06120131 CITY OF CIII-PERTINO -
BUILD:NGDIVISION PERMIT C�1N�'.RA. T�/RX1 'fRA'It4TION
M
BUILDING ADDRESS: PERMIT NO.
Ism, A
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006 .
pEFnrrTnao SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITER/ENGIHEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Hipp LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing
1OZ�F rNSetion]IXp)afDonsian3oftheBuain andPafessiunsCade,andmylreenser REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
=to in full force and cc
z Llaese Lw.# NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
t:g Dave s cru mctor �— & GRAVEL BUR.
RCHITECrS DECLAR
I W 6 I undcnwnJ my plans shall he used as public records
in
Licensed Pmfmsianal
S
OWNER-BUILDER DECe ConroON
)0 I homily.(Tian on 1 am exempt from the reantracto o e:My c Law for the
p 0 fallowing moron.Permit
r 711313,Business and improve,
deriom Calc:Any an s county
m F which its requires issuance,Permit re eonsweL alwn improve,de ermit t rte e pair any awment
munc
s—m the,best cnerdFrwentquircs dtevision of for such Permittosignedstatement
; a(co me cingwitpSewantwthcpmvisions 3die eBusi Business
ndProflaw(C ode)9 Sq.Ft.Floor Area Valuation
`eF$ (cammcncingwithSection700dof thebasisfrnfthceedessaiumn.AuionaCaee)or $2381
., Nn io u campy aerc0om and due aper for the alleged ewmpdon.Any violation of
]031.5 Ory applicant for a permit Object,the eppticanuo a civil penally of
.or.. 3 2 6 5 2 0 6 5 �Number Occupancy Type
not mora than five
we hundred dollars fssaBj.
❑I,as owner Cities grpeory.or my employees with wages pe duehwlecompensedon,
will do the work and theswcture is not intended oroRemd fnsale(Sec.7W.Business Required Inspections
and Professions Cade:The Conuecwr's License Law does not apply b an mom,of 9 P
property who builds orimprovas thereon,and whodoessuch workhimwlfurthrough his
awn emplayc as,provided duet such improvement,are not intended oroffned forsake.If,
however,the building or improvement is veld within one year of completion.the owner,
builder will have the berms of proving that he did rot build or improve for purpose of
salt.).
71 1,as Owner of the propeny,am exclusively contracting with[banned commemra to
Conswct the project(See.7064.Business and Profmsions Code:)The Consracmf's Lt.
come law does not apply to an Owner of property who builds or improves themon,and
who contracts for such project,with a co eractor(s)licensed pursuant in ase Contrwtora
License law.
I am exempt under Sec ,B&P C for this maven
Owner Data
W ORKER'S COMPENSATION DECLARATION
I by affirm under penalty of perjury rote of the following declarations:
aveand will mainuinaCeotifrumof Conwntwwlf-insumfmwm esCompere
cation,pe ..tied for by Section 3700 of the Lobar Code,for the performance of the
work hich this permit is issued.
I have and will maintain Worker's Compensation Insurance,pe required by Section
3700 of the labor Code,for the performance of the work forwhich this permit is issued.
My Workn's Compensation Inrace carrier and Nim,number ase: _
Cr x �14
Carrier 3L�( (�e`�'Poliry Na.:]LQ•.' Oef�
CERTIFlCATE OF EXEMPTION FROM WORKERS-
COMPENSATION INSURANCE
fThr section need tet bccompleted if tk permit is fororw hundreddellsra(SIM)
Of less)
1 certify dust in the performance of the work for which Nis permit is issued,1 shall net
employ any Proton in any mmsterw as,to become subject in the WOkera'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,a11cr making this Cenircam of Exemption,you should
become subject w the Worker's Compensation provisions of the labor Cele,you must
,J O foMwidu comply with such Provisions or this Permit rhall the deemed rtvakcd.
.Zi tiCONSTRUCTION LENDING AGENCY
[tea I hereby a Mom that acre is a eomtwctinn lending agency for the pefftermemc of
a the work for which this peomit is issued(Sec.3097,Civ.C.)
W�0 Undoes Name
z Undoes Address
U 0 1 certify that I have read this application and sure that the above information is
W correct.1 agree to comply with all city and county ordinances and sum laws relating to
QU building consnuaaino and hereby a uthmiremPrcsenratives of this city to enter uNn the
above-mcmwned prx Perry for insPerdnn puMmor.
W
(We)agree to save,indemnify and keep hamticss the City o(Cuperlinu against
� liebilities,judgment,,costs and expenses which may in any way acerae againstsaid City
U Z in consequence of the graming of this permit. �1
a'+ APPLIC DERSTANDS WILL COMPLY WITH ALL NON.PO NT Issued by: Date VZ-��•
SOU C LATIO
IJRe-roofs
ig are of pp icmutco r Da Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicent or future building Occupant store or handle haaardaus material
as defined by the Cupertino Municipal .Chapter 9.11.and the Health and Safety
Code,Section 15531(a>? 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
until Wermnua air emunminant,as tier y the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
I have mad the hasamaus materials requircment,under Chapter 6.95 of the Califon
nice Healdr&Sa(cryCadc.Sccdons25505,15573 an .I un M. calif due building
dors ren cu dy nano that it i pamibi y w nodfy thc oceup t of N
require t met p' cc,ofa 'rcawa(Ocuw . Signature ofApplieant Date
n Owncraramhorixdagcm Daw 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 . . . . . . . . : 32652065 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000064
REFERENCE ID # . . . : 06120131
SITE ADDRESS . . . . . : 10445 MARY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2311
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 PREFERENCE 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
• I
CITY OF CUPERTINO
11 E R 0 0
cu p E Rj IN 0 PERMIT APPLICATION FORM
Date:
Building l\c1dress:
I'llolic
Lj Lo c)
License 4:
(0
Contact: I Cupertino Business License t4:
c
Type of Roof Covcrillll;:
Prop!o�STI:
J luill-Up Rool, Gd Built-Up root'
U Asphalt Shingles U Asphalt Shingles
Cl Wood Slinkes
U Wood shill"les EJ Wood Shingles
D lriher(SI)CCilk')
cl Other(specif))—
.U11111cl of misting Q0vcl Illp's
FJ Provide I.C,13.0. Report ,/
hr Relllovccl 0 Provide MI'gi. lll.NtilllaLioll SI)CCS.
—Ulldersull1cl and Will comply With CLIJ)Cllioo'S TCaj- Off Policy:
lob Description:
Commercial
R 7 c.SidQlll.i;ll , u
❑
7- ——-------
-Irc Zone:
Ale: Confirmed with Planning Dept. if
C-0.1 k)-1—FIT ,—,I —, there are any restrictions:
❑
Type of Constriction: Occupancy "FOL11):
OtY. i f
Applic;lbic Fee 11) I-ce Description Pee GI-OLIJ)
13 P F R-'Z i\/l 1:E E BICIg Permit Fees
BUILDING
13 IF N I Y Ener�.y BUILDING
BSEISiMICRE Seismic Fee Res— BUILDING
B S�EJ,� I
SIMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fcc BUILDING
13 USL I C Business License BUILDING