06120136 CITY OF CUPERTINO �a,g� /� �.ry' y��TT�s 'rv�a�a,g�♦ I
'&ILDIN5 DIVISION PERMIT ICON7CRA T,nR TSI.R'OL�UAT-1,0
BUILDING ADDRESS: PERMIT NO.
A
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
HEaans 7T nor SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEE0.: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pp LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 beraby a1Brm that I am licensed under provisions of Chapter 9(commencing
i Atwith Section 7W0)afDiviamm 3 of the Business and Professions Cade,and my is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
in full forte antl (I
;�i Licen.elms Lm.a NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
Vi t- Dam _ Contrazor �
ARCHTI'ECI'A DECLARATION St GRAVEL BUR.
i tun stand my plans shall be used u public meet,
iy
C y Licensed Professional
OWNER-BUILDER DECLARATION
q 1 hereby affirm Nat I am exempt from the Contraztor's License law for the
:00 following mann.(Section 7031.5,Business and Professions Cadc:Any city or county
9 T which mquires a permit a ennsauct,nlmr,improve.demolish,or rePat,any sanctum
�Za poor m is issuance.also mquiras the applicant for such permit to File a signed statement
e
that he is licensed pursuant the provisions of the Dominant's License law(Chapter 9 Sq.Ft. Floor Area $2381
Valuation
a (commencing with Section 7000)A[Division 3 the B usineu and Pretentious Code)or
15
— Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of pptat Number Occupancy Type
not mart Nan five hundred dollars(M). 3 2 6 5 2 011:tl Cl'
0 L asowner of the property.army employees with underarm their aecompensatian,
will do thewark,and the swnum is nmtimmndcd watered f...I.(See.7014.Bmineu Required Inspections
and Portland...Code:The ConmazmrY License law does not apply a an owns,of e q p
Property who builds ar i mpmvm thereon,and who does such work himulr ser through his
awn employees,provided mut.ch improvements are not intended oro@redi farsam.If,
however,the building or improvement is mid within am year of completion.the own o,
builder will have the burden of proving that he did not build or improve for purpose of
.tile.).
0 1.as Owner of the property,am exclusively convening with licensed conaactou to
convect tits project(Sec.70".Business and Professions Code)The Convecar's Li-
cause law does not apply As An owner of pmFny who builds or improves thereon,and
who convects for such projects with a canlrmarm)licensed pwamnl a the Contratux's
License Law.
0 two exempt under Sec. B h P C for this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
1
I,stairs under penalty of perjury one of dm fallowing decmauans:
eve snit will smaam.Certiftare of Co..nGo self insure for Workers Compete -
se tan,us provided for by Section 3700 of the labor Cade,for the performance of the
work for w ieh this permit I.issued. -
an and will maintain Worker's Compensation Insurance.ss required by Semon -
OOOf dte labor Code,for the performance of the work for which this permit is issued.
My walker's C,om�enymtioViIsumnaCarrier and Policy numberami �q
Carier�.�//G ka At 0Policy Na.: �w 1 "C!�'
CERTIFICATE OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(This section need not he completed if the permit is formic hundred witars($100)
nr Imo.)
1 certify that in the Performance of me work for which this permit is issued,l shall not
employ any penton lusty,manner.As a become subject o the Workers'Cmumnex abm
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Oci ifcate of Exemption,you should
become subject in the Workers COMPossawn provisions of the Labor Code,you most
.,Q forthwith comply with such provisions or this permit shall be doomed revoked.
? CONS7RUCf10N LENDING AGENCY
'fr I hereby affirm mat there is a construction lending agency for the Performance of
CL> the work for which this permit Is issued(See.3097,Civ.C.)
W�A Lcndcr's Namc
Lender's Address t
U Q 1 certify that 1 have mad this application and sate Nat the above information is
C4 F^ COMM I agree to comply with all city and county ordinances and state laws minting to
U building conswction.and hereby authori,e mpmalamaloas.Rats.any to enter upon the
W ahovc-memioncd Pmperty for insPccuon purposes.
(We)agree to save,indemnify and keep harmless the City of CupemnO against
ti ti IieriliinajudgmcnB.colts and expenses which may in any way accme against said City
U z in consequence of the granting of this permit.
ti APPLIC DERSTANDS DWI PLY WITH ALL N N-POI Issued by: Date
SOU R
a Re-roofs
ig cot ApplicanUContrazar 11 Oe
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mum building acupate 9.1 or handle Heardous material
As defined by 0te Cupertino Municipal ,Chappter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes bxlrol
W01 the applicant car future building occupant a.equipment car devices which If a,..fans.installed without firs[obtaining an inspection,I agree to remove
emit havardous air contsmin m u defined the Bay Area Air Quality Management all new materials for inspection.
District?
0 Ya /J
Ihave real the m,Socu es V550als,25533 men 534.1udiapmrb.9al Cali(or.
iia Health ur Safety rade,mnmnshe it i 25531 534.1 to noddy
t eaz if the building O�
docs not currency have a¢nano Na it is m s ihility to notify dm occupant of
requite hmet rm' Ada Ccrdnamorocap ignatureofApplieant Da[
.wane,or aam.nvetl assns / Dmo All roof coverings to be Class "B"or better
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw ,
COPY # 1
Sec: Twp:. Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652011 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000070
REFERENCE ID # . . . : 06120136
SITE ADDRESS . . . . . : 10335 MARY AV
SUBDIVISION . . . . . . . _
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1339
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
•
CITY OF CUPERTINO
CUPERYINO PERMIT APPLICATION FORM
F,Pi`' Date:
�iiidim, \Ckgi
13
0WHL'IF Phone 4.
colill"mor
License #:
L01 / CO IO
Contact: -
Cupertino
-tilO BUSi1CSS License !�M
Type of Roof Coveriia:
Existiiw: Prop�Tl:
-J tuill-[Jp koof roof
,Asphalt shlm,[Cs Q Asphalt Shingles
• Wm,d slmkus El Wood Shakes
• Wo''d shill'u'le's 0 Wood Shingles
)dhcl (spcCil*\) Ll Otha(Spucify)
ol c.Nislm 0 PrOVidC I.C.13.0. Rcport 8
U7� Tri he Rcillovc(l U Provide Mfgi. Installation Specs.
ave Read. jilderstand and WiH C0111Pl)' With CUJ)Cllillo's Te2l' Off Policy:
lob DL:S(.j'jj)tj0jj:
, I _ �) \�,�
Residential Commercial
Pirc Zone:—Yes 7 No ❑ Confirmed with Planning Dept. iC
there are any restrictions: El
—Cost 7A-1—'1—o—JcCt: l')'Pe of Construction: OCCUIDaIlCy g['OLI]):
Fee 11) 17 cc Description 1-ce Group
BICIg Permit rccs BUILDING
BENE'RGY Ener€;y BUILDING
ly
BSEISN/11CRE Seismic Fee Res BUILDING
BSE'ISMICON/1 Seismic Commercial BUILDING
B )LANCHK Plan Check Fee BUILDING
BUSLIC BLISillOSS LiCCII.Se
BUILDING