06120138CITY OF CUPERTINO 1�'=
ti:- r �.a
INFORMATIQN
'--BUILWG DIVISION PERMIT
-�-C�NTRAGTOR y
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
A
M & C ASSOCIATION MGMT
605 COMMERCIAL ST
12/21/2006
NEps' T c
SANITARY NO. CONTROL NO.
(408)536-0420
ARCHITECTIENGWEER:
BUILDING PERM" INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
1 hereby affirm Nm 1 am limned under provisions of Chapter 9 (commencing
with Section 7(00)aronviskm 3af the Business and Prefcasium Code,aM my Seth cis
REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
Lifull forte antl at.
uaeI.clas — Lk.g
NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
cmi
Date RCHITECTSDFDLAR A ON
& GRAVEL BUR.
1 unan
.fd my plans shall be used a public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby vErm that I am tempt from out Conmanoh Liecna Law far the
rollnwing recon. (Section 7031.5, Business no Pmfavions Cale: Any city or county
which myu a perulrmit m construct, alter improve, demolish, or repair any structure
prior to its issuance, also requires IW applicant far such permits Glc a signed statement
Contr wesUcene Law(Chapter9
Sq. Ft. Floor Area
Valuation
that W is licensed pursued mNcpmvisiaMofthe
$2381
(commencing with Section 7000) of Division 3 of the Businss eand Profession, Code) of
Nat he is mempt therefrom and the basis for tue alleged exemption. Any vulatian of
32652007 AM
Occupancy Type
Schon 7031.5 by arty appliMi fora permit =bjeca me gpplkant w • Civil Penalty ofNumber
net more Nan Ow hundred dollars (1500).
❑ I. u awmr of tW property, m my emplaycas with mgm u delr ale campemadnn,
Required Inspections
will do the work and rhemucwteis ant Intended arnfferad fanak(Sac. 7014, Business
and Pmfesslom de: CaThe Connector's License Law dam an, apply w an awns, of
9 P
property who builds or improves disease. and who dos wch work himself or through his
awn employees. provided Nat such Improvements art not Intended proffered for ale. If.
however. Ne building ar Improvement is sold within este year of completion, the awmry
-
builder will have the burden of proving that be did not Wild or improve for purpose or
sale.).
Q 1, as owner of the property, am cum uuvely convening wish llmesed mnnemrs an
comwn he prejen (Sec. 70", Business and Prafetdom Code) The Cutaneous U.
them Law does not apply to an owner ofpropeny who Wilds or lmpravu mcrmn, and,
who contracts forsuch projects with a caamner(s) licensed Forstmann to IW Committees
Lar n at Law.
❑ I,meaem"inachrsee .B&PCfartmonemn
Owner Dam
WORKER'S COMPENSATION DECLARATION
ereby afro under penalty of perjury one of she following declarations:
haw and will maintain a Cardinals of Cansten w self insure far Workces Compcm
mean, u provided for by Section 37M of the IaWr Code, far me performance of Ne
work for eh this permit is caused.
ave and will maintain Workers Compensation Thai u required by Section
3700 of the Labor Cade, far the performance of the work far which this permit is Issued
'
My Workers Compensation Thijurance carrier and Policy number
Cmnh'. SQA oHcy No,:
^�
�/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed Btie Permit is reform hundmA dollar (5100)
or tis.)
1 certify, that in the performance of Ne work fm which this Permit It issued. T anal eat
cTploy an)' person In cry mMMr so as w kmme subject to 1W Worker] Gampaaatian
Laws of California. Data
'
Appllcaat
NOTICE TO APPLICANT: IL after making this Certificate of Ewmption, you should
become subject an the Worker's Compensation provishom of the Labor Code, you must
forthwith comply with such powlslans or this Permit shall be deemed revoked.
ON LENDING
CONSTRUCTION
ngagerAGENCY
cmuwc.30 lending agency for tie perfumers¢ of
is a c
I WmbY>Rm Dur mere is
s
Bac wish for which this Permit is issued (sec. 3097, Civ. C.)
'
Lendcs Name
,
lenderes Adtlm..
j 1 certify Nat I have reed this application and sue that the above information is
' correct l agree to comply with all city and county eminences and mate laws miming to
building censwmion. and hereby autherie eprescmatives of min city to cmcr upon the
1 sh —nn.n ioned pmperty for inspection purposes.
(We) agree to saw, indemnify and keep harmless the City of Cupertino against
j Iiabilides,judgmenu.costa and expenses which may in any way acc= egaimt aid City
in consequence of the grading or this Permit.
' APPLICA14T U DERSTANDS AND COMPLY WITH ALL NON DINT
/ Z
Issued by: Date Z ?
SOUR E 0
Re -roofs
Type of Roof
gn umaf AppliaMConuacmr Dew
HAZARDOUS MATERIALS DISCLOSURE
WIII the applkam or future building occupant store or Nndlc haamaus material
as fic0md by the Cupertino Municipal C apkr 9.13, and the Hmlth and Safety
Code, SecBon 25532()7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding ant sex equipment or devices which
emit hmndou air camamimnu u rkOn me Bay Ama Air Quality Management
all new materials for inspection.
District?
❑Yes
I haw mail the haumousmaenais requircencros under Chapter6.95 ofthe Cxlifor-
ria Health& Safely Code, SeNo a 25503.35533 and 25530.1 understand thatifine building
Jess not currently how a tenena It i ponsiM1iliry m notify the occupant of me
rcyai me i Ikon rasa eafsemfireate pansy.
Signature of Applicant Dae
/
All roof coverings to be Class "8" or better
wnec of apmanmcd epee, ,te
• 2 ITEMS OF 2
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32652007.00
DATE ISSUED.......: 12/22/2006
RECEIPT #.........: BS000000072
REFERENCE ID # ...: 06120138
SITE ADDRESS .....: 10327 MARY AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: amyw
COPY # : 1
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
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
83.66
---------------
83.66
VOICE ID DESCRIPTION
----- ---------------------
305 FRAME
601 ROOF TEAR OFF
603 ROOF BATTENS
REFERENCE NUMBER
--------------------
101358
VOICE ID DESCRIPTION
-------- ---- -----------------
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS
•
0
IFS°
CUPERTINO
CITY OF CUI'ERTINO WPM
PERMIT APPLICATION FORM
APN -
_ 2
Date:j7lLila�
Buildill! (Address.
—
Owner :; Name: _)
Phone #:
Coll ll',(,101 :
License fi:
BSEISMICRE
Contact: J
Cupertino Business License #:
C
Type of Roof Covering:
BUILDING
Gsisfing;: Propo�l:
BPLANCiIK
U IImil-Up lwol
® Built -Up roof
❑ ,Asplrilt Shin �Ies
❑ Asphalt Shingles
A wood Shakcs
Cl Wood Shrikes
C) wood Shineles
❑ Wood shingles
❑ t)thcr lShcuil\')-- --
❑ 0 th er( S pec i ly)
iJumhcruf csisiing cnacrings ---
_
❑ Prov ide l.C.B.o. Report l{
W� l o he Removed
❑ Provide Mfgr, Installation Specs. —
,/.
I I lave Read, Undcrsland end Will Comply Wilh Cupertino`s'fear Off Policy:
.lob Dcsct'Iption:
Residcnlial 0� Commercial ❑
-
Fire ZonC: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost ol'Proiect: Type of Construction:
Occupancy group:
�' azv .06 0 r) r.r7
Qi f
Applicable
Fee I D
Pee Desc ip(ion
Fee GPOn J
---_ —
_
111) 1:mFG6
Blcl F ermit Fccs
BUILDING
1317NF-RGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISNIICONI
Seise tic Commercial
BUILDING
L----- _
BPLANCiIK
Plan Check Pee
BUILDING
__—.__
BUSLIC
Business License
BUIC.DINCi