06120160 CITY OF,CUPERTINO
PERMIT r,"CT,0RjNF0 1,
BUILDIN6'DIVISION C
BUILDING ADDRESS: PERMIT r No.
in-Agc) mApy Air iwe _n11_0n1.0-n ___
OWNER'S NAME: 1.bu?9iaBA;F
ftM & C ASSOCIATION MGMT 605 COMMERCIAL, ST 12/21/2006
SANITARY NO. CONTROL NO,
(408) 536-0420
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDG PLUMB MECH
7_7 lt�g
LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I M lics:Wd Lumber Posphimseli Of Chapter 9(commencing
.10 Scene.74yfir)) fDi,bkAs 3.f ho Busbaup And istpufassmas Coda,and my limps,is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
I.(all fam.mciiss�:ll
NEW 3/8" CDX OVER EXISTING 3/8" COX NEW 5 PLY TAR
1)in CI- 'u"mcon'
—��7,1�CIDEC�—RA—Tl()N7E::;7�— & GRAVEL BUR.
I understand my plans Suit ba amid As public records
A.
l;; Liccomid Proficarianal
OWNER-BUILDER DECLARATION
I I hereby affiren Oat I am exempt from line Convactor's License Law for the
O 0following (Samos 7031.5,Business And Prafessions Code:Any city or county
which requires a permit in Construct,.her,appopi demur W,or roped,my aparmucho
prior to its bounce,Abu requires the applicant for such Permit to rile a signed supturan
ss,2< that he is liamosed parrawast on the itionvidons of the Computer's Uccam Law(Chapter 9 Sq,Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of she Business and Professions Code)or $2381
'at he is MMPL ftMfMM and the thads for the Alleged exemption.Any violation of
Section 70313 by M applicant for A permit subjects the apptinesin,in A civil penalty of
no,ream thas GK dollars;($500). 32652037 Number Occupancy Type
0 1,As owner of the propostly.a my employees with wages a their sole componsandon,
will do the walk.And than sumatare is not intended or offered for rade(Saa.7(344.Business
And Prolicasit Cosbac The Consulate.LJcAs Law does an[apply Wan cappas or Required Inspections
property who build,or Impulses Oppose,andwho doessuch waft hirecoaffor through his
puts employees,provided that such imprenscrecaus are maintained mriffespol forande.If.
houncussr,she building or Improvement Is sold within one year of completion,the owner.
builder will haus,the burden Of imbuing Out the did sup,beliki or Inaprove for p.m.of
-
sale.),
C]1,as arporm of the property..m midwar,ely contracting with lishmscal commustions W
consloact the project(Sec.7044.Business and Prefcaltions Code:)The Commences U.
came Law deep not apply to an mraur of property who Wild,or improves trumpar.and
who contracts for such projects with a monarchists)licensed pursuant to the Cormactors
Uam Law.
❑lappeoperiptarderse, _.B&I'Clorthistrusupon
Owner _DAsc_
WORKERS COMPENSATION DECLARATION
1 he ARsrm under fahaustly of perjury enc of she fiallwhas dimlimaddarm
caw and will .In alp a Cersificam of Consent I. for Walters COMPCn-
sualon,w provided for by Section 3700 of the Labor Code,for she performance of the
wort for w h this permit I.bond.
� �.d will maintain Worlser's Conspertaudium loose.e,As acquired by Sachum
37W of she Labor Code.for she Performance crops,work for which this,Permit is issued.
My Work Vj Compensation lamplice carm.or and Policy numberare:
Policy No.; 7/3_0Q1!C' ole-D,
CERTIFICATE OF EXEMPTION FROM WOMERS'
COMPENSATION INSURANCE
mus section paced Out becomphoad if its,permit is forosic hundred dollar(SI W)
or less.)
I certify that in the peafturapposes Of the woft for which this Permit is Issued.I shall Out
employ any person in my maincric,As to become subject to the Worlatoot'Communication
Law,of California.Dow
Applicant
NOTICE TO APPLICANT.If,after making;this Cenificane of Exemption.you throoW
become subject in she Workers Compensation provisions of the,Labor Coca,you am
z forOwido comply with such Provisions or this permit ashall he deemed mmkcd.
Z 0
CONSTRUCTION LENDING AGENCY
I Iscrolay&Mm dust than,is a constructions lending agency for she performance,or
> de,wells for which this Permit n ismad(Sm.3077.Civ.C.)
Lenders Name
z Lenders Address
U 0 1 color,dal I luiva send this Application And mile than she ma.information is
U, COMCL.I same in comply wish all city And county onlimpeas and sure laws mining In
Wilding mpmuc,imu and herm,..thmn.ne,ocumair,cs;of this cityu,enter upon ft
apitva..,,.uitped property I.,inapmuon purpose.
(We)agree to save,indemnify and Imp,hannican she City of DuramoreAd ills
rrn lialsilitilejudgmcnis.costs and expenses which may in my way accuse Airport us Ciy
)Z in consequence of the goinung of this remelt.
APPLICANT IND it�NDS AND�WPL �ITH ALL NON-POINT Issued by:
C
UI
Dat
1-7-C22 Re-roofs
Sign alims ofAMlicardsCommunis Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occuppaustopeorhandle lecounuourtmascrial
As delined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.SIctima 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
41 0y.
Will the applicant or future building occupant use equipment or musnecs which If a roof is installed without first obtaining an inspection, I agree to remove
craft lonobous air contamin m u dcfted
c Bay Arm Ail Quality Management all new materials for inspection.
Consul?
Oyer
I time read
niaMcal�&SafctyCMc,Sccbom2M5.25533.d�534.liandarmand hatirdin building
does not uncemly Inoo A Nat It .1.1. pr,she occumant Or Up
regmrt mwntmmua metpriarmi a adrle,learom,meSignature of App]icanit Date
Data 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 . . . . . . . . : 32652037 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000094
REFERENCE ID # . . . : 06120160
SITE ADDRESS . . . . . : 10389 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . .. CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1343
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 CU1`ERTINO
• CUPFRTINO PERMIT APPLICATION FORM
12
nDate:
W51---031 )Lj)o7
Buildini" Address-
, 1�b j I
Pholic 9:
Contractor:
License 11:
(0 Oto ltd
Coll t[w[- CUIM-6110 BL[gillCSS License P:
I ype of Roof Covering:
is t i I I Prop!o�STJ:
_j fillip-Up Notil FO BUHL-IJI) '00f
A A-Sph,11L slimples Q AsplinIt Shingles
\Vaud Shakes ❑ Woad Shakes
U Wood Shill"Ics
Ci Wood Ylindcs
D (Whel (SJ)CCijv) 0 0111c),(spcciiy)
\hgnher nl rNrsoll" co\�:1111"s
I D Provide ],C.13.0, Report 11
Lj I o he Rcmovcd Q Provide Nlfgl. IIISLU]Inlioli Specs.
lavc Read. Understand and WillComply With CLII)CI-61101S Teill' Of'J'I'olicy:
Job DcSCAlption:
Residential
liuml commercial ❑
l=ire Toilc: Yes 0 No ❑ Confirmed with Planning De )t. if
there are any restrictions: IJ
Cost ol'Pro,ject: Type of,Construction: OCCUI)MICY 01-OL11):
App I ic:11h1c Fee 11.) Fee Description Sec GI'OLIJ)
Bldg Permit Fees BUILDING
13ENFRGY Energy BUILDING
13 S EIS M I CC LR E Seismic Fee Res BUILDING
BSEI SiM ICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
Rusuc BLISillOSS UCCI)SC BUILDING