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06080145 CITY OF CUPERTINO 4aJILDINC:DIVISION PERMIT C4')N'TI2A. TQR.�INFORMA.TION.- s xwY'x+' .vxsv„ �xs:a¢ r,w <' _ o=n4•u' °�' BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMr '06080145 11082 CANYON VISTA OWNER'S NAME: PERMIT ISSUE DATE RANCHO DEEP CLIFF HOA 605 COMMERCIAL NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PER 'BLDG ELECT PLUMBMIT PLUMB MECH 0 0 0 0 Op LICENSED CONTRACTOR'S DECLARATION lob Description V EI hereby affirm Nn 1 am liaised under pm Woes of Chapmr 9(commmcing u� with Sccsion]OfNI)afDivision 3af Nc Rusinev and Prafessium Code,and mylicc�is I.Out to. ad affect. REMOVE 3 TO 4" OF TILE, FELT & BATS . INSTALL NE Licenu lass Lk.M tnl�fptn ?�- sFr- L� TI-POUNDING FELT & BATS'. ROOF REPAIR. t v, Data Co.,..,Comrmmr , ARCHIT DECLARATION i g a 1 undcmand my plI•S ans shall be used espublic roamde )yV '0 Licensed Pmfcssional OWNER-BUILDER DECLARATION <i 1 hereby alTmm Not I am exempt from the Commenors License Law for the . Q 0 following mum.(Section 707 L5,Businessend Professions Cade:Any city am county j$9 which requites a Permit to commatct alter.tm arme.demolish,or repair any structure _ito prior as its issuance,alsomequims theapplicum for such permit to file a signed summem sy Q that beulicensed pursuanttothe Provisions ofNeContractor's LicenseLaw(Chapter 9 Sq.Ft. Floor Area ValuaC�tPEl(]8 1 (commencing with Section 7000)of Division 5 of the B haircut and Professional Code)ar $ that he is exempt therefrom and the bun,for the alleged evanpdon.Any violation of Section 7051.5 by arty applicant for a permit subject the appliomtt to a civil Penalty of ApN Number Occupancy Type nut mart than five hundred dollar(SSW} 35628032 . 00 0 1,as owner artist prepeny,or my employees with wages as their solcrompeuadon, will do the work.and the structure is nathanded araRcred forsale(Sec.7014,Business amRequired Inspections us Pmom fesslCode:The Cor mier's Licence am re Law dt apply to in owner of q P p r,euy who builds tarimprovertheroon,and who doessuchwork himselfarthrough his awn employees,provided d nsuch impmvemenu amt notimomded oraRcred for sale.If. however,the building ar imp.veor.I u mid within arc yeti of Completion.the owrcr- builder .will hart the hums.Of proving that he did ret Wild or improve fur purpose of sato.). ❑I.as owner of the properly,am esduively contracting with licensed Contractors to construct the project(Sec.7044.Business and Profession,Code:)The COeOemra U. clue law dons not apply to an owner of progeny who Wilds or improves thereon.and, who contracts for such projects with a Contracmr(s)licensed pursuant to the Contractors Lice.law. ❑1.m exempt sand"Se, ,B&P C far mu meson Owrcr Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ane of the fallowing decimation,: I ham and will maintain a CcniBeom of Consent to salf-In,ua for Warkcrs Compen- sation,u provided for by Section 7700 of the Inbar Cade,for the performance of the work for which this permit is usaed. 8'fhHvc and will maintain Wmkoes Competnnian Ina onvoc,u requ old by Sacem. 37W of the labor Code,for to,performance of the work for which this permit is island. My Workers Complaisance Wu ce an i"and Policy number art: Choier..�Policy No. �- GERTIFICATEO Policy COMPENSATION INSURANCE (ITh seclon need notal complemd if the permit is formal hundred dollen(SIM) tar leas.) I comity that in the performance of the work for which this permit is touch.I shall not employ any person in any manner m u to become subject or the Workers Compensation Laws of California.Due Appliant NOTICE TO APPLICANT:If.after making this Ccnir,.w of Exemption,you should become subject to the Worker`s Commusation provisions of the lahof Coce,you mow .JO forthwith comply with men provisions or this Permit shall be deemed revoked. z� CONSTRUCTION LENDING AGENCY (—h Itotally affirm that them is a conhruction lending ageney(or the Performance of CC r++ the work fur which this pet(nh i tumult(Sec.3097,Civ.C.) QLenders Name Z:) z Landers Addmos U J 0 1 cenify that 1 have read this application and sate met the above information is (~ correct.I agree to comply with all city and county ordinances and sate laws mlating to 0 Wilding eonatmrtion,and hereby authorim mpmmmslives afihu city to Cher uPnnthe W ahuve-rucatitmed p.,,,y far instruction p reposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rF•tN liabilities,judgmcnts,coru and C.,.rs which may to my way accmc against said City U Z to consequence of me gelding of this MMiL ^h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2- 'M!= AnN S Grt of pp�twn✓Cunwcaor —� Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle Numerical material as defined by the Cupertino Municipal Cade.Chapter 9.13,and the Realm and Safety Cab.Sacoan 255324)? / All roofs shall be inspected prior to any roofing material being installed. ❑Yes p Will the applicant or future building Occupant use aquipmcnt or&vim which If a roof is installed without first obtaining an inspection,I agree to remove emit havallou it contaminants as dc0ned by the Bay Area Air Quality Management all new materials for inspection. District? DYht Nu I have mad the coodau materials requirements under Chapter 695 of the Califon ataHealth&Safety Code,Schmas 255()5,25533 and 35]34.l undcmaand that ifthe Wilding does not currently have a tmm4 mar it is my rtspon,mllity to unify de occupant of the N4Khmosmel prior to issuance:of.CemdficateorOccupancy, Signature of Applicant Date Owner or authonsnd age., DameAll roof coverings to be Class°B° or better 4' CITY OF CUPERTINO 8 of 10 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35628032 . 00 DATE ISSUED. . . . . . . : 08/18/2006 RECEIPT 4 . . . . . . . . . : 35684 REFERENCE ID # • : 06080145 SITE ADDRESS . . . . . : 11082 CANYON VISTA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RANCHO DEEP CLIFF HOA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : DRAEGER CONSTRUCTION CONTRACTOR . . . . . . . : DRAEGER, JOHN EDWARD LIC # 21895 COMPANY . . . . . . . . . . : DRAEGER CONSTRUCTION INC ADDRESS . . . . . . . . . . : 605 COMMERCIAL ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 536-0420 WE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --BENERGY-------- --PERMIT-----FEE---- -- -----115---. -56- -- ----55--. 47-- -------0-. 00-- ------55--. 4-7- ------ -0-. 00-- BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BSEISMICRE VALUATION 4 , 208 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- - --------- ---------- TOTAL PERMIT 171 . 53 0 . 00 171 . 53 0 . 00 Q CITY OF CUPERTINO cl rN FORM CUPEI�TINO PERMIT APPLICATION -D31 0�/a h• N # 2 ' D Date: OBI e OLD 70mwner's ilding Address: B•Ja ` li Mailing Address (if different from building address): Nam V Phone#: Contractor: License#: .D9 r n 1fc (01-1L01 Contact: 1 Phone:g25'313-O UU Cupertino Business License#: �� �-Lt01Idyl Fax: 0 Building Permit Info: Bldg 2�9'0[*N Elect ❑ Plumb ❑ M h ❑ Job Description: ,\/P, 8'bq 1 Residential yCommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: L 41 �Q Occupancy Group: Type of Construction: D Please check this box if the project is a second-story addition: ❑ o'ect Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL BBOILER3 Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO _. CUPiaE o PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Stom]/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 c$n MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENU14 PP i Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heatmi MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 1. V1 CITY OF CUPERTINO CUPEt�TINO PERMIT APPLICATION FORINT Ouanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING Ah PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3