07100154 CITY OF CUPERTINO � ' h,�
BUILDING DIVISION PERMIT �+������ ����� '
,;;, ,::: <
, ,....
PERMIT NO.
BU1LD �"��'���IOMESTEAD RD #226 DRAEGER CONSTRUCTION INC 07100154 .
PERMIT LSSUE DATE
��ER'S NAME: ,
HOMEOWNERS ASSOCIATION 605 CONMERCIAL ST 10/19/2007
SANITARY NO. CONTROL NO.
PHONE:
BUI(.D WG PERMIT INFO
ARCHITECT/ENGiNEER: Rj�j�J & FEPLACE LIKE FOR LIKE BLDG ELECT PLUMB MECH
� CJ � L� O
; o o LICENSED CONTRACTOR'S DECLARATION JOb DeSCTIptlOfl
'�� I hcrcby affirm that 1 am liccnscd undcr pmvisioas oC Chaptcr 9(commcncing
� z� with Scction 700U) of Division 3 0( ihc Busincss and Profcssiuns Codc. and my licensc is
:� y in full foree and eftec � Q
� � ? Licenx C1ass ��• �
p Da�c Contracmr �..Q�[�-�
: �"' � • ARCHITECI'S DECI.ARATION
j a ,a
a 1 undcrswnJ my plans shall hc uscd as public rccpnis
)aU
' a y Licensed Pm(cssional
. � a OWNER-BUILDER DECLARATION
'}� 1 hcrcby alTirm �hat 1 am cxcmp� Crom �hc Con�raaors Liccnsc Law for ttic
� p O Collowing rcuon. (Scctian 7(YS I.S, Busincss and Profcuiuns Ca1c: Any city or county
u^�i which requims a permit to conswct, altcr, improve, dcmolish, ar repair any swcmre
prior ui i�s issuancc, alw ccquires thc applicant for such permit to file a signed sutemen� �' Ft. Floor Area Valuation
-?< t h a t h c i s l i c c n s c J p u r s u a n t t o � h c provisions o! �hc ConuacWr's [rccnse Law (Chapicr 9
Y I �(commcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcssions Cadc) or
i�� �hat he is exempt tAerefrom and the buis for the allcgcd exemptioa Any violauon ot
Section 7031.5 by arry applicant Cor a peimit subjects the applicant to a civil penalty of APN Number Oeeupaney Type
not more than five hundred dollars (5500).
❑ I, as owncr o[ tlie propccty, or my employces with wages as tha'v solc campensaUon,
witt do thc work, and the stmaum is not inunded or eRercd tor sale (Sec. 7044, Business Required Inspeetions
and Professions Code: The Conuactar's License Law does not apply W an owner of
property wha builds or impraves thercon, and wM does such work himxlf or through his
own employces, providcd that such improvements are not in�ended or o[fercd for sala It.
however, the buitding or improvement is sold within one year oC complcuon, the ownu-
builder witl have the burdm ot proving that hc did wt build or improvc (or purpax af
sakJ.
� I, as owner of the property, am exdusively conuacting wi�h liansed convutars to
construct the pmject (Sec. 7044. Business and Professions Code:) The Conuactor's Li-
cense Caw docs not apply to an owner of propeny who builds or improves ihemon, and ,
who contracu Cor such projecls with a conuactor(s) licenued pursuant to �he Convactors
License Law.
[ am ezempi undu Sec , B 8c P C for this reason
.,wner Date _ . -
WORKER'S COMPENSATiON DECURATION
1 hercby affim� under penalty o( perjury onc o[ the folbwing declsrations:
❑[ h:.�e and will mainiain a Cenificate of Conscnt to self-insum for Worker's Compcn-
satian, as providcd for by Sectian 3700 of the Labor Code, for We performance o( the
work (or whieh Ihis pertnit is issucd.
❑ I have and will maintain Worker's Compensation Insunnce, as �cyuimd 6y Section .
3700 of thc L.abor Cadc. Cw thc performancc of the work [or which �his permit is issued.
My Worku's CompensaGon Insurance cartier and Policy number� uc_ ' 2 � r^ �
t' � j j v lJ
Cartier. �/�� ) V� � Poliry No.:
CERTiFICATE OF EXEMPI70N FROM WORKERS'
COMPENSATION INSURANCE
(Chis scction necd not be completed if the permit is for anc hundmA dollars (S 100)
nrlcssJ
1 cenify th�t in thc performancc of thc work for which ihis permi� is issucd, 1 shall not
e.^.iploy any person in any manncr so az to bccomc subjcct to ihe Workcrs' Compcnsation
Laws of Califomia. Date
Applicant
NOTICE TO APPLICAM: [f, aftcr making ihis Ccrti�catc of Excmptian, you should
become subject to lhe Worker's Compensadon provisions of �he Labor Code, you must
� O forthwiih comply wi�h such pravisions or this pecmit shall 6c deemed Rwoked.
CONSfRUCC10N LENDING AGENCY
(.~-� i-�. I hcsby a[firtn Wat thcre is a constnxdon Icnding agcncy Cor thc perfortnancc of -
��`✓ ihe wurk fur which this permit is iuucd (Scc. 3097, Civ. CJ ,
W Q Lendcr's Namc
� z (,ender's Address
V � I certiCy �ha� 1 have rcad this application and siatc ihal thc abovc information is
w F cortcct. 1 agrce to comply with all city and county oNinances and sute laws �clating io
O U building conswction, and hercby authori�e represenutivcs of this city io cnter upon thc
� W aM1ovc-mcntioncd property for inspcctioa purposes.
a (Wc) agree �o save, indcmni(y and kup hazmless ihe City of Cupertino against
�� liabilitiu, j mcn�s, c Is and expcnscs which may in any way accruc againsl said City ��
U z in conseq oC �hc e�g ar m�s ����. Date /0 �� -/
►-� APPLICA U D ANDS AND WILL COMPLY WITH ALL ON-POINT Issued by
SOURCE GU A O
l Q 9 �� Re-roofs �
Signuu a App � ��� T e of R oof
H DOUS MATERIALS D[SCLOSURE YP
Will the applicant or futwc building occupant uorc or handlc harardous matcrial
kfincd by the Cupenino Municipal Codc. Chapler 9.12. and Ihe Hcal16 and Safcty
..�a�, Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
�y� ❑No ,
wll thc applicant or future building occupant ucc cyuipmcnt or dcviccs which
If a roof i� installed without first obtaining an inspection, I agree to remove
cmii harardous air conuminan�s as cicGncd by thc Bay Arca Air Qualiiy Managcmcnt all new m aterials for inspec ilOil.
Disvict?
❑ Ycs ❑ Nu
I havc rcad the rdcws maicrials rcyuircmcn�s undcr Chap�cr6.95 of ihc Califor-
nia Hcalih af C tians 25505, 25533 and 25534.1 undcrstand ihat if ihc building
docs not nt ha a an4 ihat it is my rcsponsihiliry io noul'y Uu occu ani of ihc
rcyuirem wn m�x��P�o�w�5��,«arac�r�a�aro��� . SignatureofApplicant Date
°' Q � All roof coverings to be Class "B" or better
Owncr auth ' Datc
C����c����
� ' .` � CITY OF (:UPERTINO
����F pERMIT APPLICATION FORM
CUPEf�TINO
APN # , � Date:
���� lo--lq-01
Building Address: Mailing Address (if different from building address):
Z3� O � —SCTc.d, 7 �v �7 2 Z So
Owner's Name: Phone #:
� �o � — S3 �-o�Z �o
Contractor: License #:
I� LA (G � lG� C.n'� �'�R �`I �, U/ �'I � D
� ontact: Phone: �fog -'t�4-s6 upertino Business License#:
q 1J ��2r�/,. IIJ�(C. L Fax: W°`'3 - 5� �o -oy'
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job escription: ��w►o���Q,�r1a��- VI�tG— F'-oz.... V��2=
Residential 2,� wt �ai�1 L— �'— Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
��,�,�s��T'
Cost of Project: I ��� � Occupancy Group:
Type of Construction: Please check this box if th project is a
second-stor addition:
Project Size: Standard Large ❑ M��jor ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Bc�iler <= 100,000 Btu MECHANICAL
BBOILER2 Boil�;r > 100K to SOOK Btu MECHANICAL
BB OILER3 Boi ler > S OOK to 1 M Btu MECHANICAL
BBOILER4 Boil�r > 1M to 1.75 M Btu MECHANICAL
BBOILERS l3oiler > 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Irid/Off/Comm/Quasi BUILDING
BCONSTAXBQ C��n. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Cc�nstax — Resi/Mobile BUILDING
BELEC 1000 E lec 600V <= l 000A ELECTRICAL
BELEC1001 l:lec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
4
� CITY OF (;UPERTINO
�
�►n oF pERMIT APPL [CATION FORM
CUPE{�TINO
Quanti Fee ID Fee Descri tion Fee Grou
BMISCELL P�Iiscellaneous Fee BUILDING
BMITIGATC Cor�an. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM Ne�v Comm Mechanical MECHAIVICAL
BNUCOMMP rdew Comm Plumb PLLTMBING
BOVERTIME Ir�spection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE :gld Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interce tor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Pl �xi Check Add Multi BUILDING
BPLANCKREP Pl�ui Check Repeat Fee BUILDING
BPREPIPE F:e i e Of Fixtures PLUMBING
BPSEWAGE Sewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK La��vn Sprinkler/Backflo PLUMBING
BPSTORM Stonn/Rain Water PLUMBING
gpTg�p Kitchen Tra PLUMBING
BPVENT f�lt of Drain & Vent PLUMBING
BPWATER Ins�:alUAlter Water Pi e PLUMBING
BPWHEATER `Vater Heater/Vent PLUMBING
BPWSVCS P✓Iain Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A� C Unit > 10,000 cfin MECHANICAL
BREM�,IRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHAIVICAL
BREMBUSWAY Remodel Busways ELECTRICAL
B��'�T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Re lo Furnace > l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD I nstallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
B��App 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 MECHANICAL
BREMREPALT ]Zepair/Alter Heating MECHANICAL
BREMRESAPP Rf;model Res Appliance ELECTRICAL
2 of 3
� CITY OF t:UPERTINO
` �►n�F pERMIT APPLICATION FORM
CUPEI�TiNO
Quanti Fee ID Fee Descri tion Fee Grou
BREMSIGNAD Rrr dl Signs Add Branch ELECTRICAL
BREMSIGNS Rer.lodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHANICAL
BREMVENSYS V entilation S stems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM S��ismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S eciallnspection BLTILDING
BSWIM Swimming Pool BLTILDING
BTEMP 'Cem orary Power ELECTRICAL
BTEMPPERM Tein ora Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE :vlechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Pbimbin Permit Issue PLUMBING
PPLBG F lumbing 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 PERMIZ RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN ......... 32E59999.21
DATE ISSUED.......: 10/19/2007
RECEIPT #.........: BSC00003036
REFERENCE ID # ...: 07]00154
SITE ADDRESS .....: 22:30 HOMESTEAD RD #226
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............: HOr[EOWNERS ASSOCIATION
ADDRESS ..........: 444: FIRST ST #1
CITY/STATE/ZIP ...: LO:� ALTOS, CA 94022
RECEIVED FROM ....: DR��EGER CONST. INC.
CONTRACTOR .......: DR��EGER, JOHN EDWARD LIC # 21895
COMPANY ..........: DR��EGER CONSTRUCTION INC
ADDRESS ..........: 60`_� COMMERCIAL ST
CITY/STATE/ZIP ...: SP,tI JOSE, CA 95112
TELEPHONE ........: (4()8)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 SCRATCH COAT 313 ROOF NAIL