06120140 ,�u OFCUPERTINO y, x.�
11 No DIVISION PERMIT CdlN'['RA.C.�'Tl`IR'I 'kflXZ1VlA. 7 1�I
...?..i.-
BUILDING ADDRESS: PERMIT NO,
OWNER'S NAME: - PERMITISSUEDATE
Ag1kM & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
gEPnI TT'v o -(408) 536-0420 SANITARY NO. CONTROL NO.
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMH MECH
a 0 0 0
Op LICENSED CONTRACTOR'S DECLARATION 70b DDSCIIpIIOn
w I hardly affirm that 1 am licensed under provisions of Chapter 9(commencing
�Z with Seen.. Division 3 of the Business and Professions Code,and my license is REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
in full force and e e O
Iq? License Cl Lic.N� NEW 3/8" CDX OVER EXISTING 3/8" COX NEW 5 PLY TAR
y Da¢ Centocor a^
RCHITECTS DECLARATION & GRAVEL BUR.
1 on emiand my plans shall W used as public records
typ
10 License)Pmfcssisnel -
OWNER-BUILDER DECLARATION
:0 I mono .(Item on 1 am cBumpt from to Contractor's License Law for the
p O following massa permit
a](1315,Business and Professions Cade:Any tiny or county
%Q which inquires Issuance,permit re tonNum.alter.improve,h pamilt nr¢poli any tWment
?it bares inensed arsereto the thin applicant for aehpermilm censeilc LawJnatemcm
(commencing
wit pursuant to the pro visions of No Canusinesss License Law(Chapter Code)
Sq.FL Floor Area Valuation
[�O 'at he Is eta pttSection]000)th hanisofrth alegedAsumpton.Anand yavi CddeJ of $2381
$ Nat he r exempt therefrom and the aper for the alleged Assumption.to Any violation of
Section than
five
airy red d.l for a permit subjects the applicant m a civil penalty of Number Occupancy Type
non more Nan fiw hundred dollars(5500). 32652003
❑h As owner of the property,or my employers with wages As their sole compensation,
will do the work,and the swcture is not intended or offered for sale(Sec.]0/4,Business Required Inspections
and Professions Cade:The Contractors Lieemor Law does not apply m e ns an owner of Q P
propuny who build,mimprova thereon,and who daosuch wahhimself or through his
own employees,provided Nmsuch Improvements Arer riot intended aro@red forsale.If,
however.the Wilding or improvement is said within can year of compledon,Ne owner.
builder will have time burden of proving Nat be did amt Wild or improv for purpose of
sato.).
❑1.As Owner of Ne property,am exclusively contracting with licensed contractors to
construct in.project(Sec.7004,Business snit PmRssians Code:)The Communes Li.
came Law it=not apply is an owner of property who Wilds or impmwa Norton,and
who contracts for such projects with a contractor(s)licensed pursmnt no the Contractor'
License Law.
❑I oro exempt under See ,B A,P C for this reason
Owner Data
ORKER'S COMPENSATION DECLARATION
tI y arm under penalty of perjury oste of the following declarations:
ave and will maintain a Ccnificem of Con ire,m selGinsum for Workers Comped-
�n,daz pravjtletl for by gecuon 3]00 of Ne tabor Code,for Ne perfonnuim of Nc
wo — eh Nis permit is issued.
ave and will maintain Workers Compensation Insurance,in required by Section
3700 of Ne Labor Code,for the perfarmana ofthe work for which this permit is issued. '
My Workers CnmPenaation umna artier and Policy n�us�/bei are:
Cartier. uN.D Pat.-,No.; //3
CE TIFI ATE OF FJ(EMMON FROM WORKERS'
COMPENSATION INSURANCE
('this section need not becomplered hither permit is forone Wndscddollan(SIM)
or loss)
I cenify Not in the performance of No work for which Nis permit Or issued,l shall not
employ any person in any man uar.so as in become subject o the Workers'Compenation
Laws of California.Data
Applicant
NOME TO APPLICANT:If,alar making this Cenifaate of Exemption,you should
become subject in the Worker'Compensation provisions of to Labor Code,you must
,JO foMwith comply with such provision or this permit Shell be deemed revoked.
z CONSTRUCTION LENDING AGENCY
4 I heathy affirm that Nem is a conswNnn lending agency far the performance f
Oa.> In,work fur which this permit Is issued(Sec.3097,Civ.C.)
�W Q Leader's Name
z Lenders Addreu
U 0 1 conif,that 1 have read this application and suite dust the above infonnsumn is
fy f+ contact.1 agree no comply with all city and county ordinances and stare laws misting no
0 U Wilding construction,and hereby authmim representatives ofthis city to enter upon the
W shove-menhuned property lb,inspection purposes.
(We)agree to save,indemnify and keep harmless the Ciny of Cupertino agaims
sHy cAA liebilities,jidgmemacosls and expenses which may in anyway scant against said City
U z in consequence of the gmntidg of this permit.
APPLIC ERSTANDS A LL Y WITH ALL NONP NT Issued by: Date 2 •-Z't��
SOUR U ATIONS.
Re-roofs C7 ��—
oglimikum,orApplicangComoselor fDa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or forum building occupanlstort m handle hazardous material
As defined by the Cupertino Munici 1 Csit Chapter 9.12.and the Health and Safety
Code,Sterna 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Ya
Will the applicant or future Wilding occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
cont hazamnus air conteminants u Jefm thy the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes is
Ihave,Safer Code,amuses materials myviad255rvems unJer Chapter
tand that ofor Calding
nr Health urSafcry Code.Sections2550.5, M; and 8534.1 understand the
building /v/)
Jots not currently hew a tenant.Nat it is my nsihiliny m nrotil'y tiro attupant of
require r i beaten wI ad sC &.frcateofOrap cy. Signature of Applicant Date/
ownor nr wmnnve ,gem / Da - AI I roof coverings to be Class"B"or better
ry
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32652003 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000074
REFERENCE ID # . . . : 06120140
SITE ADDRESS . . . . . : 10319 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1338
RECEIVED FROM . . . . : RECEIPT INTERFACE
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
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2, 381. 00 83 .16 0. 00 83 . 16 0 . 00
BSEISMICRE VALUATION 2, 381. 00 0. 50 0. 00 0. 50 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 83 . 66 0. 00 83 . 66 0. 00
.METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 83 . 66 101358
---------------
TOTAL RECEIPT 83 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF. 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
P,Mai I
-c', ' CITY OF CUPERTINO
r.;00 MKIZ0091,
t HY Of
CUPERJINO PERMIT APPLICATION FORM
17 Date:
37-u -5-2- -003
Building Addrowsm,
N-1111 , -------
lit, el 111, �-6 Phone
n VV Voy�� �1
CO)I I i"Ic to r: Licensc #:
Contact -) Cupertino BUShicss License #:
Type of Roof Covering:
Proposed:
U ANAah Shkgks 0 AsQwhShkgks
A Vad Shakes El Wood Shakes
U Wo"d shhl�'Ies 0 Wood Shingles
❑ ()[11c, El 011m
Ci Provide I.C.B.O. Report I/
C.7r Ta he RC111m,ccl L) Provide MI'gir. Inslnllatinn Specs.
• Unclersumd and"OH C()jjjpjy With CUpoy!Q'S "Fear CUT p0hey: R'
101) 6-usmPnon:
Commercial
_F11v"Z(v11_e Yes [I No El Confirmed with Planning Dept. if
Mere are any restrictions: ❑
Cost_:I F-1-11oli cct Type 0CC011StRJCti()11: OCCUIX111CY gI'()Llp:
App licahle Pee D Fee Description He Group
c
BPERNAFEE, Bldg Imm"I 1 Pecs BUILDING
' 1.111
BENERGY Energy BUILDING
BSEISMICRE Scismic Fee Res BUILDING
I
BSFiISMICOM scismic Commercial BUILDING
BPLANCHK An Check Fee BUILDING
BUSLIC BUShICSS UMISC BUILDING