Backflo PLLTMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Inst<<IUAlter Water Pi e PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT IZeinspection Fee BUILDING
BREMACOVER A/C' Unit > 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI .�ppliance Install MECHANICAL
BREMBUSWAY R_emodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFLTRN Re .ocation of Furnace MECHAIVICAL
BREMFURNOV Relc� Furnace > lOK btu MECHAlVICAL
BREMHEAT �[eater Installation MECHANICAL
BREMINHOOD In �tallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
B���App Rerr Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Powcr Device/A aratus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R�;pair/Alter Heating MECHANICAL
BREMRESAPP Rer.iodel Res Appliance ELECTRICAL
2 of 3
� �` � CITY OF CUPERTINO
���Y�Fj�� pERMIT APPLICATION FORM
CUPERT
Quantity Fee ID l�ee Descri tion Fee Grou
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rem��del Signs, Mar uee ELECTRICAL
BREMTHEATR The �trical Lighting Fix � ELECTRICAL
BREMVENFAN Ver�t Fan Sin le Duct MECHANICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD �cb Specific Plan BUILDING
i BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE :>eismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM 3wimming Pool BUILDING
BTEMP T �mporary Power ELECTRICAL
BTEMPPERM Tem orar Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC �:usiness License BUILDING
ELECTRIC Llectrical sq foot ELECTRICAL
EPERMITFEE Elf�c Permit Issuance ELECTRICAL
MPERMFEE 1V:echanical sq. foot MECHANICAL
MPERMITFEE Me �h Permit Issuance MECHANICAL
PPERMITFEE Plu�nbin Permit Issue PLUMBING
PPLBG Pl�zmbing Fee sq foot PLUMBING
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'I RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng Sub: Blk.: Lot:
APN ......... 32E59999.06
DATE ISSUED.......: 10/19/2007
RECEIPT #.......... BSC00003036
REFERENCE ID # ...: 07�00146
SITE ADDRESS .....: 22_30 HOMESTEAD RD #312
SUBDIVISION .......
CITY .............. CUI'ERTINO
IMPACT AREA .......
OWNER ............: HOPIEOWNERS ASSOCIATION
ADDRESS ..........: 44�: FIRST ST #1
CITY/STATE/ZIP ...: LO:� ALTOS, CA 94022
RECEIVED FROM ....: DRt�EGER CONST. INC.
CONTRACTOR .......: DR��EGER, JOHN EDWARD LIC # 21895
COMPANY ..........: DR.i�EGER CONSTRUCTION INC
ADDRESS ..........: 60`.i COMMERCIAL ST
CITY/STATE/ZIP ...: SAI7 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 FR.AME 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 SCR.ATCH COAT 313 ROOF NAIL
Community Development
�` � ' 10300 Torre Avenue
}� ' Cu ertino CA 95014
�' . .�s�° ` P
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEI�TINO
Buildin De artment
JOB ADDRESS: PERMIT # /'
oM�S���7 ��' � '12 �� � C)� l "T'l�
OWNER'S NAME: b� PHONE # �a$ -53b --c� Lb
GENERAL CONTRACTOR: (Z4 � �p � rL � � 1� V FAX # ° d 53 b, a�Z �
I am not using any subcontractors: J —��_� 9 " ° �
Si ture Date
Please check a licable subcontractors and com �lete the followin information
SUBCONTRACTOR BUSIr1ESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Fini.shing
Electrical
F�ccavation
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
�,, ) t n—( t �
er/Contra or S' ature Date