06120124 CITY OF CUPERTINO _ -� _y
i3UILDING•DIVISIOtN Is '�C�NTRAGTC)R I 'k`ORMATIC}l�i -.
tt s m A -.
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NE.S-'n3 r'r'nno SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMMNFO
BLOC ELECT PLUMB MECH
0 0 0 0
18 p LICENSED CONTRACTOR'S DECLARATION -
M 1 hereby affirm am that 1 licensed under provisions of Chapter 9(commencing Job Description
;z� with Section 70M)orDivisme 3 ofthe Business and Prefc>siom Codc.and my license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
!'�w m full tome order ec
i� Damnsc u Li aacmr NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
f legs RCHITECrSDECLARATION & GRAVEL BUR.
1 understand my plans shall W used as public meet&
iy
C Licensed Pmfceienei
0 g OWNER-exempt fr mDECLARATION
1 herchy.(Sect the 1 1. exempt from the Caton.C's License Law for the
o yO� following reosan.(Section flonstr Business and Profusdnm Code:Any City.,canny
�y Y.
which 2gY1R3 a permit Irl ronaWCt,altar.improve,demtfiah,or repair any SWamm '
30x• pdermits issuance,also requires the applicant forsuch permit to file a signed summenl
< that he is licensed pursuant to the provisions of the Contracuis License Law(Chaper9 Sq.Ft. Floor Area Valuation
i r$ (commencing with Section 7")of Division 3 of the Business and Prohssions Coca)or 2 3 81
— that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penally of
not mom that five hundred dollars(3500). 32652051Aff Number Occupancy Type
P Y
0 I,ss owner of the property,or my employees with wages as their solo compensation,
will do the work,and than suctum is not intended or offered pertain(Sec.7W.Business Required Inspections
and Professions Cade:The Contractors License Law doe e ns not apply to an owner of q p
property who builds or im prove thereon,and who does suc h work himself or through his
own employme.provided tholsech improvements are not intended oro@sed for We.If.
however.the building at improvement is sold within one yew of compledon.the owner-
builder will have the burden of proving that he did net Wild or improve for pulp=of
We.).
❑1,as owner of the property,am exclusively contracting with licensed rnnuacmes to
construct the project(Sec.1004,Business and Professions CoJc:)TW Convector's Li
cense Law docs not apply to an owner of property who Wilds or improve memon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Concectofs
License Law,
❑I ore exempt under See. B h P C for this memo
Owner Data
WORKERS COMPENSATION DECLARATION
hk I reby+(firm under penahy of perjury one of the following decimations:
av<and will extends.Car iftcam of Canxnl to self-insure far Worker'sCompen-
.non,a provided for by Section 3700 of ton labor Code.far me pmfmmance of the
work fo bleb Nis permil is Issued.
ave and will maintain Workers Compensation Insurance,u required by Section
J of ore Labor Codc,for the performance of the work for which this Word,is icued.
My Worker's Compensate trial artier and Policy number am:
Cartier. S9'*'M Ff..f.In Polity Nm.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuuction need Trot W completed dine permit is Temno hundred dollars($100)
or less.)
1 comfy that in the performance of the work for which this permit is issued,I shall not
employ any person in any memento as in become subject in the Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation pmvisiom of the labor Cede,you most
z forlbwim comply with such provisions or this permit shall he deemed msmked.
ztO CONSTRUCTION LENDING AGENCY
[-+ Ihereby affirm that then is a coetmctien lending agency for the perfurmance of
f1 .>-r the work for which this Permit is issued(Sec.3097,Civ.C.)
Dd Q lcndefs Name
z Landme3Addmss
U Q 1 certify that 1 have read this application sed suk that the move information is
ly F correct.I agree to comply with all city and county ordinances and sum laws minting to
Q U building construction,and hereby aummim representatives of this city to enter upon the
W above mentioned p.,,(y for im,tuon purposes.
tiG (Wc)agree to save,indemnify and keep harmless me City o(Cupertino against
y liabilides,judgments,costs and expenses which may in any way acerae against sod Cly
V z in consequence of the granting of this permit.
t-' APPLIC LIDERSTANDS AND COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EG Tf
Re-roofs �---
Sigrallifire.1'ApplicandCoRi au
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding e.Chapter
9.1 or handle Health a material
ss deRncd by the Cupertino Municipal Code.Chapter 9.12,and IW Health and Soley
Codc,Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will the applicant or future building=open[use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it W'rardous all cenlaminants az de0ned by the Bay Arca Air Dealiy Management all new materials for inspection.
D'xuia?
❑Yes Sahli
I have mal the Amardaus materials requirements under Chapter 6.95 ofthe Califor-
ria Hcalmg:Secy Code Sectiae 25505,25533 and 25534.1 andopmed!thstif me building /V^
dna sol cu tly a i a m 4 mat k is my tcsponsi " m eatiry me occupant ser the
rcyuimmc emus tpde ante a 'fcamo(OcCup LgnatureofApp ' ant Date
Owner memmernred saV 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 . . . . . . . . : 32652051. 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000057
REFERENCE ID # . . . : 06120124
SITE ADDRESS . . . . . : 10417 MARY AV
SUBDIVISION . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1344
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
•
T CITY OF CUPERTINO
�f10 P,
IY )I
C L)413J IN 0 PERMIT APPLICATION FORM
Date:
13 t j i I chi i i-1; Cl I—I
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7� � I �OCLN ft%le—
Name: Phonc &
Vn(,oy"A Slnd\Q03 u c)
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a
Pilonc 4
lLOS=
r( License N:
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Collwct ----------------------------
CCLI13ert,
113 1
upelino Business License
crl�
oI, rill(
Type of Roof Coverijig:
1g: Pr=op�oTsl:
HLJIt-llp kooj D Built-Uproot
1.1) Asphalt Shillg[CS 0 Asilwk Shingles
A NOW Slvikcs 0 Wood Shakes
,U Wood Shingles Wood Shingles-J Oillcl (Speci fy) 0 Other(Specily)
�'Wjllhcl of "isling coven ligs 0 Provide I.C.13.0. Report 11
,�J' To he Relllovccl Q Provide M[gir. Installation Specs.
love Cod. UndCl-StanCl and Will Comply With CuPelt,11WS Teal. Off Policy: z�
jol.)
Residential ❑� Commercial ❑
Tire Zone: Yes ❑ No F-1 C011fil"lled with Planning Dept. if
there are any restrictions: ❑
Cost ohProlect: Type 0 f Construction: OCCUIX111CY group:
Qty. if
Fee 11) Fee COSCHP6011 Fee Group
BPERMFEE BW- Permit Fees
BUILDING
BENERGY Energy BUILDING
BSMSN[ICRE §6002 Fee Res BUILDING
BSGIS[MICOM Seismic Commercial BUILDING
BPLANCI-IK Pin Check Fee BUILDING
BUSLIC Business License BUILDING