06120157 CITY,OF CUPERTINO ,.s
BUILDING DIVISION PERMIT `I Q CRtIiCT, INFO�LIVIA"It.
BUILDING ADDRESS: _ PERMIT NO.
OWNER'S NAME: ATE
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
HBF•'nx 7T 0 cxo SANITARY NO. CONTROL NO.
(406) 536-0420
ARCIMECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION
Job Description
with Wn,by aBirm that I am liamcd under providom ofCbPter 9(commencing
m iNSccuon]IXMI)ofDivision3aftheBudneuandPr�fessionsCode,andmylkernmu REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
is(tall force and e a 9 / 6
iqi DaNnmcl a Lic.. err L NEW 3/8" COX OVER EXISTING 3/8" COX NEW 5 PLY TAR
AR CrS DECLARATION & GRAVEL BUR.
i 1 understand my plans shall W used u public records
jaU
I„ Licensed Profcssianel
-BUILDER DECLARATION
I I herebyhy alRnn OWNER
Nal I am exempt from On Cantranafs License Law for the
0o following reason.(Seen 7131.5,Business and Professions Cade:Any city or county
i22 which n,quims a permit m construct.altcn borrow,demolish.or repair any structure
-iy prior.its icon.,aim requin,a on,applicant for such Permit to file a signed statementValuation
-
f�$
thanheislicensedpurmanuo thepnowuhts.1NeContractoriLianseLaw(Chip.9 Sq.Ft. Floor Area(commcneing with Sormo 7000)of Division J.(ft Busmen and Profeniom Code)or $2391
thm W is esempt therefrom and On basis for the alleged exemption.My Adial n of
Sawon 70713 by airy applicant fora permit subjects the applicant to a civil penalty of �p�at Number Occupancy Type
not mea than Rs hundred dollars(M). 32652043 Aff
❑1,u owner of the pmpeny,m my employed with wages d their mle compemadon,
will da thewerk,mdtheswnure is not lnlerWedaroResed formic(SeeID .Bwinda Required Inspections
and Professions Code:The Conmcme,License Law dad soe nst apply in an owner of q p
property who builds.bestows Berson,and whodadsuch wants honselfor through his
awn cmplayem.provided that such improwmenu art cot intended aroRaind fm sale If. - .
however,the Wilding orimprovement is sold within one year of cnmpleuon.On owner- -
builder will have the burden of proving that he did not build or improve for purpose of
ask.).
❑1,as owner of the property.am exclusively..=I.&with Gamed comancen to
construct the project(Sec.7044,Business and Professore Cade:)The Camerons U.
came Law does not apply in an owner of property who Wilds or improves Orman.red.
who contracts for such projects with a eantrsurar(s)licensed pursuant in tW Contractor's
L camm Law, It
❑l am exempt under Sec ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I by M.under penalty of perjury mte of the fallowing dmlaaions:
1 sand will maintain aCeniftcate of Cammm to self-insure for Woftes Com .
on,u pmvitictl for by Section 3700 of One labor Code,far On perfennma of On
workfor ieh Nis permit is issued.
eve antl will maintain Workch Compensation Insurance.he acquired by Senior
3700 of Oc LaborCode,for the performance of the were,for which this peritonitis issued.
My Wor s Compensation in race=I.and Policy number art:
Cartier. alley No.: i) ^�
CERTIFICA OFEXEMP KIN FROM RKERWO S \
COMPENSATION INSURANCE ,
(Thu salon sed not W completed ifflea permit Is roranc hundred dol(SIM)
or Icm.)
1 certify that in the performance of the work fm which this Permit is issued.I shall not
employ any person in any Interior so as in become subject o the Workcn'Compema0on
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
became subject to the Walmes Compensation provisions of the Labor Code,you must
.,O forthwith comply with such prees m th
visiois permit shall W decmcd revoked.
Zr. CONSTRUCTION LENDING AGENCY
[-�� I hereby affirm Out there is a construction lending agency for the perromima of
On work for which this permit Is issued(Sec.3097,Civ.C.)
ALenders Name
7 z 1<ndefs Add.
U Q I certify Nat I haw Rad this application and sesic that On man information is
L, P Caren.l agree m comply with all city and county ordinances and state laws relatingto
O U Wilding construction.and hereby authorise represenatins or this city to enter upon Oc
atow mentioned property for impccuon purposes.
(We)agree to now,indemnify and keep harmless the City of Cupertino against
Ln liabilities,judgmena,cosu and expenses which may in any way accmc against mid City
U in consequence of the granting of this permit.
APPLICANT NDERSfANOS AN LL COMPLY WITH ALL NON-POINT Issued by: Da
SOU U
Re-roofsz�'
Si naturcofAp peso ua
oncDatar Data
7 -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futon,Wilding occupant state or himilc hasudous..most
as defined by the CupertinoMunicipal Cade,Chapter 9.11.and On Health and Safety
Cade,section 25531(a)7 [ All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will the applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit W.W.us it conta.im, es din y the Bay Anna Air Quality Management all new materials for inspection.
District?
E-]Y.
IhasafcyOxomd the, ,acetum 25505un,33ard 55 underdler arh.9Jer On Cali for.
ria HaW&S.dyyCad0.Secun,'an I,15JJJ and ZSSJ4.l m Will, Nm 1.1c Wilding
docs oat euen,ntiy has s tenant.Nat it' y ter ihility.noulj tW mcupsut ser the
qui n is an .Cl pa a certiRmraor Occupancy. Signature of Applicant Date
All roof coverings to be Class "B"or better
O ncr or authonzcd agent Oate' '
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652043 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000091
REFERENCE ID # . . . : 06120157
SITE ADDRESS . . . . . : 10401 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M &. 0 ASSOCIATION MGMT SERVICE
ADDRESS .
CITY/STATE/ZIP . . . : .CUPERTINO CA, 95014-1336
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 CUl"ERTINO
• CUPEkTINO PERMIT APPLICATION FORM
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Dale:
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C11111, Acicllr ss,
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Coll (actor:()I:
License #:
('01)[Oct Cupertino BUsillCSS LiC011SC ij
Type of Roof Covering:
Prop�o�S�J:
J Built-Up Roof 9 BUHL-IJI)roof
;Q \Sj)lll]L Shill.-des 0 Asphalt Shingles
li W,md SlInkQS 11 Wood Shakes
ij \V,wd Shill"Ics cJ Wood Shingles
U Odhcl (SI)Qclt\ cl 0111cl (Spccij)')
EJ Provide I C11.0. Rciloil 8
o he Rcilloved Q Providu tvlf'gl,. Installation Spccs.
•
-Ti—
�llld Will COMI)l)' With CLIPCI-til WsTealr OfTPolicy:
Job DUs(:1-1j)tl0l):
Rcsidentiul
'ED Commercial ❑
Fil-c Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions:
Co- ❑
SICTIC-171--01ccl: Type Of coms—tructiorv. Occupancy 81-0111):
Qtv. if
Fee 11) Fee Description Fee GI-OLIJ)
MF'7'
13 P E IZ M FF—F, -- Bldg Permit Fees
BUILDING
BENERGY Energy BUILDING
t3 Sr S\11C
_,I
13SEISIX111CRE Seismic Fee Res
BUILDING
BSEISMICOM Seismic Commercial BUILDING
BI)LANCHK Plan Check Fee BUILDING
13 li S L I C: Business License BUILDING