06120158 CITY,OF CUPERTINO xi >' ` ti( ^'
BUDAI NC DIVISION PERMIT :toNTRACTOR NFORMr1T1ON '
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NE;.+ns rTrnc SANITARY NO. CONTROL NO.
(406) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;Oz LICENSED CONTRACTOR'S DECLARATION - Job Description
u Fj I hereby artirm the,1 am IiaenvA under provide.of Chapmr 9(ammeneing p
zt�n with Section 7000)af Division Sof me Business and Preload..Cade.and my license is REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
w n full foes and trot t "', f
�p Da¢niy �coaractor NEW AVE CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
7W
ARCHITECTS ECTS DECLARATION ��� & GRAVEL BUR.
n < 1 understand my plans shall an used as public ox,mda
myU
Licensed Pmfcssianal
mp m 3 Met I am exempt
fr DECLARATION
f e o I hereby moo ,(Tire on 11. .So from the Coaurafessimmar's License Law for to
o tp following mason.(SaOan 7071.3.Basions and Profeatinm Code:Any city or county
'm which requirca issuance,permit a,uimsthe alley,improve,deermitt ore asir any u men,
pat he is ed p.ruonquire thecant Me Contractor's
Lim aalgnedmmmcnt
o
that wdPursuenl7")ofDiviorm 3ofMe nuslocat and
ssonLaw C Code)
Sq.Ft. Floor Area Valuation
l�
(commencingtheisxaminleNon7andMDexamfroftheeged easaMon.Any
Cadc)on $2361
Nat o u exempt therefrom and the Eau for dte alleged exemption.Any violation of
Section 7031,5 by airy applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not ream man five hundred dollars(SSW). 3 2 652 041 A1961
❑1,ss owner of Ne ptapmsy,m my wploym Wim wages u Meir.ls ampenatian.
will do the work.and floamocue la not intended oroflimi fonale(Sea.70 N,Business Required Ins ections
and Professions Code:The Contractors License Law does ant apply m an owner of q p
property who Wilds or improrea thesran,and whodoes such work himselfor through his
own employers,provided Wt such imprevemenu am not intended Mattered(orals.IL
however.Me building or improvement is sold within ane year of completion.the owner.
builder will have Ma burden of proving mat he did not build or improv:for purpose or
ale.).
❑1.as name,of me propenY,me exclusively contracting with licensed conuseen to
construct me project(Sec.7044,Business and Profession Coda:)The Contractor's Li.
cense law does not apply to an owner of property who Wilds or improvca thereon,and
who contracts for such an jecs with a canuamm(s)licensed pummel to the Comua:tar's
License Law.
❑1 am exempt under Sec .B&P C for this more
Owner Data
WORKER'S COMPENSATION DECLARATION
1 h alum under penalty of perjury one of the following declarations:
are and will maintain a Cerdfine of Consent to elf-ineum for worker's Compen.
.tion,.provided for by Section 3700 of the labor Cade,far the performance of the
work fa,w this pemB is issued.
va end will maintain Warker's Compensation Insurance,u required by Socuon
37W of the labor Cock,for me performance clubs work far which Nisarmit is Issued.
My WmkSfsCompecaaon jusmance cagier and Policy
Cartier.1592Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu secdan need notM complsted if the Permit Is(mane hundred dollar($100)
loo.)
1 CMaIv that In We performance of the work for which this permit Is Banco.I shall not
employ any person in my manner.as b become subject to the Worten'Compenation
laws of Cahfomis.Data
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
become subject a the won s Compccaation provisions of the liber Cade,you raw
.J z forthwith comply with such provisions or this Permit shall he darned revoked.
z4► CONSTRUCTION LENDING AGENCY
t-rI hereby alfirm that then laacatstrocdnn Itndingagcncy for the penormrmeof
(Yi> the work for which this permit is issued(Sec.3097,Civ.C.1
Q Lender's Name
z lender's Address
U O I certify that 1 have read this application and sum mat the move in1consi un is
U, P correct.(agree to comply with all city and county ominances and suite laws muting to
0 V building construction,and hereby aulhorim representatives or this city to enter upon me
r LsJ
aWvc mentioned pmterty for inspection purposes.
G (We)agree to un,indemnify and keep hermlca the City of Cupenino against
r fA liabilities,judgment.Boss and expenses which may in any way seem against said City
t.)z in consequence of the granting of this permit.
., APPLICANT U E STANDS AND WILL CO WITH ALL NON-POINT Issued by: D e
SOUR RE
�a— P Re-roofs
Signature of Appli or Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof / Ob
Will the applicant or future building Occupant store or handle hamrdous material
u defined by the Cupentno Municipal Cod Chapter 9.13.and tlme Hcaldt and Safety
Code.Section 35333(,)? All roofs shall be inspected prior to any roofing material being installed.
0y.41 a
Will the applicant or(mum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hoankne,air cantamimms as dcfi the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
Ihavoroed them,S=M s255msM05,25533sls mmc 5534.1rChapter thmifhe Wilding
ria Halm&Safety Cade,Smmt, 35509.ISSI. aro tImmer theoccmc Wilding ✓�/,C/l
Jars trot cumntly haat a tenant,met it u M'. mihility m noul'y dm Occupant of the
require naw ich usl Ecmetpnntai f amora<apmc. Signature of Applicant t Date
OwnermmMmlmd,gam 'Date- 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 . . . . . . . . : 32652041. 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000092
REFERENCE ID # . . . : 06120158
SITE ADDRESS . . . . . : 10397 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 8
3 .16 0. 00 83 .16 0. 00
BSEISMICRE VALUATION 2, 381. 00 0.50 0. 00 0.50 0. 00
63 66 0. 00 83 . 66 0. 00
TOTAL PERMIT '
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
OL012-0156
CUPFRjTlN0 PERMIT APPLICATION FORM
924- 52-04, Date:
Building \cdres
Date:
a
I'llonc 9:
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(01
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1c,
Cupertino Business License P:
C-A
7—
Type of Roof CON101,111":
E x is I i I I Prop�OSTJ:
.J JiLlift-lip Roof (2 Ruilt-Up lool,
A.Sphalt ShIllu'les :1 Asphalt S'jjjjj4I,,
\V,)od Shakes 0 Wood SlIACS
LJ \V ),Cl Shill'-des Ej Wood Shingles
LI (WICI (Sipwk
Cl Othcr(Specify)—
`!upthcr ol,existing wVC11......
El I'loviclu I.C.13.0. Report it
I o he kelllovcd ❑ Pmvidu Ml'
'gi nsialkilioll
—Understand and Will Comply With Cupertino S Tcj)j' Off,Policy:
ob Ptioll:
Rcsidcntinl DiCommercial
Piro 71-11-1_C: Yes ❑ No Lj C011f-l"I'led with Planning Dept. if
there are any restrictions:
CONt 01 1 r0[ccl:. Type 0 1'Construction: Occupancy (,['OLII):
Applic;ible Fee 11) Fee Description 17 cc GroupI!wmmw I.-,GBICIn Permit Fees BUILDING
BENFRGY Gncrgy BUILDING
BS17-ISi\/IICRI-- Scismic Fee Res BUILDING
BSEISj\/IIC0IvI
Scisillic Commercial BUILDING
BI'LANCHK Plan Check Fee BUILDING
BUSI-ICBusiness License BUILDING