06120125 -----------------
CITY�OF CT'pERTINO + .�
BUILDING DIVISION PERMIT CONTAAC nit IN I IATION�,
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
pEnnnrnoc SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p
LICENSED CONTRACTOR'S DECLARATION
w 1 hereby affirm Nat I am Ikensea under pravisioos of Chapter 9(commencing Job Description
with Section 70101 of Division 3 of be Busismse and Prafesmna Code,and my license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
;may in full Come Mod c t.
Lk. (p�`f��tj NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
iv�Z Licenses p
1F Dem ARCHITECTS DECLARATION & GRAVEL BUR.
i e 1 Undersand my plans shall he used as public m studs
i iyU
°pt; Licensed Professional
1 OW I a BUILDER DECLARATION
:n O 1 hereby.affirm(Sce Nat 1 L exempt from Ne tensions Code:
:Any c Law for the
❑O following mssan.Permit
t 71131.;Business and Pretensions Cole:Any city or county
'm which mquiru a permit re restconstruct.alma improve,demolish,or e pair any structure
azY In.hnitscensed c.also olto to tWvitim Of forMe ontracch torNofiense La (Chate9
• < thahcisliccnuJpursuanitotheprovisiomofNcConwcmr'sLiccnselawlChapatr9 Sq.F[.Floor Area 2381 Valuation
2�$ (commencing wish Section 70f)(1)of Division 3 of NC Business and Professions Code)or
R E Nat be u exempt Nemfrom and Joe bola for On alleged exemption.Any violatlon of
Section 7031.5 by any applicant for a permit subjects the applicmuo a civil pea.,,of A, 7 Number Occupancy Type
not moa Nan five hundred dollars(S500). 3 2 6 5 2 0 5 3 :tl 1Y'
0 1,as owner of the property,or my employees with wages as their sole compensation,
will the thawork.and the immum,isout mmndedoroffered for We(See.7aa,Business Required OCUORS
and Prefessimu Cad.The Committees License Law does sol apply m im ownm of 9 P
Property who builds or improves thereon,and who dose such work himself or through his
own employees,provided that such improvements are not inandW moRercd parade.If,
however,On building orimprovement is sold within ane yeti of completion.Ne Owner-
builder will have the burden of proving Nat he did not build or improve for purpose of
aa.l.
0 1,as Owner of On property,am exclusively contacting with licensed comsactoa w
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cera Law does not apply in an Owner of property who Wilds or Improves thereon,and.
who contacts for such projects with a eanuace r(s)licensed pursuant un Ne contractor's
License Law.
0 I oro exempt under Seo B&P C for this moon
Owner Data
WORKER'S COMPENSA730N DECLARATION
1 y affirm under penalty of perjury ane of the fallowing declarations:
am and will mama"a Cenificme of Commit self-inmm for Workers Campen-
on,a oded for by Section 3700 of the Labor Code,for On performanm of On
ork nch Nis permit is intend.
t I have and will maintain Workers Compensation Inmmum,a required by Section
3700 of Ne labor Code.fer Ne Perfarmanm of Joe work for which Nis permit is issued.
My Workefs Compensabonrlitsuan m carrier and Policy
rinumber am: I.�L.—
V
Car .,:1 MPolicy Na:nu.( a
CERFI AEOF��TIONFROM ORKERS'
COMPENSATION INSURANCE
(Thu action trued nos becompleled If the permit is format hundred dollars(SIM)
or less.)
1 mrtify that in the Performance of Ne work for which Nis permit is issued.I shall not
employ any person in any mannerm m in become subject o the Workers'Compensators
Laws of califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making Nis Cerificam of Exemption,you should
become abject M be Worker's CompenMdon provision of On Labor Code,you moa
.JO foMwith comply with such provisions or his permit shall W ma
doomed boked.
,Z.i ti CONSTRUCTION LENDING AGENCY
E+a�•v Ihereby affirm thmthem is a convection lending agency for Ne performance of
a> the work for which dds Permit is Issued(Sec.3097,Civ.C.)
W�Q lender's Name ,
r7 z Lexim',Address
U Q I termly thn I have read Nis application soil sea Net dm be.infarmmiun is
c,F Correa l agree to comply with all city and county ordinances and scam laws miatingto
QU building convection,and hereby authorim representatives of Nis city to enter uponNc
W nhavc mentimcd prapeny for m,fineuan pagwses.
W (We)ague to save,indemnify and keep harmless Ne City of Cupertino against
ti N liabililin,judgmcnts.cous and expenses which may in any way accmc against said City
O Z in com"clucreq or the granting of this permit Q
APPLIC U E AND D W C MPLY WITH ALL NON- DINT Issued by: Date `— /L4i0-G
SOU G A NS.
Re-roofs
ignmurc Of APph antra etc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant rm forum building occupant store or handle Heath and
az dented by the Cupenina Municipa c.Chapter 9.12,and the Heath and safety
Cale,Seed.35532(,)? All roofs shall be inspected prior to any roofing material being installed.
0Yc o
Will dm applicant or future building occupant use equipment or devima which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardnus airccmuminanu a Jeri y IN Bay Area Air Quality Management all new materials for ins p tion.
Disaict?
Oyes �s
I have mail Ne mushinvs materialsmquirements under Chapter 6.95 ofthe Califor.
on Health&Safety Code,Sccdon,35505,35533 and 35534.1 undersand Nm if me Wilding
Jmx not c rcntly ove ant.Nat it is m mihility m andry Ne ne ens of
rcquiu tsw m Wre a gene ftCbmncamaroc ignatureofAppl ant Date
Owner or authori. agcm Dam 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 . . . . . . . . : 32652053 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000058
REFERENCE ID # . . . : 06120125
SITE ADDRESS . . . . . : 10421 MARY AVE
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
•
CITY OF CUPERTINO
C U PE Rj IN 0 PERMIT APPLICATION FORM
PN Date:
-3 -
wim Name.
o
I, I I Phone 4:
License r{.
A
uu-',
CLIpertinc, Business License P:
C
Type of Roof Coverina:
E,xistim,
I uilh-lip kool
Jbilt-Up lool,
j ,Asphalt S J I ill—fl es D Asphalt Shingles
J \\,),l(I Shakos 0 Wood SIIAcs
;j Wo"d Shinnies Z) WOOLI Shill"ICS
❑ (W)CI Spc
OtIlcl (specify)
EJ PIONeidC I.C:.13.0.
07 I o h� RclllovCd U 1'1()Vi(lc Migi. 11I.SMIJItion Specs.
v-c Read. Understmid and Will Comply witil CLII)CI-61 (�S TCM- Off Policy:
Job Description:
-1� , )� �ff�( �,X�I',,
Eesiciclll.iad commercial
-F,I-c To-,I—c: Yes 7 No F-1 Confirmed with Planning Dept. if
there are any restrictions: El
_ff(-)-S t 7) -o I c c t: Type OCC011ARICti011: Occupancy group:
Applicah1c Fee 11) Fee Description Fee 01-01.1j)
11 p 1E R im P E,17- Bldg Permit Pecs BUILDING
BENERGY Energy BUILDING
BS LE I S!N/I I CC jP\E Seismic Fee lZes BUILDING
BSE'ISMICOM Seismic commercial BUILDING
BPLANC1-1k Plan check Fee BUILDING
R US L IC BUSilleSS License BUILDING