06120155 ------------
CITYsOF CUPERTINOTt1�,iTT y� Bryk. , p ` x '"`�
BUILDINGU(VISION PEy�y I l.�
p ''u PERMIT NO.
BUILDING ADDRESS:
OWNER'S NAME: PERMIT LSBUE DATE
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
acn.17TnDO SANITARY NO. CONTROL NO
(406) 53670420
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION IOb Description
m 1 hereby affirm Nm 1 am Becl ud under provisions of Chapmr 9(commencing Job
U -ithSection 70M).fDivision 3Ofdin Bull.and ProfessmusCods.mWan,lbenuin REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
in full farce antl a f
ucroseclasr Lm.n NEW 3/8" COX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
ret„ Dam Comraear a
FF9997 LTS DECLARA.nON & GRAVEL BUR.
J K< 1 underman my plans atoll shall be used as public leardv '
+dU
LiccnuJ Pmfasianal
S
OWNER-BUILDER DECLARATION
iI wo'hy.(Sect on 1 am exempt Imre the l Contractor's :Any c Law for Na
p o following,ores..(Saito cmustr,Business and Profusion Calc:Any city or county -
m which require a permit re requires
on alar,improve,demolish.m repair ed swcure
�¢< prim m its issuance,also mquirn Ne applicant for such permits tilt reigned saumem
shut W is licensed pursuant to Ne previsions of Ne Connector's License Law(Chapter 9Sq.F1, Floof Area ,2381 Valuation
«� (commencing with Section 7")of Division 3 of the Business and Profusvians Cook)or
that he b exempt therefrom and Ne bub for Ne elicited exemption.Any violation of
Section not more Nan five bundled dollars(1500).7031.5 by any appllant for a permit subjects the applicant to a civil penalty of 3 2 6 5 2 0 4 7 Number Occupancy Type
❑I,as owner of the pmperty,or my employees with wages as their sol,:compenedon,
will do the work.and tWstoeule is natintended or offered Book(See.711,14,Bnirwa Required Inspections
and Professions Cade:The Communes Lsc.Law does not apply m an owenu of q p
pmpeny who builds or im proves thereon,and who does such work himself or through his
awn employcu,provided that such improvements are not maned oroffemd torsade.If,
however,the wilding orimprovement is sold within one year o(ampletion,the owner,
builder will hive ter burden of proving that he did not build Or improve for purpose of
sale.).
0 1,as now of Ne property,em exclusively contracting with licensed commons to
convect the project(Sec.7044.Business and Profession Code)TW Conuacner's Li.
cense law docs not apply to an Owner of property who Wilds or improves Nonan,and
who contracts for such projects with acmumeur(s)licensed parsnnl to the Conuactar's
License law.
I amexemptumder Sec. ,B&PCforthiemaon
Owner Date
WORKER'S COMPENSATION DECLARATION
I by affrtm upenity,
nder, aof perjury Om of the following locomotion. - - ,
am and will maimem sCerlifeateof Conaesuo self-enure fe-WmkersCompen-
noun,as provided for by Section 3700 of ere labor Code,for the perfamancc of the
workfor w h do$permit ei issued. -
ve and will maintain Worker's Compensation Insurance,as required by section
3700 of on,Labor Code,for Ne performance of the work for which Nis permit is issued.
My Workers Compeuationlane curie and Policy aumMrale:
Cartier. 1/A✓� Paliry No.: _ 2
ERTLFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thin aw ou raced notbecomplewd lithe permit is foram,hundred ddurs(1101)
or Icss.)
1 certify that in to performance of the work for which this permit is issued,I shall not
employ any person in any manneru az in become subject in the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making one Cenif+ca c of Exemption,you should
become subject in the Workers Compensation previsions of Ne Labor Code,you mut
.J z farMwiM comply with such provisions or this permit shall W deemed mmked.
„z•,51 CONSTRUCTION LENDING AGENCY
E-, IWreby air,.Out Nem is aeonsuuctimn loti for the performance of
Cli.�-r the work for which this permit Is issued(Sec.3097,Civ.C.)
OW.Q Leuder's Namc
z Lenders Address
U Q 1 anify Nat I have read this application and sum Nat Ne above information is
LI. P torted.1 agree to comply with all city and county ordinances and state laws relating to '
O U building construction.and hereby ruthorim representatives Or Nis city to enter upon the
r W shave-mcnuuncd pmpmty for inspccuno purposes.
(~
04 (We)agree m save,indemnify and keep harmless Ne City of Cupertino against
VI liabilities,judgments,casts and cxpcncs which may in any way accrue against said City
U z in conuqucnce of the granting of this permit.
�••� APPLICANT UNDERSTANDS ANO W COMP ITH ALL NON-POINT Issued by: Date 603
SOU EG A
r7 Re-roofs
Sig arc OTApplicanUCO Dem
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding e.Chapter
handle hvartous mamrim
az deRnsd by J.Cupenins Municipal Cade,Chapter 9.11.and the H,aiN and Sleety
Code.Section 25533(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yen
Will than applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit bux c us air contaminants a JeRnctl by the Bay Ana Air Quality Management all new materials for inspection.
District? t
❑Yes
ilive&Sarman t Neharamuons 255 5.255 Sand 2tsunJcrCWpmrd.95ofthe Califon.
ria Health&Smey Cod,,Satan at it 8577 aP.55J4.lu lumily de oco.pairMc n of Me
JO,a not eurten0y ha a mnan4 Nat h b m po "ty m notl'y tW aeupant of tW
require john st tprior to a millertp i atureo1Applicant Date
Owner m stern(+eJ agar — Dire - 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 32652047 .00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000089
REFERENCE ID # . . . : 06120155
SITE ADDRESS . . . . . : 10409 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER M & 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
BSEIS14ICRE 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 Du 1X0156
CUPFRJINO PERMIT APPLICATION FORM
I Building /\cl qlic6s�i
6 , -- ,
I ILI I L; IN Ile one Ph4:
Phone
Contractor: License of:
Ai �Lo i D
Contra t Cupertino Business License 4
Type of Roof Covering:
EANg: Prof)071:
Built-lipRoof BASUP roof
,Asphalt Shingles LI Asywh Shhous
A M& Shakes CD Wood Slhakes
A Wood slhlll�elcs 0 Wood Shingles
()dlul ('Sjpcci(vEl Othul,(Spccify)
L,1�111 Li of cxreltll" coverings0 Provide I.C.B.O. Report U
61Jles hr Reinu`'eCl U Provide Mfgl. Installation Specs.
I I hive Read,—UnCICI'Sta11d IlIld Will C01111)]Y With CUpCI'tillWS Tear Off Policy:
i0l) bc—sc—npunll:
---]_L
ROSIC Commercial
fireZ
--one Ye, El No El Confirmed with Planning Dept. if
there are any restrictions: El
Type of Construction: Occupancy group:
aS%i - 00
Qly. if
AllpEic_able Fee 11) Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy
BUILDING
BSEISMICRE Seismic Fee Res BUILDING
13SEISIN/11COM Seismic Commercial BUILDING
BPLANCHK An Check Fee BUILDING
BUSLIC Business LiMISC BUILDING