06120133 CITY OF CUPERTINO PERMIT �0yrj iCT,0RJ, �r0, �' ��',Z N
�^ BUIL.DINC DIVISION
„a. .. e.
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NEFns rrnsno SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION IOb Description
1 hereby affirm Nm 1 am hermsed under provisions of Chapter 9(commencing
z1 with SectionTOM)ofDivision3oftheBusinessandProfcssiomCode.andmylicenseis REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
yinfull force and fcc
tqz LicenseClazs Lic.# NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
�t-p Dele Conlractur
�^Q CHITECTS DECLAmeet & GRAVEL BUR.
uunderstand.1 plain be ss shall used publicc mrnrds
iyU
°Q Licensed Professional
OWNER-BUILDER DECLARATION
:C 0 1 hereby.(Tien that 1 1. exempt from Ne Conws Coe License Law far the
p o following reason.(Salon RD LS Business and ve,demes Cndc:Any city or roomy
1$ which inquires a permit m ennawcL etre(.improve,dkmolish,or.pair any structure
.miprior to its housnce,slu o:quires me applicant for such permiva file a signed summbil
thin he is licensed purseunt In the pmvisians of the Contractor's Liecnu Law(Chapter 9Sq.F1. FIOOIArea 2381 Valuation
IsF (commencing with Section 7")of Division 3 of the B armors and Professinm Code)or
5 2 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 the mm0cam in a civil penalty OfNumber Occupancy Type
nal more than five hundred d.11.(M). 32652061 :Vl7'
O L m owner of Use property,O my employers with wages as their sale comp ctudon,
will da the work,and Ne swcture is nut intended or offered fonal.(Sec.7W.Business Required Inspections
and Profe sadmic Cade The Comructor's License Law does rot apply m an owner of q p
property who builds or improves thereon,and who dos such work himsel f or through his
own emplayoos,provided that such improvements are not intended aroffemol forme.If,
however,to building or improvement is sold within ane year of campledon.me owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
O 1,as Owner of the property.am exclusively contracting with liorued comments to
container the pmKes(See 7s 1.Business and Professions Code:)The Couacmr's Li-
cense law does not apply to on owner of property who Wilds or improves therton,and
who conuacu formich projects with a CimusecO.)licensed pumuant to the Cmubi -
Llcevas law. -
E]lam exempt under Sm. .B A P C far thix msson
Owner Dau
WORKER'S COMPENSATION DECLARATION
I by affirm under penally of perjury.of the following declam0ans:
hxre and will maintain a Certificate ofCorleenl m self-inaum far Worker's Compcn-
.him,as provided far by Section 3700 of the labor Code.for Ne performance of the
work fo ich this permit is issued.
have sad will maintain Worker's Compensation Insurance,as required by Section
3700 of the Latin Cade,for the performance of the work far which this permit is issued
My Warker'a Compensation 1. nnoca/rri�er Pend Policy nmbe^' 0QJVCartier. Oaliey Na.:
CET OF EXEMPTION FROM KERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars(SIM)
or loss.)
I certify Nat in the performance of the work for which this permit is iesucd,I shall not
employ any person in any manneru as m became subject to the WorkeW Compensation
Laws of Califomia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject in the Worker's Compensation provisions of Ne later Code,you must
.J O forthwith comply with such previsions or this permit shall he doomed revoked.
'fit-
-' CONSTRUCTION LENDING AGENCY
I hereby allrm that there is a construction lending agency for the performance of
0.i ti the work for which this Permit is issued(Sec.3M7,Cin C.)
14 Q UO&,'a Name
.7 z Lender's Address
U O 1 certify that 1 have mad this application and sum thin to above information is
W f" coneCL I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby sumunire reprcsenutims ofthis city to enter upon the
4 shove-mknuoned property for inspkcdon pugmses.
(We)agree m rave,indemnify and keep harmless the City of Cupertino against
aF"y 4 Iiabilides,judgmcnu,casts and expenses which may in any way accrue against mid City
U z m consequence of the mining of Nis permit. �1
^s APPLIC NT N STANDS AND LY WITH ALL NON-POI Issued by: Date
SOU U
Re-roofs ^�
Signature of Apph onsmmor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dre applicant or future building oecupantmore or handle hmardous mamdal
a defined by one Cupertino Municipal C ,Chapter 9.12.and the Hedth and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Oyer
Will the applicant or fuu building Oreo ant use nominated or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
mil hovardnss air contaminants as define Bay Arca Air Quality Management all new materials for inspection.
District?
0Yes /s /)
Ihavc mad the hazardous materials tequircmcnts oink,Chapmr6.95 ofthe Calif.,.
nia Hialthdr SamtyCede.Seen.25505,25533 and Jmsmnd thmifthe building /VX VT
does not cunni( aw nl Nat' ' ms sihilit noul'y Ne Occup t of the
rcyuire s metp' rwi of 'rani. c an n IgnatureofApplicant Date
Owner or authorized agcnl DateR' All roof coverings to be Class "Bn or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sea: Twp: Rng: Sub: Blk: Lot:
APN . ... . . . . . : 32652061.00
DATE ISSUED. . . . .,. . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000066
REFERENCE ID # . . . : 06120133
SITE ADDRESS . . . . . : 10437.MARY' AV
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1345
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
•
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CITY OF CUPERTINO
fI yOj
C1_IPFR lN0 PERMIT APPLICATION FORM
AI'N r Date:
_�_
iBuilding Addms-
Owner's Nam.c: J Phone #:
1� (_ 1��;��(�Ci��,� iCt1 '1v`�r�twvrd �F r � I�P� C� u�5 cl i n
Contractor: Li1
cense ,l:
Conuu:.t: J .- Cupertino Business Liccnse 1: -
Type of Roof Covering:
q
Lxisthg: Propose I:
J Buil!-I I p Rool
I 2 Built-Up tool' -
'.] ,\sphalt Shingles ❑ Asphalt Shingles '
❑ Wood Shokcs ❑ Wood Shakos
❑ "WA Shingles ❑ Wood Shingles
❑ Uthcr(Spacity)-- _ ❑ Officr(Specily) _
Nwnhcr of csiming coverin_s—' -- ❑ Provide I.C.B.o. Rcporl II
.ti l o hr Rcnwvecl ❑ Provide iM fgr. Installation Specs.
•
I--- —
I hn�c Read. Understand and Will Comply With Cupertino's 'fear Off Policy: ❑" I
.lob Description:
Residential Commercial ❑
fire Zine. Ycs ❑ Nu ❑ Coal rme4 with Planning Day if
there are any resvItions: ❑
Cost of Project: I ype of Construction: Occupancy group:
� '
otv. iF
App kiNc_ Pce ID Fee Description Pec Group
BPGRiMFE 1314" PerFees BUILDING
13DNL;RGY Energy BUILDING
BSGIS\IICRL" Seismic Pec Res
-___-- BUILDING
_ BSIHISMICOM Seismic Commercial BUILDING
BPLANCI-IK Plan Check Fee BUILDING
BUSI.,IC Business License BUILDING
i