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07100155 CIT�' OF CUPERTINO ' �: ' BUILDING DIVISION PERMIT ���'+ITJ�.���Cl� �������'I�N* .' <:: _.. _.. : ::: : BUIL PERMIT NO ° �"�����IOMESTEAD RD #225 DRAEGE� CONSTRUCTION INC 07160155 . NER'S NAME: PERMIT LSSUE DATE ' HOMEOWNERS ASSOCIATION 605 CO�II�'IERCIAL ST � 10/19/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECTBNGINEER: RM�J &�EPLACE LIKE FOR LIKE BLDG B ELECT GPER p UMB MECH � � 0 0 i p p LICENSED CON7RACTOR'S DECLARAT(ON JOb DESCI1PIlOf1 � v� 1 hcrcby affi[m �hat 1 arti liccnsed undcr provisions of Chaptcr 9(commcncing ; Z� wiih Scction 7000) of Divisian 3 of ihc Busincss and Profcssions Code, and my liccnsc is '� y in futl Corce and eCFec ( 6(� j�? Licensc Class Lic. M : F ` p Dam ' Contraclor !� ARCHITECI'S DECLARA ON 7 a a 1 undcrstand my plans shall be uscd as public records )yU ' u. y Liccnsed Profcssional � y � OWNER-BUILDER DECLARATION [ hcrcby alTrm �hat 1 am cxcmpt trom thc Can�ractors Liccnsc Law for thc � p O Collowing r�ason. (SccUon 7031.5, Busincss and Profcssions Ca1c: Any ciry or coumy �°� � which requims a pertnit to conswct, al�cr, improvc, demoli.eh, or repair any swcmrc � Z�y„ prior u� ils issuancc, also rcquires the applicant for such permil to filc a signcd sta�meni �_ � ihat he is licensed pursuant to �he provisions of the Contracwr's license Law (Chapter 9 Sq. Ft. Floor Area Valuation u t- $ (commencing wiih Section 7000) of Division 3 of the Business and Professions Cade) or �, �.. ihat he is exempt thcccfrom md ihe basis Cor tl�e allcgcd exemption. Any violation o[ Section 7031.5 by arry applicant Cor a pemiit subjccu �he applicant to a civil penalty of APN Number Oceupancy Type not morc than fivc 6undred dollars (SS00). ❑ I, u owncr oC the property, or my employces with wages as the'v solc compensation, will do the wark, and the swtture is not intendcd or offered for salc (Sec. 7044. Business Re uired Ins ecti ons end Professions Code: The Conuactor's Licenu Law docs not apply w an owner of Q P property who 6uilds or impraves thercon, and who does such work himselCar �hcough his own employces, providcd that such improvements are not imended or otiercd Cor sala If. however, the building or improvement is sold within one year oC compledon, tlie owner- builder will have the burden ot proving �hat he did not build or improve (w pu�pou of saleJ. ❑ I, as owner of the propcny, am exclusively convuting wi�h littnsed rnnlractors W construct the projea (Sec. 7044. Business and Protessions Code:)17u Contrutor's Li- ccnse Law docs not apply to an owncr af propeny who builds ar improves Ihaeon, and , w6o contracts [ar such pmjects with a con�ractor(s) iicenud pursusnt to the Convactor's r.icense Law. 1 am uempt under Sec. , B& P C for this reasan .,,vner Date _ . _ WORKER'S COMPENSATTON DECLARA170N i hereby affirtn under pena�ty a[ perjury one of �he following declarations: ❑[ hs.�e and will maintain a Cenificam of Conscnt to self-insure for Workers Compen- satian, u provided for by Section 3700 of the Labor Code. (or �he performance o( the work (or which this pertnit is issucd. ❑ I havc and will maintain Workcr's Compensation Insurance, as �equired by Scction 3700 of �hc Labor Codc, for thc perfarmancc of �he work for which this permit is issued. My Work r's C nsation Ins rancc carticr and Policy numbcr arc: O O � Cartier. �v `���� Policy No.:� � — I 2I I CERT[FlCATE OF EXEMPI'[ON FROM ORW KERS' COMPENSATlONINSURANCE (Chis section nccd not bc completcd if [he permit is for onc hundrcd dollars (5100) nrlcssJ ' 1 cenify �hat in thc performancc of thc work for which this pertnit is issucd, 1 shall not e.^.iploy any person in any manncr so as �o bccomc subject to the Workcrs' Compensatlon Laws of Califomia. Datc Applicant NOTICE 7'O APPC.ICANT: lf, aftcr making this Ccrtiticatc of Excmption, you should become subjcct to ihc Worker's Compcnsduon provisions of the Labor Codc. yau must � O fonhwi�h comply wi�h such pravisions or this permit shall bc dccmed rcvaked. z ""'' CONSfRUCCION LENDING AGENCY (� � I hcrcby aflirm that thcre is a conswc�ian Icnding agcncy for the perfortna�c uf a� thc work fur which ihis permit is issucd (Scc. 3097, Civ. C.) W� Q Lcndcr's Namc ' a z L,cnder's Address (� � 1 certi(Y Iha� I havc rcad ihis application and su�c tha� thc abovc infortnation is w"' cortcct. I agree ta comply wi�h all city and county onlinances and sUte laws relating �o � U building conswction, and hercby authori�e rcpresenutives of ihis ciiy to enter upon thc � W above-mentioned property for inspecUOn purposes. a (Wc) agrce to save, indcmnity and kecp hartnless the Ci�y of Cupertina against H � liabilitiu, judgmcn�s, costs and expenscs which may in any way accruc against said City V z in consequcnc af tbc granting af ihis permit. � APPLI AMf' NDERSTANDS AND WILL COMPIY WITH ALL NON-POINT Issued by Date G-��-�' SOUR E E L TIO . ��� �° Re-roofs ��� Sig re oCAppli onvutor Datc T of R oof HAZARDOUS MATERIALS DISCLOSURE }�� Will thc applicant or (uturc building occupant uorc or handlc haarardous matcrial cfincd by the Cupenino Municipal Codc. Chaptcr 9.12. and [hc Hcalth and Safcty _.� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Ycs ❑ No Will thc applicant or futurc building accupant usc cyuipmcnt or dcvices which If a roof i s installed without first obtaining an inspection, I agree to remove • emit harardaus air comaminan�s az dcfined by �hc Bay Arca Air Quality Managcmcnt all new rr aterials for inspecr.ion. ��s���� ❑ Ycs Q Nu I havc rcad the ha�ardcws mucrials requiremcnts undcr Chaptcr6.95 o(ihc Calitor- nia Hcalth & cry Codc, Scctions 25505, 25533 and 25534. f undcrs�ind that i[ du building d no cu ly havc a tcnan4 �at it is my responsibility lo notiCy thc a:cupant af thc rcy ve cn ich 5�n�me�P�a�w;uu��orac�r�a�ara�uP��. Signature ofApplieant Date ner authorizcd agcnt '� p�� All roof coverings to be Class ��8�� or better 0�� Oc� I�S ��� �• CITY OF �CUPERTINO CITYOF pERMIT APPI.ICATION FORM CUPEi�TINO APN # 2� nnQ ° � Date: � `� "� � Building Address: Mailing Address (if different from building address): 3 0�I-o�i�s � a I'tflw � � t zz Owner's Name: Phone #: �-I-o� �-I�n� -53b-a�z� Contractor: J ' � � License #: 10r2.s � k =�- Ca�sr � T.� (o i�l ( � o Contact: Phone: 4� -�- -� �° Cupertino Business License#: �c �YL��►���Z Fax: �ko5 -`.3b-oV-z Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job escription: �C;^'►����� PI4G� V��=�G �a't.. �-���� Residential '�� •� � S�� �R/ 21E Go 4 t' Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: '�,/ O � Occupancy Group: b 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 Ap liances MECHANICAL BBOILERI B�iler <= 100,000 Btu MECHANICAL BBOILER2 BoiJer > 100K to SOOK Btu MECHANICAL BBOILER3 Bo iler > SOOK to 1M Btu MECHANICAL BBOILER4 Boi er > 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX I ldlOff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR C �nstax - Resi/Mobile BUILDING BELEC 1000 �;lec 600V <= l 000A ELECTRICAL BELEC1001 :�lec 600V > 1000A ELECTRICAL BELEC200 � ElE c Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 �.. CITY OF i�UPERTINO CuPE�,T�NO PE�IT APPI,ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Co�nm. Housing Mit. Fee BUILDING BNUCOMME T1ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHAIVICAL BNLTCOMMP Vew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G,�s Piping System Fee PLUMBING BPINTERCEP vid Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD P_an Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE lte i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLLTMBING BPSTORM Storn1/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT .�lt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pi e PLUMBING BPWHEATER 'JVater Heater/Vent PLUMBING BPWSVCS Vlain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A�C Unit > 10,000 cfin MECHA1vICAL BREMAIlZHAN A/�� Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN �_elocation of Furnace MECHANICAL BREMFURNOV R�;lo Furnace > lOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD lnstallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE F'ole/Platform Fixture ELECTRICAL BREMPOWER Po��ver Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHAI�]ICAL BREMREPALT :Zepair/Alter Heating MECHANICAL BREMRESAPP R�;model Res Appliance ELECTRICAL 2 of 3 � CITY OF ��UPERTINO ` ��n�F pERMIT APPI,ICATION FORM CUPEI�TINO Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Re;nodel Signs, Marquee ELECTRICAL BREMTHEATR Tlieatrical Lighting Fix ELECTRICAL BREMVENFAN V ent Fan Sin le Duct MECHANICAL BREMVENSYS `'entilation S stems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tem orary Power ELECTRICAL BTEMPPERM Te;n ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE E lec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE M ech Permit Issuance MECHANICAL PPERMITF`EE Plnmbin Permit Issue PLUMBING PPLBG �'lumbing Fee sq foot PLUMBING PLLONGRNGC Plannir. LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planni� Lon Ran e Residential PLANNING 3 of 3 CITY OF CUPERTINO 3 ITEMS OF 36 PERMI'P RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blc: Lot: APN ......... 32�59999.22 DATE ISSUED.......: 10/19/2007 RECEIPT #.......... BS)00003036 REFERENCE ID # ...: 07100155 SITE ADDRE5S .....: 22330 HOMESTEAD RD #225 SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OVJNER ............: HO:�IEOWNERS ASSOCIATION ADDRESS ..........: 44� FIRST ST #1 CITY/STATE/ZIP ...: L03 ALTOS, CA 94022 RECEIVED FROM ....: DR�EGER CONST. INC. CONTRACTOR .......: DR�EGER, JOHN EDWARD LIC # 21895 COMPANY ..........: DR�EGER CONSTRUCTION INC ADDRESS ..........: 60i COMMERCIAL ST CITY/STATE/ZIP ...: SAJ JOSE, CA 95112 TELEPHONE ........: (4J8)536-0420 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00 BPERMFEE VALUATION 1,800.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 1,800.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 123.58 0.00 123.58 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 SCR.ATCH COAT 313 ROOF NAIL