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07100153 CIT�I f1F CUPERTINO {''� ' BUILDING DIYISION PERMIT ��`�`� ��"'�� ,:.- ,,,: ,::;; __ _ . _:__.: PERMIT NO. BUIL D � N �� o � ES �OMESTEAD RD $� 2 21 � 2 2 3 DRAEGE � COl� `'TRl7CTI ON INC 0 710 015 3 . PERMIT LSSUE DATE NER'S NAME: HOMEOWNERS ASSOCIATION 605 COI�IERCIAL ST 10/19/2007 SANITARY NO. CON'fROL NO. PHONE: BUILDING PERMI'I' INFO ARCHITECT/ENGINEER: RM�J &]ZEPLACE LIKE FOR LIKE BLDG ELECT PLUMB MECH � � 0 0 i p p LICENSED CONIRAGTOR DECLnxAr�oN Job Description � v� I hcrcby affirm �hat I am licensed undcr provisians oC Chaptcr 9(commcncing ; Z� with Secuon 7000) of Division 3 of ihc Busincss and Profcssions Codc, and my liccnsc is '� y in full Corcc and eCf . �' �` 1� � v� z Licensc C1ass Lic. ii „ ' Datc O� . �O Conaactor 1n.11 E : F ' � A CHI7ECI'S DECLARATION j a 6 1 undcrstanJ my plans shall bc uscd as public rccords )yU ' u. F' Licensed Pn�fcssional ' � < OW NER-BUILDER DECLARATION '�� 1 hcrcby al7rm U�at 1 am cxcmpt Gom ihc Conuactor's Licrnsc Law for thc � o O (ollowing rouon. (SccGon 7b31.5, Busincss and Profccsiuns Calc: Any ciry or coon�y �,°, Pi which ccquires a pertnit to conswct, altcr, improvc, dcmolish, or repair any stcucwre � Z y prior ui i�s issuancc, alsu rcquircs ihc applicant Cor such permit to filc a signcd statcment Valuation < �hat hc is liccnscd pursuant to ihc provisions of thc Convactur's Lic�cnsc Law (Chaptcr 9 3q. Ft. Floor Area Y F� (commencing wiih Scction 700Q) of Division 3 of �hc Busincss and Profcssions Codc) or y�� that he is ezempt therefrom and Ne basis (or the altcgcd exemption. Any violation o( Secdon 7031.3 by airy applicant for a peemit subjecu �he applicant to a civil penalty of ppN Number Oeeupaney Type noc more than fivc hundred dallars (5500). ❑ 1, as owner of Uie pcopercy. or my employces with wages az their wlc compensadon, willdotheworkandU�estructuieisnotintendcdoroHe�edforsale(Sec. Required Inspections and Professions Cade: T6e Conuacwrs License Law docs rrot apply w an owner of Qropeny who builds or improves thercon, and who daes such work himself or through his own employces. providcd ihat such improvements arc not in�endeA or ot[ered Cor sala I[. however, the building or improvemem is sold within one yesr of compledon, the owner- builder will have the burde� oC proving Iha� hc did not build or improve [or purpose of sa1eJ. ❑ I, as owur of the property, am ezclusively conuacting wi�h licensed convactors to construct the pmject (Sec. 7044. Business and Profcssions Code:) The Con�rxwr's Li- cense Law does no� apply w an owncr o( propeny who builds ar improves Ihereon, and , who contracu for such projects with a conuactoKs) licensed pursuant to �he Convacto�s [,icense Law. l am eaempt under Sec. . B& P C(or this reason �,vncr Date _ . _ WORKER'S COMPENSATION DECLARATION I 6ercby �rm under penalty ot perjury onc of �he follawing declarations: ❑ I hsve and wilt maintain a Certificatc of Consent lo self-insure for Worke�s Compen- sation, as provided for by Secdon 3700 of the Labor Code. far �he performance of ehe work [or which Ihis permit is issucd. ❑ 1 havc and will maintain Worker's Compensation (nsunnce, as �cquired 6y Scction 3700 of the Labor Code. Cw the performanee of �he woric for which this pertnit is issued. My Workefs Compensarion !ns rance carrier and Poliry number� Z D � Cartier. �` � L�� Poliry No.: ' �( D CERTIFICATE OF FJCEMPftON FROM WORKERS' COMPENSAT[ONINSURANCE ' ([his sccUon need not bc complcted if the permit is for anc hundred dollars (5100) • o� Icss.) I cenify that in thc per(ormancc af ihc work for which �his pertnit is issucd, t shall not employ any perwn in any manncr so az to bccomc mbjcct w the Workers' Compensation Laws oC Cali(omia. Da�c Applicant NOTICE TO APPLICAM: If, af�cr making this CcniCicate of Exemption, you shoulJ bccome subjcct to �hc Worker's Compensation provisions af thc Labor Codc, you muu , O forthwith comply wi�h such provuions or this pecmit shall6c decmed �evoked. z ""' CONSTRUCTION LENDWG AGENCY (— � 1 hccchy all'irm �hat thcre is a conswcuan Icnding agcr�cy Cor thc perfortnancc uf . p; � thc wurk fur which this permi� is iuued (Scc. 3097, Civ. C.) W Q Lendcr's Namc � z L.cnder's Address V � 1 ccrtify �hat 1 havc rcad this applica�ion and sia�c �hat thc abovc infortnaUOn is � �►� corrcct. I agree to comply with all city and county onlinances and sute laws relating �o rJ U building conswction, and hereby authori�e representatives of ihis city to enler upon Ihc � W abovc-mcnlioncd property for inspccuon pur�wses. a (Wc) agrce to save, indcmni(y and kecp hartnleu the Ciiy of Cupcnino against �� liabiliUes, 'udgmcn cos�s and expenses which may in any way accruc against said City /,_ U z in co cc oC ��g oc m�5 ��. Date V��' �" APPWC UN E STANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by, j SOURC E L TI NS. ' � �' Re-roofs �� s�� , o��o� °a� TyPe of R.00f HAZARDOUS MATERIALS DISCLOSURE Will thc applicant or futurc building occupant storc or handlc Aarardous ma�crial icfincd by the Cupenino Municipal Codc. Chaptcr 9.12, and thc Hcal�h and Safety _a� Scction 25532(a)? All roofs shall be inspec[ed prior to any roofing material being installed. ❑ Ycs O No Will thc applicant or futurc building occupant usc cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove emii harardous air contaminan�s u dcfincd by thc Bay Arca Air Quality Managcment all new n aterials for inspecrion. District? ❑ Ycs ❑ No 1 vc reaJ �he h ardous maicrials �equircmcn�s undcr Chap�cr 6.95 of �hc Califor- niaHcal SafctyC Scctions25505,25533and25534.1undc�stv�dthatiC�hcbuilding dces no urtcnt ha tcnant, �hat it is my rcsponsibility to notiCy �hc occupant nf ihc royui n us bc me prior u� issuancc of a Certifica�c of Occu ry. Signature of Applicant Date ��' ``� All roof coverings to be Class "B" or better Owncror au�horizcd agcnl �� --� � v� � � � � k '`` CITY OF ��UPERTINO ��n �F pERMIT APPI,ICATION FORM CUPEf�TINO APN # �� o Date: �.v l �o -( �t -O Building Address: Mailing Address (if different from building address): 22 3 o N- -s�r� �� .� ��- z�i �a� ZZ� Owner's Name: Phone #: �.f.o� _53b-v�Zo Contractor: License #: n e 4�. �� (,o��-C c,�t�a I � c, c� l � c� l� � ontact: Phone: 4 a�- z-o `� �� Cupertino Business License#: l� �"�GI2��.Z Fax:4�o�-53b-o�ZS Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: �2 �� o��C J t� � plo t.1E �-� � lt; �-o � Lt L'.�- Residential �a�'i-Tt � � � .�..� CA �t J C�� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: I 3(o S G1 f� f Cost of Project: Occupancy Group: �d'0� "- Type of Construction: Please check this box if t� project is a �( rj,(D second-stor addition: Project Size: Standard Large ❑ M.ijor ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERI B��iler <= 100,000 Btu MECHANICAL BBOILER2 Boil�r > 100K to SOOK Btu MECHANICAL BBOILER3 Bo:ler > SOOK to 1M Btu MECHANICAL BBOILER4 BoiJer > 1M to 1.75 M Btu MECHANICAL BBOILERS :3oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX vid/Off/Comm/Quasi BUILDING BCONSTAXBQ C�n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR C��nstax - Resi/Mobile BUILDING BELEC 1000 F lec 600V <= l 000A ELECTRICAL BELEC1001 ]�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 � � � CITY OF I�UPERTINO ��n �F pERMIT APPL,ICATION FORM CUPE(�TINO Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Vliscellaneous Fee BUILDING BMITIGATC Corrim. Housing Mit. Fee BUILDING BNUCOMME 1`lew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP :�1ew Comm Plumb PLUMBING BOVERTIME IZSpection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS G;is Piping System Fee PLUMBING BPINTERCEP Itid 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 Disposal PLUMBING BPSEWER Sewers PLUMBING BpSpRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT .�lt of Drain & Vent PLUMBING BPWATER InstalVAlter 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 MECHANICAL BRE1ViAIRHAN A/�� Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL Bg��T Lighting Fixtures ELECTRICAL BREIVI�'ITRN �.elocation of Furnace MECHANICAL BREMFURNOV Rr,lo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD l nstallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREn�INRApp Re m Non-Res Appliance ELECTRICAL BREMPOLE �'ole/Platform Fixture ELECTRICAL BREMPOWER Po•�ver Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHATIICAL BREMREPALT 2epair/Alter Heating MECHANICAL BREMRESAPP R:model Res Appliance ELECTRICAL 2 of 3 � CITY OF (�UPERTINO ` ��TM �F pERMIT APPL ICATION FORM CUPEI�TINO Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rrr. dl Signs Add Branch ELECTRICAL BREMSIGNS Rer.iodel Signs, Maxquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN VE�at 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 3pecial Inspection BLTILDING BSWIM Swimming Pool BUILDING BTEMP ",em orar Power ELECTRICAL BTEMPPERM Ter,i ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE El ec Permit Issuance ELECTRICAL MPERMFEE P✓Iechanical sq. foot MECHANICAL MPERMITFEE M��ch Permit Issuance MECHANICAL PPERMITFEE Pliimbin Permit Issue PLUMBING PPLBG P�umbing Fee sq foot PLIJMBING PLLONGRNGC Plannin 7 LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin�7 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 ......... 32E59999.20 DATE ISSUED.......: 10/19/2007 RECEIPT #.........: BSC00003036 REFERENCE ID # ...: 07100153 SITE ADDRESS .....: 22'30 HOMESTEAD RD #221,223 SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............: HOr[EOVJNERS ASSOCIATION ADDRESS ..........: 44� 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 ...: SAPf JO5E, CA 95112 TELEPHONE ........: (4(�8)536 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 2,000.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 2,000.00 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 FR�ME 306 HOLDOWNS 307 IN5ULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCR.ATCH COAT 313 ROOF NAIL Community Development " m , �` 10300 Torre Avenue � ;��° Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�,TINO Buildin De artment JOB ADDRESS: PERMIT # Z233 D M r sT�� °� 2 �.�z3 � � � O� l� OWNER'S NAME: M� �� tS' o r a�r�v PHONE # ��-S3;e-o�t� GENERAL CONTRACTOR: Y,)� � (� �-- �s �� .FAX # � o� - �3,� -o � zS" I am not using any subcontractors: � v � �-«-�� Si gna Date Please check a licable subcontractors and com lete e followin information: SUBCONTRACTOR BUSIr1ESS NAME BUSINESS LICENSE # Cabinets & Mill�vork Cement Fini.shing Electrical 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-I�i- o� Owner/ on actor Signature Date