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07100149 CIT�' OF CUPERTINO T ` !1 ? ' BUILDING DIVISION ��,i'R�1' ��'�� i��V�? ; ,,,:< ; ,.,: ;. _ , . .: BUIL � n �� ESS: HOMESTEAD RD # 2 2 8 DRAEGEI: CONSTRUCTI ON INC PER 71 � 014 9 ,JER'S NAME: PERMIT LSSUE DATE HOMEOWNERS ASSOCIATION 605 COPiMERCIAL ST ' 10/19/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECC/ENGINEER: BUILDING PERMIT INFO RMV/REI'LACE LIKE FOR LIKE BLDG e�rr PLUMB MECH ri � � 0 0 i o p LICENSED CON7RACTOR'S DECLARATION ry T i V�' � hcrcby affirm that I am licenacd undcr provisions of Chaptcr 9(commencing T "' Job Description �< a with Scction 7000) of Division 3 of thc Busincss and Prokssians Codc, and my liccnsc is .� y in full force and ef(ec (�' �(_ l� �,� ? Licensc lass Lic. N YJ \O � ; F W Datc Contractor �11� d 1G fw G�L.! ,� A CHITECI'S �ECLARA ON �� U 1 undcrstand my plans shali bc uscJ as public rccords ,a ' LL. y Liccnsed Pmfcssional � y � OWNER-BUtLDER DECLARATION �� I hcrc6y atTirm that 1 am cxcmpt Crom thc Contractors Liccnsc Law for thc p O following rcason. (Scction 7031.5, Busincss and Profcssions Codc: Any city or county �°„ � which tequires a pertnit w conswct, altec, improve, demolish, or �epair any sWCture ° Z} prior W iLS issuance, also requires the applicant for such permit ta fiie a signed statemem � s � �hat Ac is liccnscd pursuan� to �hc provisions o[ thc Conuacwr's Liccnsc Law (Chaptcr 9 ; iq. Ft. Floor Area Valuation r F- (commcncing wiih Scction 7000) of Division 3 of Ihc Business and Profcssions Codc) or L�� that he is exemp� theretrom and �he basis Cor tMe allegcd eumpuon. Any violation ot Section 703I.5 by airy applicant Cor a peimit subjccu the applicant �a a civil penalty of APN Number Occupaney Type not morc than fivc hundrcd dollars (5500). ❑ 1, as owncr oC ttie property, ar my employces with wages u their snic compensadon, wilidoehework,andfheswctumisnotintendederoReredforsak(Sec.7044,Business Re uireci Ins ections and Professions Code: The Conuactor's License Law does �rot apply to an owner of Q P propeny who 6uilds or improves ihercon, and wM does such work himulf or tlwugh his own employces, provided that such improvemenls are not intended or o[Lered [or sale. IC, however, We buildiag or improvement ia sold wilhin one year oC completion, i6e owneo- builder witl have the burden of proving that he did not build or improve Cor purpose of saleJ. ❑ I, as owner o[ the property, am ezclusivdy conlracting with limnsed conUaeWrs to construct the projen (Sec. 7044. Business and Professians Code:)'ILe Cootractors Li- cense Law dacs oot apply to an owner af propeny wha builds or improves Wereon, and . who contracts Car such projecls wilh a conuactor(s) licensed putsuant to the Convx[ars � �cense Law. ' am uempt undu Sec , B& P C for ihis masan „wner Date WORKER'S COMPF_NSATION DECLARATION " ' ` I dereby �rm undor penalty ot perjury onc of the following declarations: ❑ I h:ve and wili maintain a Ccrtifiqte of Consent to ulf-insurc tor Warker's Compen- sation, as providcd for by Section 3700 ot [he Labor Code, [or thc perfamancc ot the work for which this permit is issucd. ❑ I havc and will maintain Worker's Compensation Insunncc, az mqui¢d by Section 3700 oC the Labor Codc, for the pcdortnanu of the work for which �his permit is iswed ' My Worker'q C_ompensa on Insucance carticr and Policy numbcr are: / �(/� Carrier. V� �� Policy No.: �I W` I Z I I U V� CERTIF[CATE OF EXEMPCION FROM WORKERS' COMPENSATION INSURANCE (This scctian nced not bc complcted i( ttK pccmit is for onc hundred doUa� (S1U0) or IcssJ . 1 cenify th2t in thc pertormancc af thc work for which this pertnit is issucd, t shall not employ any person in any manncr so az W bccomc wbjcct �o lhe Workcri Compcnsa�ion Laws of Califomia. Date Applicant NOTICE TO APPLICAM: 1f, aftcr making t6is CeniCicatc of Ezcmption, you should bccome subjcct w �he Worker's Compcnsatian provisions of thc Labar Codc, yau muu , O forthwitfl comply with such pravisions or this pccmil shall bc dccmcd revokcd. z �"" CONSfRUCT10N LENDING AGENCY .-i (-� �-+ I hcrcby allirm lhat �hcre is a consuuction Icnding agc�y far thc perfartnancc uf Ri � ihc wurk [or which lhis pertnit is issucd (Scc. 3097, Civ. CJ ' W� Q Lendcr's Namc , � z L.cnder's Addrecs V p I certi[y ihat 1 have rcad �his application and siatc that thc above information is � �"" cortcct. I agree to comply wi�h all city and county orelinances and sute laws relaung to � U building conswction, and hc�cby authori�e ccprescntativcs of �his city to cntcr upon tAc � a aM1ovc-mcn�ioncd properry for inspccuon purposes. ( (Wc) agrc to sav indcmni(y and kecp hartnlcss thc Ci�y o[ Cupertino against H � IiaEilitiu, judgm n, cas and expenses which may in any way accrue against said City V,'� in consequcnce C g "ng of this pertnit. �� APPLICANT R S AND WILL COMPLY WI"fH ALL NON-POINT Issued by: Date l� 9 SOURCE S � �� Re-roofs � Signawrc of ApplicanUContracwr Da�e ' HAZARDOUS MATERIALS DISCLOSURE Type of Rc of Will Ihc applicant ar futurc building occupant storc or handlc harardous ma�crial kfincd by thc Cupertino Municipal Codc. Chap�cr 9.IZ, and the Hcalth and SaCcty _oa�, Scction 25532(a)? All roofs sl�all be inspected prior to any roofing material being installed. ❑ Ycs ❑ No �11 thc applicant or futurc building occupant usc cyuipment ar dcvices which If a roof is installed without first obtaining an inspection, I agree to remove • cmit harardous air contaminants u Acfncd by the Say Area Air Quality Managcment all new ma terials for inspection. Districc? � Ycs ❑ Nu ' 1 havc rcaci the hazardcws matcrials requircmcnts undcr Chap�cr 6.95 of ihc Cali[or- nia Hcal�h & 5 cry Cadc, tions 25505, 25533 and 25534. f undcrstand Uut iCihc building docs not cu �y h nan4 ihat it is my responsibility in noafy thc occupant of �hc rcyuircmcn�s hich e� prior �a issuancc of a Ccnifica�c ��qarrcy. 0� Signature c f Applicant Date Owncr or auth rized agcnt � o„� All roof coverings to be Class "B" or better � ��,� CITY OF CUPERTINO � � � �� F pERMIT APPLI CATION FORM CUPE�TINO APN # �� — � �. � Date: Building Address: Ivlailing Address (if different from building address): Zz3�o ��sr�c .hb �20�4� t�v i f 2z Owner's Name: Phone #: � o ,� l.� 0�- 5'� b -�o `�- Z a Contractor: License #: a� �►� �NS ��T�� J � (0l7 6( a Contact: Phone: `� �a - 20�� -S � Cupertino Business License#: LOI� � A,vD�C:L- Fax:4a� .S 6 -o`�z5 Building Permit Info: Bldg Elect ❑ P lumb ❑ Mech ❑ Job Description: � IE � o tG ►2 � p(� �tC l.1 r-l� �'=o n. L t�G t�c Residential �;�� r� < <�1 (s�Ti�1 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: l3�o S� Cost of Project: Occupancy Group: ��p — Type of Construction: Please check this box if the project is a second-sto addition: � Project Size: Standard ❑ Large ❑ Maj��r ❑ Quanti Fee ID l�ee Descri tion Fee Grou BAPPLOTHER C�ther Appliances MECHANICAL BBOILERI Boi ler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL BBOILER4 Boile� > 1M to 1.75 M Btu MECHANICAL BBOILERS Bc,iler > 1.75M Btu MECHANICAL BCONSTAX C'onstruction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cor�. Tax for BQ Zone BUILDING BCONSTAXH l�otel and Motel BUILDING BCONSTAXR Cor stax - Resi/Mobile BUILDING BELEC 1000 Ele c 600V <= 1 OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA lnvestigation fee BUILDING 1 �f 3 �.. .��: . - CITY OF CUPERTINO . �..� C�uP��T�NO PERMIT APPLICATION FORM Quanti Fee ID �'ee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corrun. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNLICOMMM New Comm Mechanical MECHANICAL BNUCOMMP N�;w Comm Plumb PLUMBING BOVERTIME In�pection Overtime BUILDING BPBACKFLOW Atniospheric Vacuum PLLTMBING BPCESSPOOL Cesspool PLLTMBING BPERMFEE B ld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMSING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce tor PLIJMBING BPLANCHK I'lan Check Fee BUILDING BPLANCKADD Plaii Check Add Multi BUILDING BPLANCKREP Plar Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa e Disposal PLUMBING BPSEWER Sewers PLUMBING gpSpRINK Law� SprinklerlBackflo PLLTMBING BPSTORM S :orm/Rain Water PLUMBING gp'I'RAp Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pi e PLUMBING BPWHEATER W ater Heater/Vent PLUMBING BPWSVCS M�.in Water Service PLUMBING BREINSPECT F:einspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHAI�ICAL BREMAIIZHAN A/C'Jnits <= 10,000 cfm MECHANICAL BREMAPPLI E�ppliance Install MECHANICAL BREMBUS WAY R emodel Busways ELECTRICAL BREMFIXT I,ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace > 1 OK btu MECHANICAL BREMHEAT H eater Installation MECHANICAL BREMINHOOD In� tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREl��INRAFP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po? e/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc 11, Switch & Outlets ELECTRICAL BREMRELOCA R�,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Rerr�odel Res Appliance ELECTRICAL 2 of 3 � � � .- CITY OF CUPERTINO ��n�� pERMIT APPLICATION FORM CUPEI�TINfl Quanti Fee ID l�ee Descri tion Fee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Rem��del Signs, Marquee 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 BSEISMICOM Seismic Commercial BUILDING BSEISMICRE �►eismic Fee Res BUILDING BSPECIAL S pecial Inspection BUILDING gsWIM ;iwimming Pool BUILDING BTEMP T��mporary Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS remp Dist Svcs ELECTRICAL BUSLIC Eusiness License BUILDING ELECTRIC l:lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE M echanical sq. foot MECHANICAL MPERMITFEE Me�:h Permit Issuance MECHANICAL PPERMITFEE Plu�nbin Permit Issue PLUMBING PPLBG Ph�xnbing Fee sq foot PLIJMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING = of 3 CITY OF CUPERTINO 3 ITEMS OF 36 PERMI`I RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ...... 32E59999.09 DATE ISSUED.......: 10/19/2007 RECEIPT #.... ...... BSC00003036 REFERENCE ID # ...: 07100149 SITE ADDRESS .....: 22'30 HOMESTEAD RD #228 SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............: HOb:EOWNERS ASSOCIATION ADDRESS ..........: 449 FIRST ST #1 CITY/STATE/ZIP ...: LO: ALTOS, CA 94022 RECEIVED FROM ....: DR�.EGER CONST. INC. CONTR.ACTOR .......: DR�.EGER, JOHN EDWARD LIC # 21895 COMPANY ..........: DR�.EGER CONSTRUCTION INC ADDRES5 ..........: 60`_ COMMERCIAL ST CITY/STATE/ZIP ...: SArf JOSE, 95112 TELEPHONE ........: (4(�8)536 FEE ID UNIT QUANTITY ��'IOUNT 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 3Q2 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 r�• '�� '� �� Cupertino CA 95014 Telephone (408) 777-3228 C1TY OF Fax (408) 777-3333 CUPEI�TINO Buildin De artment JOB ADDRESS: PERMIT #�� U Q � 22 � o � ►� 22 °� '-� � OWNER'S NAME: �o,l� 1-} p � D �G., �.4 �sSO G PHONE #�f o 6-�3 �- 0 Za GENERAL CONTRACTOR: FAX #� o� -� 3�- o z..�" I am not using any subcontractors: ' � � � � d � ( � "- � � S�;na e Date Please check a licable subcontractors and com � e the followin information: SUBCONTRACTOR BUSIrTESS NAME BUSINESS LICENSE # Cabinets & Mill�vork 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 . `,,.o �� l 0- I G- o�] Owner/Con act Signature Date