07100151 CITY OF CUPERTINO *, T '` ' `
BUIL�ING DIVISION �ERlvii l ����� ���� ����`��� '
: ;;. ...: .:.. < ,:, _ .::
BUIL PERMIT NO
i RD #314 DRAEGEF CONSTRUCTION INC 07100151 .
. NER'S NAME: PERMIT LSSUE DATE
HOMEOWNERS ASSOCIATION 605 COD�'IERCIAL ST � 10/19/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHIT'ECi'lENGINEER: BUILDING PERMiT INFO
REMV & REPLACE LIKE FOR LIKE e�DC ELEGT PLUMB MECH
� 0 � 0
i p � LICENSED CONTRACI'OR'S DECLARAT[ON IOb D2SCilptlOil
� V� 1 hcrcby affirm that I am IicensM undcr provisions a( Chaptcr 9(commcncing
; z, � wi�h Scction 700U) of Division 3 of ihc Busincss and Profcssiuns Codc. and my liccnse u
�� y in futl Corce and eCteq (� t�1 /� `�
v� Z Licensc Class 1 Lic. M vi / vi
� —���.0 �1
: F �p pa� � Conuaclar �
�a ARCHITECI"S DECLARATiON
7 a 6 I undcrstanJ my plans shall bc uscd as public rccords
)yU
° u. y Licensed Profcssional
� y � OWNER-BUILDER DECLARATION
1 hcrcAy alTirm lhat 1 am cxcmpt trum ihc Can�raciors Liccnsc Law for itic
� p O Collowing rcason. (SccGon 7()3I.5, Busincss and Profcssiont Calc: Any city or rnunty
�,°, Pi which requires a permit to conswct, alter, imprnve. demolixh, or iepair any svucture
° Z} pnor w i�s issuance, alw requires �he applican� far such permit to file a signed sta�emen� �. Valuation
-< �hat hc is liccn:cd pursuant to thc provisions of thc Conuacwr's Liccnsc Law (Chaptcr 9 ,,q. Ft. Floor Area
� t �(commcncing wiih Scction 7000) of Division 3 of ihc Business and Profcssions Codc) or
y�� that he is e�eempt therefrom and the basu Cor the ailegrA eumption. Any violaGon o(
Secdon 7031.5 by arry applicant for a petmit subjecu the applicant to a civil penalty of ppN Number Oceupaney Type
not more than fivc hundred dollars (5500).
❑ l, as owncr oC ttie property, ar my employces with wages u We'v solc compensauon,
wilt do thc work. and the swcture is not intendcd or offeced (arsalc (Sec. 7044. Business Re uired Ins CCtIOIIS
and Pro(essians Code: The Conuactor's License Law docs not apply to an owircr of 9 P
propeny who builds or imptoves thercon, and who does such work himselCar Ihrough hia
own employces, providcd that such improvemenls are not imm�ded or oQered for sala I[.
howevu, the building or improvemen� is sold within one yesr of compleGon, ihe owner-
builder wiU have the burden oC proving Wat he did not build or impmvc for puryase of
salc J.
❑ I, as awur o[ the property, am exclusively conuuting wi�h (icensed conuac�ors W
constmct the ptojen (Sec. 7044. Business and Ptofessions Code:)1Tte Coavutot's Li-
ccase Law docs not apply to an owner of property w6o builds or improves thueon, md .
who convacts Cor sucA pmjects with a conuactor(s) licenaed pursusnt to �he Cantnctnr's
License Law.
I am uempi under Sec. , B dc P C for Utis muon
wner Date _.. _
WORKERS COMPENSATION DECLARATION
1 hereby atTirm under penalty of pery'ury anc of the following declaratians:
❑ f hsoe and will maintain a Cenifiwte oCConsenl to self-insurc for Workcrs CanQen-
sation, as provided for by Sectian 3700 ot the Labor Code, for �he performance of the
work tor which this pertnit is issucd.
❑ I havc and will maintain Workcr's Compensation Insurance, as �cquired by Scction
3700 0( thc Labor Cadc. Cor thc performancc af �he work for which U�is permit is iss�d.
My Worker's Com Insurance carticr and Poliry number azc: Q 0 .
Carrier. �� V"� l b N Poliry No.: 1�� G� 2�� O�J
CERTIF[CATE OF EXEMPfION FROM WORKERS'
COMPENSAT[ONINSURANCE
(This scction need not bc complctcd if the permit is ku onc hundred dotlars (5100)
or lcss.) �
I cenify that in thc performancc of thc work for which �his permit is issucd. I shall not
employ any person in any manner so as to become mbject to ihe Worlcers' Compensazion
Laws of Califomia. Datc
Applicant
NOTICE TO APPLICAN7': I(, aftcr making this CcniGcatc of Faccmption, you shoukl
become subject to ihe Worlcer's Compensation provisions of the Lahor Codc, you must
� O forthwi�h comply with such provisinns or this pccmi� shall bc dccmcd awokcd.
z "" CONSfRUCTION LENDING AGENCY
[.�-� ►�-� I hcreby aftirtn Wat thcre is a conswction Icnding agcncy for thc perfortnancc of ,
(� � �hc work Cur which U�is permit is issucd (Scc. 3097, Civ. CJ
W Q L.endcr's Namc '
� � Lcnder's Address
V � 1 certi(Y Ihai I have rcad this application and sialc tha� Ihc abovc informatiun is
w �' correct. 1 agrce to comply with all city and county ordinances and sute Iaws relating w
rJ U building conswction, and hcreby authori�e reprcsentativcs of this city to cntcr upon Nc
� W ahovc-mcniioncd propcny (or inspcction purposes.
a (Wc) agrce to save, indcmnify and kcep harmless thc Ci�y of Cupertino against
�.�'� � liabilities, judgmcn�s, cos�s and ezpenscs which may in any way accruc against said Gty
V,'� in conuquenc C thc g ting o( this permit. Date �� �( � L�j
� APPLICA N NDS AND WILL COMPLY WI'ft{ ALL NON-POIM' Issued by:
SOURCER UL N
( "— ( �' ° Re-roofs ���
Sign turc P�� u a. D9 c Type of R�of
HAZAR S TERIALS D[SCLOSURE
Will �hc applicant ar futurc building accupant storc or handle ha•rardous matcrial
lefined by lhe Cupenino Munici al Codc. Chap�cr 9.12. and the Hcalth and Sakty
nlc. Scnion 25532(a)? All roofs :�hall be inspected prior to any roofing material being installed.
❑ Ycs No
Will thc applicant or futurc building occupant usc cyuipmcnt or dcvicrs whicb
If a roof i: installed without first obtaining an inspection, I agree to remove -
cmi� hazardous air conwminan�s as dcfined by the Bay Area Air Qualiry Managemcm all new m�terials for inspection.
Dfsv;ci? ��/
❑ Ycs J�rvu
1 havc rcad the ard<ws maicrials requircmcn�t undcrChap�cr6.95 of ihc Califar-
nia Hcalih afct C, ctions Z5505, 25533 and Z5534.1 undcrstand �haz itthc 6uilding
docs no� cu nlly a a nan4 lhat it is my rcspoasibility w noufy Uic a:cupant a( �he
rcyuircmcn whi m �������«oraca,;rrca�aro���r. Signature �fApplicant Date
m ' 4 `� ? All roof coverings to be Class "B" or better
Owncr or a horizcd agcnl �,�
� � �..,�
CITY OF C'UPERTINO � � � � �� � r
��TM�F pERMIT APPL=[CATION FORM
CUPEF�TiNO
APN # �� / _ � (� `� � + 1 � Date:
�.�� l
Building Address: Mailing Address (if different from building address):
2''� 3 0 +^� -- S A� �� t,�✓ r T 3 l
Owner's ame: Phone #:
� D !�r- �f Q�-3 - -r b - o �{-zo
Contractor: License #:
I� Qo, �, lo �,�2 (,o � S T'Z► 17 � o'J �� C� • (� l � �j ( �
ontact: Phone: � d 8-�a g- S� y Cupertino Business License#:
v �}�►?��`'J�ILL Fax: �F° � -S7 4, --o`fZS"
Building Permit Info:
Bldg Elect ❑ F'lumb ❑ � Mech ❑
Job escription: 12� n�t °vl't-/ �r�.�14 �� 'G.; � �L� �o �, �-I �IZ,
Residential ❑ �a►Z.'f � � ` '� I "�t S � 7 I �(� � Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: r �, � fl � Occupancy Group:
Type of Construction: Please check this box if th project is a
second-stor addition:
Project Size: Standard Large ❑ Major ❑
Quanti Fee ID ]�ee Descri tion Fee Grou
BAPPLOTHER ()ther Appliances MECHANICAL
BBOILERI Boiler <= 100,000 Btu MECHANICAL
BBOILER2 Boile�� > 100K to SOOK Btu MECHANICAL
BBOILER3 Boilf;r > SOOK to 1M Btu MECHANICAL
BBOILER4 Boile: 1M to 1.75 M Btu MECHANICAL
BBOILERS B��iler > 1.75M Btu MECHANICAL
BCONSTAX ('onstruction Tax BUILDING
BCONSTAX Inc/Off/Comm/Quasi BUILDING
BCONSTAXBQ Coii. Tax for BQ Zone BUILDING
BCONSTAXH :3ote1 and Motel BUILDING
BCONSTAXR Cor.stax - Resi/Mobile BUILDING
BELEC 1000 ElE c 600V <= l 000A 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 C'UPERTINO
; ��n�F pERMIT APPL][CATION FORM
CUPER
Quanti Fee ID �?ee Descri tion Fee Grou
BMISCELL l�[iscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME Nf;w Comm Electric ELECTRICAL
BNUCOMMM Ne� Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLIJMBING
BOVERTIME In,;pection Overtime BUILDING
BPBACKFLOW Atrnospheric Vacuum PLiIMBING
BPCESSPOOL Cesspool PLLJMBING
BPERMFEE B ld Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK J'lan Check Fee BUILDING
BPLANCKADD Plai Check Add Multi BUILDING
BPLANCKREP Plaii Check Repeat Fee BUILDING
BPREPIPE R�� i e Of Fixtures PLUMBING
BPSEWAGE � ewa e Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn Sprinkler/Backflo PLLTMBING
BPSTORM Stonn/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Insta 1VAlter Water Pi e PLUMBING
BPWHEATER W ater Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT F:einspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfin MECHAI�ICAL
BREMAIRHAN A/C :Jnits <= 10,000 cfin MECHANICAL
BREMAPPLI t,ppliance Install MECHANICAL
BREMBUSWAY Remodei Busways ELECTRICAL
BREMFIXT I,ighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relc Furnace > l OK btu MECHANICAL
BREMHEAT H eater Installation MECHANICAL
BREMINHOOD In� tallation of Hood MECHANICAL
BREMMISC Vlisc Apparatus ELECTRICAL
BREMNRAFP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Po] e/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Rc il, Switch & Outlets ELECTRICAL
BREMRELOCA Rr,location of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Rerr odel Res Appliance ELECTRICAL
2 �f 3
= i CITY OF C'UPERTINO
CU + PE TINO PE�IT APPL:[CATION FORM
�
Quanti Fee ID E'ee Descri tion Fee Grou
BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR The atrical Lighting Fix ELECTRICAL
BREMVENFAN Ve�it Fan Sin le Duct MECHANICAL
BREMVENSYS Vf�ntilation S stems MECHANICAL
BSCBLVD `�cb Specific Plan BUILDING
BSEISMICOM Se smic Commercial BUILDING
BSEISMICRE �3eismic Fee Res BUILDING
BSPECIAL � pecial Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Tem orary Power ELECTRICAL
BTEMPPERM Tem orar Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC liusiness License BUILDING
ELECTRIC �lectrical sq foot ELECTRICAL
EPERMITFEE Elf�c Permit Issuance ELECTRICAL
MPERMFEE 1V:echanical sq. foot MECHANICAL
MPERMITFEE Mezh 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
? of 3
CITY OF CUPERTINO
3 ITEMS OF 36 PERMI�' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: BlJ:: Lot:
APN ......... 32t;59999.11
DATE ISSUED.......: 10,'19/2007
RECEIPT #.......... BSI)00003036
REFERENCE ID # ... 07:_00151
SITE ADDRESS .....: 22:i30 HOMESTEAD RD #314
SUBDIVISION .......
CITY .............. CU]�ERTINO
IMPACT AREA ......: .
OWNER ............: HOIZEOWNERS ASSOCIATION
ADDRESS ........... 44�E FIRST ST #1
CITY/STATE/ZIP ...: LO:i ALTOS, CA 94022
RECEIVED FROM ....: DR:�EGER CONST. INC.
CONTRACTOR .......: DR��EGER, JOHN EDWARD LIC # 21895
COMPANY ..........: DRI�EGER CONSTRUCTION INC
ADDRESS ..........: 60.'i COMMERCIAL ST
CITY/STATE/ZIP ...: SAIJ 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 SCR.ATCH COAT 313 ROOF NAIL