06120156 CL'r.-`Y OF CUPERTINO �'gd , .�"' .
BUILDING DIVISION PERMIT �'CCNTRACTOR INFORMATION
tz
BUILDING ADDRESS: PERMITNO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
LgEcox rT f.y,d. SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC IENGINEEW BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
18 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Nal I unlicensed under provisions of CMplcr 9(commencing
�i`uf with Sccuan]gKBaf Division 3 of On Business and nefcxomms Code.and my license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
n full forte and 59reL
Lice'% -'�9 Lm.;r NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
1 — Dau _ TSDECr
ARCHITECTS DECLARATION GRAVEL BUR
1 undcmanJ my plain shW W uxtl ss puM1lic rtcorN
rd
b Licensed Prufcuional
OatNEm exempt
DECLARATION
iI 1 battery.a .(Sero on I am uempt from Nc lontracmh License Law for the
:O O following one,((Stenon 11)31.3,Business and improve,
cseium Code:Any city air county
1$ which its Whom,
•permit o nimthconstruct.astir,improv,demobs t ri mash any amstum
Z< prior to its issuemc.ales¢quirts Nc applicant for permit to rile a signed suumcm
(commencing
mcitpurxany t000n )of Division 3 the Cantrxes License Law(C ook)or Sq.FL Floor Area $2381 Valuation
(comm�s exemiNSccfiramadta basis
rth alleho ged
Business My
CrCc)of
— that io i campy ana,fmm and Ne bass far bj alleged mempnt to Any violation of
Semon a tio. by airy applicant for a permit subjects Ne applicant to a civil penalty of Number Occupancy Type
not more Nan five hundred dollars($500). 32652045 :V Cl'
❑I,u awmr of the propmty,or my employes with wage ss their xleeompenssaon,
and do Newark nose,The Constantine.
on iinenmMedoraw dean.(apply to
ooas ower of Required Inspections
and prof ws v lade mp Conti mn, d wi Law dins rot app%Nan owner is q P
Owpcnywho Wilds orimpmvesch improvements
aresstctende aroffear Nwughhu
awn ver.%
Wilding
provided that v such impsovemmu are not intended uoeeretl tarsale If.
builder.Ne Wildingru Improvementisxld within am year ofimpove for throw of
builder will have the burden of proving Net k did rot Wild or improv far purpose of
1,as awes of Ne property am exclusively contrasting with licensed mnvauars to
construct the project(Sec.1044.Business and Professions Cade:)The Contractor's Li.
cense Law does not apply Nan owns of property,who Wilds air improves Nsreon,and
whocontrarN for such projects with a contrxtor(s)licensed pursuant N the Conusetors
License Law.
❑I am exempt under See ,B&P C for this won
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under Porosity of perjury am of lie following declarations:
w and will maintain a Omofiam of Co..[to self-insure for Wmkor'sCompen-
sation,as provided fm by Section 31M of the labor Cade,for Ne performance of the
work for which 's permit is issued.
end will maimm.Worker's Campauathm Incas . u mqulred by Section
3100 of the Labor Code.for Ne performance of Ne wink for which this permit is issued.
CMayrtWieor.rkCompenaoIua omiu nd Polity nu ram:
, 8GGF*U.Q,lilyNa.: 0 v
713- 91.3
EPf10N
FROM WORKERS'
COMPENSATION INSURANCE
(This season nand Out W eoundcu l if Ru permit is forone Wndreddellars($10()
or les,)
1 certify that in roc performance of We work for which this permit H Wood,I shall not
employ my perm in my manmrx as at become subject to the Workcra'Compemanan
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IC after making Nis Certificate of Exemption.you should
become subject m the Workers Compensation previsions of the LaWr Cade,you most
.,O foMwiN comply with such provisions or Nis permit shall be decmed rooked.
z CONSTRUCTION LENDING AGENCY
i•+`y" I herehytlfrm Nat Nertuand(Secd 097,Cing agenry for Nc pedormanaof
CL> the wars for which Ni permit is isuW este 3091,Civ.C.)
Lender's Nairne
r7 z Lender's Add.
C)Q I comfy that I have read this application and sou that Ne above information is
LU f' correct.1 agree to comply with all city and county ordinances and state laws relating to
(]U Wilding construction.and hereby amhorire tenewmadves of this city to enter upon the
D-1
move-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
ito luddi ia,judgmente,cou U.and expenses which may in any way acerin againstsud City
C)z tAnPPLnsIeCA ncoaf EIM DS AtNec WILL PLY WITH ALL NO Issued by: Dat
SOURC ATI ^ 1
�/ rJ Re-roofs C7
sign n ornpvna o RDOU Dones
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
or future Wilding eccupant rmrc or handle h Health ad
as acRmd by the Cupertino Municipal Code. aper 9.11.and Lite Health and Safety
Cade.Sestim 13331(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit hazardous air contaminants as dc0ned by the Bay Aro Air Quality Management all new materials for inspection.
District?
❑Ya
IhawmaJ duhuvrtlmm M5O5Hrtquirtmcnuundcr Chapser6.93ol Nc Califon
nie Health&Safetyhaveawetiom 13303,23333 and29334.1 undcrsund Netifthe building ' _/—
dins not curmn0y have a¢nano Net it i my raps "y to nonl'y roc arupanwf the
rtyuircm wni Wmetprir ran a rNateofoa r Signature of Applicant Date
owns armmanactl gest Dow 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 . . . . . . . . : 32652045.00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000090
REFERENCE ID # . . . : 06120156
SITE ADDRESS . . . . . : 10405 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNERM & C 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 CUPERTINO owl Ec) l5v
ify
CUPERYINO PERMIT APPLICATION FORM
Datc:
3W -52-0�6 12-)/-))q�
A(ldre 77���
—J6!��, L
1,11011c 9:
Conurictu)C)
Or:
License #:
C I`l t Cupertino Business License ?:---
ct 1--)
Type of Roof Covering:
Mlilt-Up loof
;Asphalt Shingles ❑ Asphalt Shingles
,j Wmqj slizilkcs 0 Wood Slhakcs
U Wood shimLles 0 Wood Shingles
❑ (SpCcifp 011hul,(specl ry)
V',nnl,cr o I cxisl i[1" Lovcl 111 's
D Provide J.C,13.0. Report 11
l'o he kcnlov°d LJ Pimddc Mfgj. Jjjstajjatj()jj Specs,
1alvc RcaCL Understand and Will Comply With CLIJ)Utillo�S Tell' 0j'f'j)0jjcy:
.lob Description: -
Commercial 7
T�lr—c Z-1 1-1—L::- c�El No ❑ Confirmed with Planning Dept,—if
-
there are any restrictions: ❑
Type 01-collstiliCti011: OCCIII)MICY "I-OLIP:
C)0
Qtr. it
Applic;dhic FCC 11) Fee Description Fee Gl'OLIJ)
[I pE lz N'l Blcl(, Permit Fecs
0 BUILDING
1,1ENiERGY Energy BUILDING
3
S.[SIN/11CRE Scismic Pee Res
BUILDING
f3sl--ls,.mlc0m Seismic C01111"c"ci',-11 — BUILDING
BPLANCHI< Plan Check Fee BULDING
RUSLIC Business LicenseBUILDINGBLJILDING