06120144 CITY OF CUPERTINO *enur�` T1�FU�tMAT10
'BUILDIIIG DIVISION PER iCONTRACTOR
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BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
gfl�ns rTnnc SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION lob Description
U I hereby air..Nal i am formed under previsions of Chapter 9(ro nnumeing p
wM Section 7000)of Division 3 of the Business and Professimu Code,sed my Hemen is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
.mow in full forty and act. �17/ 'n
I4? Li=ane Lk.g� (rO.L�_a( NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
;F� Dam ARCHITECTS OECLARA IT ON Z — & GRAVEL BUR•
i1 understand my plans shall M used as m
as
public cords '
'pt', Licensed Pm(cssionel
5 OWNER-BUILDER DECLARATION
Cmdr ON
400 I henry.(Tire I a1.exempt from the Connectors License Law for the
a O following mason.(Sectiont71n LS,Business and Pmfessium Cao:Any city s county
$tai which requires a permit m cmnswcL alter,imPmve,demalLN,or minor any,wmum
prior or its issuance.also requlru the applicant for such permit to Ole a signed statement
that he is licensed pursuant to tiro provisions of the Comment's bane Law(Chapter 9 Sq.Ft.Floor Area Valuation
Sr (commencing with Section 7000)of Division 3 of NC Business aM Profession&Code)or $2381
that M be attempt therefrom and the bub for the alleged nmmption.Any vuMton of
Section 7031.1 by arty applicant fees paten sumps.the aPplk.L I.a civil p rel"of �,p�Number Occupancy't�
not mom than Bon hundred dollars(S300). 32652077 . p y -+pe
❑1.u owes of tiro Propmny.a my cmploym with wager u Ibe'v sok compensation,
will ad the work.and meswcmrs b rot intended or offered for asks,(Sm.704l,l,Business Required Inspections
and Prefessns ioCode:The Connector's License Law does rot apply m an owner of q p
property who build,&improv Hereon,and who docssuch work himselfor through his -
own employees,provided Nm such improvements tae not intended tar oRerea forsak.If,
however.Ne Wilding or improvement Is sold within one year of completion.ate owner-
builder will have tbo bard.of proving that bo did rot build or improve for purpose of
sak.).
❑1.u owner of the property.em eaelutively contracting with llmuad smomm ms to
construct the projem(Sec.7014,Business and Profusion Calc:)The Canwclars U.
emus law does not apply to an owner of property who Milds or improv thereon.and.
who contracts for such projects with a mmracmr(s)licensed founded in the Connaaah
License Law.
❑Iamame,ounder See ,Rk PCAuthismams
Owner Date
WORKER'S COMPENSATION DECLARATION
I affirm under penally of perjury one of the following duluatiou:
am and will maintain a Certifream of Concert to self-lesum for wo lmysCompen-
utian,u provided(a,by Section 3700 of the Labor Code,for the performance of Ne
work fes 'ch this permit is issued.
ve and will maintain Workh Compensation Iwrma.u retired by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation In rsna artier and Policy number are:
Cartier. Policy No.:�� a7�� Q
CERT FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Inds section need not c completed Ifthe Permit is furans hundred dollars(SIM)
or lc=)
I certify Not in the Performance of to work for which this permit Is issued.1 shall not
employ any person In any menrre, u in biome subject to Be Wmiceri Com,ormcke
Laws of C4lifomia.Data
Applicant
NOTICE TO APPLICANT.If.after making this CcniRcam of Exemption,you should
became subject m the Workers Compensation provisions of the Labor Code.you mot
.J O forthwith comply wife such provision or this Permit shall bo deemed revoked.
'ZEE CONSTRUCTION LENDING AGENCY
��+ 1 hereby affirm that them Is a consuucden lending a far the f a f
the(•'t Y g genet' per tw rya u
G' Le work for which feb Permit b lured(Sec.3(191,Civ,CJ
Lc Nedra
WD z recs
a z Lancee&AddAaanns, ,
V Q 1 certify Net I have read this application and sum Nos Ne be.information b
gU P comet.1 agree to comply with all city and county ordinances and state laws relating to
DU building consuuction,and hereby aummine representatives of Nis city to enter upon lM
[+7 shove-memiuncd prupeny for inspection purposes.
6, (We)agree to sare,indemnify and keep Won].the City of Cupertino against
liabilitice,judgmeeta.costa and expcuu which may in any way eater against old City62�
U z APPL CANT Uf the grant f ihDEVTANDS An per IL CO Y WITH ALL NON-POI Issued by: Date
SOUR RE N
�a Re-roofs
im-Ium a(Appika rbComunor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or ran.Wilding axupulstaro or Irsodlc hazardous material
as defrru d by the Cupenim Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 85324)? All roofs shall be inspected nor to an roofing material beim
pYro �ty� p p y g being installed.
Will the applicant or future building occupant use equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hm�rdous air conuminenuude0nc Bay Area Air Quality Management all new materials for inspection.
District?
Yrs
I have mad the retention,nolud.ls ro,iremcnu under Ch,pmr 6.95 of the Califmr. /^
nice Hed"SafmyCaae.Seen.25505.8533md 4.lunderstand Ilea if lM building !QJ
does not cum ly ha a e Nat' tai i 1 m rally the a:cu t of
req.' cc. ie u m p, rmi eniI., r M Signature of Applicant Dat
O or or mthorie=d al=ret 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 . . . . . . . . : 32652077 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000078
REFERENCE ID # . . . :. 06120144
SITE ADDRESS . . . . . : 10469 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . : .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1349
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 83x16' 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
CLJPFR'TINO PERMIT APPLICATION FORM
APIN Date:
llllildlll, Address:
L--.-,-- , lbq-LLO'S - 5�
oW11c]
Phone
L"c I v k,-03 o r-)
coillrnctor:
Contact: )
Cupertino Business License 4:
(u l" Type of Roof C CIE
F i;ting:
Prop!O�Tsl:
J HL1111-till 1\',)()] Buill-Up roof
!.J A S p 11u I L Shingles ❑ Asphalt Shingles $
J
Wood Shakes 0 Wood Shakes
❑ Wood Shillules cJ wood Shilliales
'-J ()thcr(Sjpccilv) cl 001cr(SpQcl-:r))
N .
QNIMc0%01 110S Provide I.C.13.0. Report 4
Tu bc Rclllov�ccf Q Ptovidc Mf
Installati()II SPLLS
dVC Read. UnderstandandWill Comply With CUI)el-til o's Tear Off Policy: 12'
e s I j C W commercial
hire -Z(*)-1l—(2: Yes 7 No ❑ conf91-Illed with Planning Dc)t. if
there are any l*estrictions: LJ
Cost ,I Project. T)'PC 0I'C01lStl'LlC1i0ll: Occupancy roup:
Qn. if
Applic;lhlk: Fee 11) Fee Description Fee GFOUJ)
13 p F.,1\1 VI F F E 131dg Permit Fees
BUILDING
13ENF-RGY Energy BUILDING
--- 3S El S—[\/,,cp\r Seismic Fee Res BUILDING
BSI---lSiVIIC0N1 Seismic commercial BUILDING
BPLt\NCI IK Plan check Fee BUILDING
BLISiUSS UMISC BUILDING