Loading...
06120150 CITY OF CUPERTINO uS ce,w, f UILDINDIVISION PERMIT "C ' INFO �w BUILDING ADDRESS: PERMIT NO. 10'167 MARY Aw QRARrRR !lie OWNER'S NAME: A M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006 IV NEP V N r-s't o o SANITARY NO. CONTROL NO. (406) 536-0420 ARCHI EC(ENGINEER: BUILDING PERMITINFO BLDGELECT PLUMB MECH 0 t0 0 oo LICENSED CONTRACTOR'S DECLARATION IOb Description 1 somby affirm don 1 Am licensed under provisiors of Chapter 9(commencing with Section 70K)Ipof DiNsion3dfthe Businessand Professi.ru Code,andmyliccom REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL n full force and eCl — ue.a NEW 3/8" CDX OVER EXISTING 3/8" COX NEW 5 PLY TAR CHITECTS DContECIARATIOf GRAVEL BUR. i¢ 1 understand my plans shall he used az public records ids y Licensed Professional 5 OWNER-BUILDER DECLARATION p 1 berehy fR m than I am exempt from th,Contractors License Law for tint :D o rallowing mason.(Soetmo 1031.3.Business and Professions Code:Anycity ar county 29 which requim,A p"mit m construct.eller.imm.ve,demnlL .m repair any uroctum !i< prior,oris issu...also wIt.n.Ne applicant for such Nounto file aligned statement - s ieNes he is licensed pursuant to NIinm e provisions of the Comment's ceLaw(Chapter 9 Sq.Ft. Floor Area $2381 Valuation F AD (commencing with Seeuon 7000)of Division 7 of the Business and Proleaions Code or a 5 2 that An,4 esempt therefrom and the basis far the alleged esemprion.Any doliumn of Scdon 7071.3 by any appfam for A petrel,subjects he Apple=I.a civil penalty of ratg�Number Occu more than fiw hundred dollars(5300). 32652026qfiN enc: P y Type 0 I,a owner of tion property,or my employes with wages az tack sale compensation, wBl do the work,and On,smscture U nonimmoded.1offlul fer sale(Sec.70th,Business Required Inspections And Profesaam Code:The Contractor's License Law docs not apply m to owner of q P property wind builds.,improve theca.,and who doasuch wmkbimself or through his awn employees,provided that such improvements are trot intended oraRcred for tale.If. however,the building or improwment Is sold within ane year of completion.the owner. builder will haw,Ju Menden of proving that he did tet Wild or improve for purpose of sale.). 0 1.as owner of dm pmpeny,am escluAwly conuaning with licensed conmcmn to convect Ne project(Sec.7044,Business and Profeesiom Cade:)The Contractors U. tante Law dace nos apply man owner of property who builds.,improve Nemo.,and who tomato for such projects with a eanuanor(s)Ilcanmd pumuant m the Contractors License law. 01 am amnipt under Sec .B&P C for this mea" Owner Date WORKER'S COMPENSATION DECLARATION 1 y>Rm under penalty.(perjury Arte of the following dwltntions: ave and will maintain a Cen riiau ar Consent m self-insum fm Workers Compen- sation,az prow tied for by Section 3700 of the Labor Code,for the perf.onamo of Nc work fo nth this permit is Issued. haw®d will maintain Wntkers C.mpenseian Insurance,Am required by section 3700 of the labor Codc,for the performance of the work for which this permit is issued My Work Compensauoo In cc cart."and policy morl,cr Cartier.� nPoliry D CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section nettl Mt he completed if tate permit Is for one hundred dollars($101) or less.) 1 certify that in the performance of to work for which NO Permit Is Issued,I shall not employ any pesm in any manner so az to Wcomo subject to she W.rkeri Compensa0on Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making this Ccniflcam of Exemption,you should become subject in the Workers Compensation provisions of the Labor Code,you most .J O faMwith comply with such provisions of this Permit shall W deemed rewlecd. 'Z,,.'� CONSTRUCTION LENDING AGENCY F lhemhy AM.that dere is.comuuctinn lending agency far Ne perfunnonmuf > due work for which this Permit is Issued(Sec.3097,Civ.C.) W Q Undoes Nam, z Lenders Address U O 1 certify that 1 have mad this application and Auto Nat But show information is ty, cooed.I agree to comply with all city and county onlinances and sure laws reluing to 0 building construction.and hereby authoriaa mposentatiws of this city to enter upon the 4 show-memam.d P.,,Iy for impceuon pwlnses. (We)agree to saw,indemnify and keep harmless the City of Cupertino against ,Fa VI liabilities.jutigm,ns,casts and..NO.,which may in any way¢emc against said City U Z inemim uNTcoNNcRstAi 9ofthisprmiL OMPLY WITH ALL NON-POINT Issued by: Dale SOUR U TIONS ��" Re-roofs' Sig um ofApplianuCon Dam HAZARDOUS MATERIALS ocgl3 DISCLOSURE Type of Roof Willy t o Cupertino or fMuni Wil:pal Cg occupant aore2,Andhandle Hoslih And Safial ety As dc0neti by Ne Cupertino Municipil Code,Chapter 9.12,and Ne Health and Safety Code.Section 255324)? / All roofs shall be inspected prior to any roofing material being installed. C Ya []+ Will the IPPlicmt or rumor Wilding occupant use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove mit hmANoos air conumirtantsaz dcOned yNe Bry Ama Air Quality Managcmcm all new materials for inspection. District? CYa Ihaw moul cy Codc,Seed ma505. 5533&B255N.derChapmrd.93orNe Wild nu HalN&Safny Cadc.S¢9ons29505,25577 w173314.1 undcruanti NuiftM Wilding dire swt tune by w a..L that it u my m mobility m mufy the occupant of do repot hi mould I a facerufmamorOccupancy. Si atureofApplicant Date Owner or aturd6rind egcm ao' All roof coverings to be Class "B"or better q CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32652026.00 DATE ISSUED. . . .. . . : 12/22/2006 RECEIPT # . . . . . . . . . : BS000000084 REFERENCE ID # . . 06120150 SITE ADDRESS . . . . . : 10367 MARY AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1341 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 t $3. 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 CUP'ERTINO CLJPFRTINO PERMIT APPLICATION FORM T�J;� Date: owilel N1,1111C. Phone 4 �M-- 9 LP c) Conuactgr License fi: "V W(V- —L,i Contact: CUI)CIlino Business License 4: Type of Roof Covering: Fxkt illP.: Proposed: J Hildr-Up lool, ©' Built-Up roof U slmm,[Cs D Asphalt Shingles ood Shakes C) Wood Shakes ,,,j Wood Shim- ll dcs 0 Wood Yli .,fles J Odm 0111cl (Spccil'y) _ , 111111hul ol cxislillp covmll�,-s D PlOViCIL: I.C.11.0. IZCI)01[)/ N, Tu hr Ro11lovQ(I I'lovide Nl g1r. Installation .Sjpccti 1-1,1vu. kcaL UnclersLand and Will Comply With CLlj)Cl'tillWS TCM- Off Policy: Er Job Residential [�� VN' J Commercial n- 1 VC: Yes ED No 7 Confirmed with Planning Dept. if Type of Construction: there are any restrictions: ❑ OCCUIMICY "I'OL113: —2— itv. if ;Applicable= 'Fee 11) Fee Description Fee GFOUI) rl 1 m Bldg Permit Fees BUILDING 1317-N I-RGY Ener ;y BUILDING Seismic Fee Res ---B—UILDING 13SEISN/11COM Seismic Commercial BUILDING BPLANCHK Plan check Fee BUILDING RUSLIC 13LISillOSS UCCIISC BUILDING F—