07100150 CITY �F CUPF,RTINO ' '
BUILDiNG DIVISION PERMIT ���k� ��:�� �����T '
,
, ,.. ,.- _ _.::::. .:_.
BUtL a► �� c � ES �OMESTEAD RD # 311 DRAEGEF CONSTRUCTION INC P � R 071 O 015 0 ,
PfiRMIT ISSUE DATE
1ER'S NAME:
HOMEOWNERS ASSOCIATION 605 CONMERCIAL ST ' 10/19/2007
SANITARY NO. CONTROL NO.
PHONE:
ARCHITECC/ENGiNEER: BUILDING PERMIT INFO
RMV ANI� REPLACE LIKE FOR a�oc ELECT PLUMB MECH
0 � 0 0
; o o LICENSED CON7RACTOR'S DECLARATION ^, �_,,, r _ _„ JOb DeSCilptlOil
� V� ( hcrcby �rm that [ am licensed undcr provisions oC Chaptcr 9(cammcncing
; z� wiih Scction 7000) of Division 3 0( thc Busincss and Protcssiuns Codc, and my liccnsc is
;� y in fuli forcc and ef( t /� 1� 6�,p
� v� Z Licensc Clasa � Lic. # 1 (/ � -
: �„ ❑ Datc Conuacy�r IL_ b�.'V N�
� ARCHITECI'S DECLARATION
7 a Q 1 undcrs�an�i my �lans shall be uxd as public rcconls
)yU
' u. �"' Liccnud Pro(cssional
` � < OW NER-BUILDER DECLARA'C10N
'}� i hcrcby alfirm th�� 1 am cxcmpt from thc Conuaccors Liccnsc Law for �hc
� p O Collowing r: ason. (Sccdon 7(Y31.5, Busincss and Profc.ccions Codc: Any city or county
t°„ Qi which rcquires a pertnit to conswct, altcr, improvc, dcmolieh, or repair any suuaurc
°"' y prior W il� issuance, also ecquires �he applicant for such pertnit to file a signed sta�ement i, Valuation
�_< that hc is liccnscJ pursuant to thc pmvisions of thc Conuactor's Lic-�nsc Law (Chaptcr 9 .� Ft. Floor Area
r F- $(commencing with Scction 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or
y�.. ihat he is exempt the�c(rom and ihe basit (or Ihe allegcd exemption. Any violadon ot
Section 7031.5 by a�ry applicant for a pumit subjects �he applicant to a civil penalty of APN Number Oeeupaney Type
not more than five hundred dollars (5500�
❑ I, u owncr oC tt�e property, or my employces with wages az their sote compensation,
will do ihc wark, and the swctuce is notintended or offered (orsalc (Sec.7044, Busi�ss Required Inspections
and Professions Cade: The Canuactor's License Law dacs nut apply to an owner o(
property who builds or improves thercon, and who does such wark himselCor through his
own employces, providcd that such improvements are not intended or otCered for sala If,
however, �he building or improvement is sold within one yesr oC complction, U�e owner-
builder will have �he burden oC proving �Aa� hc did no� build or improve for pmpose o[
salc.).
❑ I, as owner o( �he pcoperty, am eaeclusively contracting wi�h liansed conuutars w
conswct the projm (Sec. 7044. Business aad ProCessions Code:) The Contnctor's Li-
cense Law docs not apply to an ownu o( propeny who builds or improves ihaeon, and .
who convacls [or such projects with a conlractor(s) Iicented pursuant to Itte Conuactar's
License Law.
' am exempt under Sea . 8& P C for ihia reasan
_ ..ner Date _ .
WORKER'S COMPENSATION DECLARATION
1 hercby aflirm under penalty o[ pe�jury one of the follawing declaraGons:
❑ I hsye and will maimain a Cenificate of Canscnt to self-insure for Workers Compen-
sation, u provided far by Sectian 3700 of the Labor Code, for �he performance of the
work for which this permit is issued.
❑ I havc and will maintain Workcrs Compensauon Insunnce, as requircd by Scction
3700 of �he Labor Codc, Cor thc performance of �he work for which this permit is issued.
My Warkefs Com In ncc carricr and Policy number are: f^ O
Carrier. �^� �+ y� �� Poliey Na.: � I W�i � Z �� V�
CERTIFICA7E OF EXEMPTION FROM WORKERS'
COMPENSATlONINSURANCE �
(fhis secUon need not be complctcd if the pertnit is for onc hundred doilars (S t00)
or IcssJ
I cenify �hct in thc performancc of thc work for which this permit is issucd, t shalt not
employ any persan in any manncr so u w bccomc subjcct to the Workcrs' Compcnsation
Laws of Calitomia Da�c
Applicant
NOTICE TO APPLICANT: If, a(�cr making ihis CcniCcatc of EzcmpGon, you should
become subjcct to �hc Workcr's Compensadon provisions of ihc Lalwr Code. you muu
� O foMwi�h comply with such provisions w this pecmit shall be decmed revoked.
z ""' CONSfRUCT10N LENDWG AGENCY
�� I hcrcby aftirtn ihat there is a conswction Icnding agency lbr the perfortnance of
a, .� thc wurk for which this permit is issucd (Sce. 3097. Civ. C.)
[L� Q L.endcrs Namc
� � L.cnder's Address
(� � 1 certiCy �hat I have rcad this applica�ion and sia� Ihat �hc above infortnauon is
��'" correct. 1 agrce to comply with all city and county oniinances and sute laws relating w
rJ U building conswction, and hc�cby authori�e reprcscntativcs of �his ci�y to cntcr upon thc
�� ahovc-mcnlioncd property for inspccuon pur�wses.
(Wc) agree to save, indcm�ify and kecp hazmless ihc Ci�y of Cupertino against
U z I�abititia, judg nts, cos�s and expenscs which may in any way accruc agains� said City
in co nc o �hc rantin of Ihis rmit.
�-+ APPLI U DERSfANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � � "��
SOURC U AT[ON .
0 ��Q - a 7 Re-roofs ��
Sign o(Appli o � of R�of
OUS MATERIALS DISCLOSURE TYP
�11 thc appli r futurc building occupant storc or handlc harardous ma�crial
cfincd by tlu Cupenino Munuipa Codc. Chaptcr 9.12, and the Hca�� and Safety
.,� ,Scction25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Y� � .
Will the applicant or futurc building occupant use eyuipment or devices which
If a roof i;� installed without first obtaining an inspection, I agree to remove
cmit harardous air con�aminan�s u dc d by the Bay Arca Air Quality Managcmcni all new m aterials for inspecr_ion.
oistrict? .
❑ Ycs No
I havc the haiardcws matcrials rcquircmcn�c undcr Chap�cr 6.95 o(ihc Califor-
nia & S y Codc. Sc uoat 25505, 25533 and 25534. I undcrstand thaz i( �hc building
d n u nan[, �hat it i� my responsibility w notify U�c occupant of thc
rcy� ni st metpriortuissuancco[aCenificateofOccupancy. ` Signature ofApplicant Date
� All roof coverings to be Class "B" or better
cr authorize n Datc
� CITY OF C'UPERTINO �� � `� � � � �
:�.
�
- �►�oF pERMIT APPL=[CATION FORM
CUPEf�TI(�O
APN # Date:
a���aaar� ��-��_o,
Building Address: Mailing Address (if different from building address):
223�� � sr � tzr� v�t � 3 � t
Owner's Name: Phone #:
1 r-q t�0 �'� IC- rL 11-sSo G �� Ti o J �-�' 0�- S 3 b-�o � z o
Contractor: License #:
�� .(r� _ C�ONST'('t.J L'�o J � �l C. �z. c�t _ 6`f � ���O � � �
Contact: Phone: 4�'O� -u �-�o Cupertino Business License#: G /
�OU 1� K�2'�'-'`�� t�Z Fax: �-!� o � -5'3 �> -o �3 �� 4 r .�
Building Permit Info:
Bldg Elect ❑ �'lumb ❑ Mech ❑
Job escription: �1����� A^�'� �GP���'� �� �i� �Q� L��-K=
Residential f,� �A �"i $, � � � (.� (� �.'C� v � • Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
l�� S� r—�
Cost of Project: Occupancy Group:
S'$ a� —
Type of Construction: Please check this box if thg project is a
second-stor addition: �
Project Size: Standard Large ❑ Major ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER ()ther Appliances MECHANICAL
BBOILERI Bo: ler <= 100,000 Btu MECHAI�TICAL
BBOILER2 Boile -> l 00K to SOOK Btu MECHANICAL
BBOILER3 Boil�;r > SOOK to 1M Btu MECHANICAL
BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL
BBOILERS B�iler > 1.75M Btu MECHANICAL
BCONSTAX (:onstruction Tax BUILDING
BCONSTAX Inc VOff/Comm/Quasi BUILDING
BCONSTAXBQ Co:i. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Co�istax - Resi/Mobile BUILDING
BELEC 1000 Elr,c 600V <= l 000A ELECTRICAL
BELEC1001 E: ec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD F,nergy Add Multi BUILDING
' BINVESTIGA :nvestigation fee BUILDING
1 of 3
- � CITY OF (rUPERTINO
* ��n�F pERMIT APPL=[CATION FORM
CIJPfR,�TINO
Quanti Fee ID Fee Descri tion Fee Grou
BMISCELL TZiscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME N�,w Comm Electric ELECTRICAL
BNtJCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP r ew Comm Plumb PLLTMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW At�nospheric Vacuum PLLIMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE ��ld Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Ga: Piping System Fee PLUMBING
BPINTERCEP Inc� Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plai Check Repeat Fee BUILDING
BPREPIPE R�� i e Of Fixtures PLUMBING
BPSEWAGE ��ewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lav�n Sprinkler/Backflo PLtTMBING
BPSTORM � torm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BPVENT A: t of Drain & Vent PLUMBING
BPWATER Inst��lVAlter Water Pi e PLUMBING
BPWHEATER W ater Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT lZeinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfin MECHAI�TICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI .�ppliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT I,ighting Fixtures ELECTRICAL
BREMFURN Re: ocation of Furnace MECHANICAL
BREMFURNOV Relc► Furnace > l OK btu MECHANICAL
BREMHEAT �_eater Installation MECHANICAL
BREMINHOOD In;�tallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Po e/Platform Fixture ELECTRICAL
BREMPOWER PowE r Device/A aratus ELECTRICAL
BREMRECEPT Rc �:1, Switch & Outlets ELECTRICAL
BREMRELOCA R:location of Hood MECHANICAL
BREMREPALT Re pair/Alter Heating MECHANICAL
BREMRESAPP Rerr�odel Res Appliance ELECTRICAL
2 of 3
� � _� � CITY OF C'UPERTINO
�:
CUPE TINO PE�IT APPLJ[CATION FORM
�
Quantit Fee ID :F'ee Descri tion Fee Grou
BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR The atrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHANICAL
BREMVENSYS VE ntilation S stems MECHANICAL
BSCBLVD `�cb Specific Plan BUILDING
BSEISMICOM Sei smic Commercial BUILDING
BSEISMICRE ��eismic Fee Res BUILDING
BSPECIAL �pecial Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Tem orary Power ELECTRICAL
BTEMPPERM Tem ora Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC liusiness License BUILDING
ELECTRIC :�lectrical sq foot ELECTRICAL
EPERMITFEE EIE�c Permit Issuance ELECTRICAL
MPERMFEE 1V:echanical sq. foot MECHANICAL
MPERMITFEE Me �h Permit Issuance MECHANICAL
PPERMITFEE Plu:nbin Permit Issue PLUMBING
PPLBG Pl»nbing 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: B11;: Lot:
APN .. ....... 32i>59999.10
DATE ISSUED.......: 10,'19/2007
RECEIPT #.........: BS�)00003036
REFERENCE ID # ... 07:_00150
SITE ADDRESS .....: 22:330 HOMESTEAD RD #311
SUBDIVISION .......
CITY .............. CU:?ERTINO
IMPACT AREA .......
OWNER ............: HOI'IEOWNERS ASSOCIATION
ADDRESS ..........: 44�1 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'i COMMERCIAL ST
CITY/STATE/ZIP ...: SAl1 JOSE, CA 95112
TELEPHONE ........: (4�)8)536
FEE ID UNIT QUANTITY ;�'IOUNP 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 FR.AME 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
Community Development
x` � ' 10300 Torre Avenue
� '`;,�. , Cupertino CA 95014
Telephone (408) 77�-3228
C1TY OF Fax (408) 777-3333
CUPEt�TINO
Buildi:n De artment
JOB ADDRESS: PERMIT # � � ( � �' �
223 � Nro ►� �-�r �� �a .
OWNER'S NAME: �p w( ���s �,Sp �c�•TiQ J PHONE #�-� �-� 3 6- o y- z0
GENERAL CONTRACTOR: X�rl,q ��2 Cr��f � FAX #'-�o �-- � 3 c - o� Z�
I am not using any subcontractors: . �°- 0 V �-{ � O�. °� -�-(
Si�;na e Date
Please check a licable subcontractors and com �let followin information
SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
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
� (�J N 1 o'I°l- o�
Owner/Contracto i ature Date