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03060071 (2)CITY OF CUPERTINO "°x a^xdt 3 '- , NFORMATIO�NN, BUILDING DIVISION PERNIIT OWNTRAc�fTQR . BUaDINC ADDRESS: 11272 QR DRAEGER CONSTRUCTION INC PERMITNo.03060071 OWNER'S NAME: 605 COMMERCIAL ST rEeMrr 69A/%9/2003 NE: (408) 536-0420 SANITARY NO. CONTROL NO, ARCHITECT/EbIGINEER: BUILDING PERMIT INFO BO ELECT PLUM B MEOCH . LICENSED CONTRACTORS DECLARATION t I aunder provisions of Chapter 9 (Commencing 1 Itenby affirm Net m limned Job Descript�t with Section 7000) of Divldon 3offtnuygce�and Professions Code. and mylicenab �+ Lfull fo¢dwOtJ�TRcI. ✓ Lieenxe la 'CZL� - Dam— ^t nvjL SIDING L�� ARCH LIRA ON iuntlenund ORIG.#02100047 EXPIRED QUG 2 7 HALF FEES PAID (06/09/2003) 2oa3 mypWssNll rte used upubit. rremdi Licensed P.f..i... I OW NER-BUILDER DECLARATION BUILDING I hereby am. that Earn acmpl from the Cantrmtor's Licmnu Lew far the following honor. (Section 703 1.5, Business and predications Code: Any city of county which requires a permit to convect, alter, improve, demolish, or repair any structure prior to its issuance, also requites the applicant for such permit to Glc asigne i mammcnl Nat m is licensed pontoons an the provisions of she Character's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing wish Secllms 7000) of Division 3 of the Business ane Normal.. Cost) or that be I. exempt lbe.from and the bais for the alleged exemption. My violation of APN Number U0#&Qy TYpe Section 7031.5 by any applicant fore permit subjects she appllunl to a civil penalty of not mom than five hundred dollen (5500). I,aownerof Ind property,or em ployeswishwageutheir vele rompenutian, - Required Inspections I, 7044. 1111111howner of will dathe wart, and sheat.eta¢bOut and Profeta Come: The Convuror's License Law Ores ret apply lf owner rsLieeaerawdort,.1 apply q, P t is progeny who builds orimprow Nereoe,and whodaea such week himalfu through Ms bis awn employees. provided that such improvements she rat intended oronemd forst If. 101 — FOUNDATION however, the building. improvement is sold within ane your of completion. the Owmr- bullcim will have dm burden Of proving that he did not Wild or Improve for purpose of 102 -. PIERS nate')' 103 - UFER 0 I, ss Owner of Its, property, am aeluabely contracting with licensed contractors to REBAR construct dM project (sec. 7014. Business ad Profestio. Code:) The Gnaacmr's Li. 104 — cera law does not apply m an owner of property wed Wilda or Improves Nehmen, and 105 - ANCHOR BOLTS who concocts for such projects wish acomrsc o (s) licensed pursuant N she Contractor's License Law. 106 - SEWER & WATER ❑ lamaemptumer Sem. ;B&PCfarthisreaon 202 — UNDERFLOOR PLUMBING Covent Data 203 - UNDERFLOOR MECHANICAL 204 — UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I lumbyamrm under penalty of perjury am of des following tleclantio.: 205 — UNDERFLOOR INSULATION I have and will maintain Certfbate of Cement to elf-l.um for worker's Compos- union, u provided fa by Section 37M of the labor Code. fm the porronnamx of the 301 - ROUGH PLUMBING work ret which this permit is issued. _ 302 - TUB & OR SHOWER 0 I have and will maintain Worker's Compensation Insurance. u required by Section 3700 of the labor Codc,for the performance of one week for which this permit is issued. 303 — ROUGH MECHANICAL My worker'.Campe.adool.. e.t ierad Policyoumberam: 304 — ROUGH ELECTRICAL Car Or` e1yQyla.: 305 — FRAME CERTIFI FFXEM QN FROM WORKERS' COMPENSATION INSURANCE 306 - HOLDOWNS ffhh so.tha end not hecomplemd if she permit is Earn. hundred radiant 307 - INSULATION arlma.) 308 - SHEETROCK 1 anify that in Ne performance of the work far which this Permit is issued, I Nall not employ any person in any manmf so a m become subject retie wokc rn'Campasation 309 - EXTERIOR LATH Laws of California. Data 310 - INTERIOR LATH Appliant 311 - SCRATCH COAT NOTICE TO APPLICANT: IL after making this Certificate of Exemption. you should became subject N the Wodeer's Compensation provision, of the Lane, Code, you most 313 — ROOF NAIL forthwith comply withsuch provisions or this permit Mall he dmmcd revoked. 501 - FINAL ELECTRICAL ENERGY CONSfRUCT10NLENDINGAGENCY I hereby storm that Nen iso co.trmdnn kndingagemy for dap mirarmamcar 502 - FINAL PLUMBING ENERGY - am arwhich Niepermituiumd (See .J097.Ch, CJ lender's Undoes Name 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY Lender's Adema Ianify Elan 1have read ads coup andpatethat is abovews 505 - FINAL ELECTRICAL county totaling ty and cesnd sun hest relating m bonding I agree N comply with all city nttlinumnnd building mnatroction, and hereby wNarin representatives of abs city mentor upon 0e ri — GAS TEST above-mentioned pmpcny far inspection palpasGl 0 F I (We) agree to ave, indemnify and keep harmless the City of Cupertino against Ilabllitia,judgments, costs and exposes which may in any way... against said City C ICAL 7 in conxegmncc of the Sanding of this Permit. APPLICANT UNDERSTAN AN ILL COMPLY WITH ALL NON -POINT Issued by: 5 Date 7 S E REGU 0 Re -roofs 514 INAL PUBLIC WORKS Type of Roof ' - sigmaurea le -memter Data HAZARDOUS MATERIALS DISCLOSURE Will rite applicant or future Wilding occupant slot of hanele harardou, ata read a donned by the Cupertino Municipal Code. Gepter 9.12, and the Health and Safety ale, section 25532ay? ❑Yea All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove wtu IM.ppOmanl ter (ulu c banding occapant use egalpmat or aevtees wmeb it haruanu air Contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. isvittT 0Y. �o 1 have road the haardrus materiels requirements under Chapter6.95 of thc Califon nice Health&SefcdyC^dn5ccdo.M505,25533.d25534.1undcmand Nedifdx Wilding dna not euovntiy how a moa. u my responobilhy m Cory led occupam of ac mgnirepgtswmen amm�nC atehr mpaey. Signature of Applicant Date All roof coverings to be Class "B" or better owner or radon r agent am CITY Or CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM /��7� RJ � 71 PKPN # Date: Fee Group BAPPLOTHER Building Address: '1673 iDr Owner's Name: Phone #: C /0 Contractor: License #: C Gt Contact: Cupertino Business License#: Boiler > 500K to 1M Btu MECHANICAL Building Permit Info: Bld Elect ElPlumb ElMech ElJob escription: Residential Commercial El q.Ft. Floor Area: $/Sq.Ft.: c� .Gid Cost of Project: Occupancy Group: —i o BUILDING e o� nstruction: Con. Tax for BQ Zone � Q BCONSTAXH i Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BEN VESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 Cm o !'1 IDrDTIkin CITY OF CUPERTINO PERMIT APPLICATION FORM 2of3 Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 Issuance PLUMBING PPLBG Plumbing F e sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 j4 Pon 2 of 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36651061.00 DATE ISSUED.......: 06/09/2003 RECEIPT #.........: 22101 REFERENCE ID # ...: 03060071 SITE ADDRESS .....: 11673 SEVEN SPRINGS DR SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OPERATOR: conniew COPY # : 3 OWNER ............: RAYMOND CHAN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5.128 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 TRT.RPHnNR _____ (4np)rlr-n4?n MEE ID UNIT QUANTITY --------------------------------- BENERGY PERMIT FEE 177.00 BPERMFEE VALUATION 12,000.00 BSEISMICRE VALUATION 12,000.00 TOTAL PERMIT : METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : J AMOUNT ----- 374.65 374.65 AMOUNT PD -TO -DT THIS REC 26.55 0.00 26.55 88.50 0.00 88.50 0.60 0.00 0.60 115.65 0.00 115.65 NUMBER ------------------ 101940 0.00 0.00 0.00 0.00