06120143 CITx-OF CUPERTINO . -
P ING DIVISION PERMIT ON RAGT('RINFORM.QTIO,N
- _
BUILDING ADDRESS: PERMITNO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
nTTTnDO SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION Job Description "I
n 1 hm Nal
ereby affirm 1 am Oased
eunder pmviaionsof Oupter 9(mmen
mcitig
�Z
< with Section 7")ar DiA.C.a J of Ne Bualrlelt and Prorca.YnN Code,Ndmy license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL ;
, sry L easeull Ie and [fen C�7� � � NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
t�?
License
chi Lic.N
k, Da¢ ' Conlranar l���pg Z
RCHITECTSDECJ_A rt)ir & GRAVEL BUR.
i 1 u Hund my plans shall ha used u public rcCurtis
yV
'O.t, Livened Professional
'N 5 =I Con exempt fr DECLARATION
Zi I hcrcM a?irm Nat 11. exempt free Nan Conlns Cm License Law for the
a o fallowing moon.(Section]03
1.5,Business end Pmfessiuu Cada:Any city or county
-$ which requires a panned,n con.0 aim,.improve,demolish,of repair any structure
=< prior to its knomme,also mquires lM applicant for such Permit o file a signed statement !
jG dwthe isliccnscdCommon nCpde,Provisions ofme,ConuswriLiaueLaw(Chapter 9 Sq.Ft. Floor Area Valuation
3�$ (commencing with Secdum 7000)a Division J of Ne Business and Professions Code)Or $2381
7 — Nat he Is exempt therefrom and the basis for Ne alleged eump ion.Any violation of
Section 7031.5 by any applicant for a permit subicN the appllcaN to a civil penalty or Number Occupancy Type
net mon son Bye hnndma doll.($500). 3 2 6 52 07 9
D 1,uownerof Nepmpeny,ormyumpla withwagesu Noirsolecompenudon,
will do the work,and Neswcuse is W,intended or offered foesale(Sec,7DN,B Wines.
and Pmfe ajo is Code:The CanuactoYs Liana Law dao Int apply n an owner of Required Inspections
pmpeny who buildsarimproms Chosen,and whodossuch work bimulfor through his -
awnemployees,provided Out such imPromments am Just Intended or offered for sake If, -
ho onmr.Ne building or impmmmCot b sold within ane year of completion.dm owner.
builder will br m rhe human of proving Na,he did not build or improve for purpose of
sale.)
D 1,as mora of the propeny,am aacludvely conuuting with licensed concomors or
construct the project.(Sec.70M,Business and ProfeadoN Code:)The Cm=wri U.
canna law does not apply in an owner or property who builds or improves thereon,and,
who conmem for such prokcts with a contractor(s)licensed pursuant on the Contractor's
License law.
❑lamuemp,under See ,BAPCfar Nbreason
Owner Date
WORKER'S COMPENSATION DECLARATION
1anwillY+!firam under paJW ty of perjury,One of Chat following declaration:
am d mkmukn a Certificate of Consent o self-Insum for Workc's Compen-
scuu m,u provided for by Section 3700 of the labor Code.for Ne performarta of Cote
work for h this permit is issued.
an and will maintain Wokafs Cumpcnation Insurance,as required by Sectio
3700 of the labor Code,for the performance of the work for which this Permit is issued.
My Wa sCompensation bilmtcee�carria�r and PolityTE nu her rt:
Carder. tEXEMM iN RO �p2
ERTIFlC OMPE SATION ONPRAN WORKERS'
CNSATIONINSURANCE
(This anion need no,he completed if the permit is i.e.hundred dollars(SIM)
or ices)
1 ceni(y Nat in the performance of Ne work for which this Permit is issued,l shall not
employ any person in any manner so as to become abject to the Workers'Comp tar sation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Coda,you must
.,z ronewith comply with such provisions or this permit shall M deemed revoked.
z` CONSTRUCTION LENDING AGENCY
(~� I hereby allim doll them is a construetinn lending geey for the Performance Of
C the work for which this permit b issued(Sec.3037,Civ.C.)
CQ Undoes Name ,
z leadch Address
U Q 1 Curtis Chad I ham mad this application and state Cal the,above information is
correct.I agree to comply with all city and county urdivmnew and sum laws relating to
0U building Conswction.and hereby authorin,mpetsentadms of this City to enter upon the
G shove-mcmiuned pmpeny for inspection pu,potts.
(We)agree to sae,indemnify and kap u Ne l umleCity of Cuperdnu agaiw
N liabilities,judgments,cotta and expenses which may in My way accrue againsudd Ckty
U z in consequence of the granting of this permit,
^ APPLIC ERSTANDS A LL LY WITH ALL NON-POINT Issued by: Date P2. —2�—UL
SOU S.
Re-roofs
i6 mrc of pi usr Dare
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the Cuart or future building occupantstore 9.12.and HeamoWmaterial
u dcOnN by Ne DYpenlao Munidpal Cade. per 9.13,and the HNIth and Safety �
Code.Section 35532(.)? All roofs shall be inspected prior to any roofing material being installed.Dyes
Will the applicant Or(uom building occupant use equipment or Ikvias which If a roof is installed without first obtaining an inspection,I agree to remove
Omit huardnW air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Diurict7
Dyes
I ham most the hanmoW materials requirements under Chapter 6.95 once Csifor. /v
JiaHWINd:Sa(cty Cade,Scniau ZSSOS,ZSSJJ and 25534.1 undcnund thazif Nan Wilding d '
dos CA, ham tenant Cal II ls m nihililY to nodl'Y Nan ac ant car N P—
mgoln x rad a an Cory"'Cteor p Signature of Applicant Date
Owner tar authonzcJ agentDoc
All roof coverings to be Class"B"or better .i
CITY OF CUPERTINO .
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: . Blk: Lot:
APN 32652079 .00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000077
REFERENCE ID # . . . : 06120143
SITE ADDRESS . . . . . : 10473 MARY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER M & CASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1350
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 VOICEIDDESCRIPTION
-------- ---------------------------- ------ ------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
11IE.W)OF
CUPER.TINO PERMIT APPLICATION FORM
DaLc:
0-79
13 u i I d I[I!;.t\ddl ess:
O —ic Phone #-
r
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Cone actor:
4
`110oc
c #
License
(0
CLIJI)el-tino Business License
Type of Roof Covering:
sc g:
Existing: Proposed:
�j HuiP.-Up "ool 2<3uilt-Up roof,
"J Asphalt shingles 03 Asphalt Shingles
U Wood ShAcs U Wond Shakes
U Mud Shingles 0 Wood Shingles
D (Whel (SI)m1y) ZI 001cl (Spccify)—
�' --
�l I pflu �()Vcli.11�'S cJ I'lovide. I.C.11.0. Report 8
L�j 'I'o hr Renitivc(I 0 Provide Mfgi. Installation Spccs.
Invc Rcatl. Understand and Will Comply With Cupert Ws 'Fear OffPolicy:
lob DearMUon:
Rcsidcnti-117—
commercial ❑
Fire Zone: Ye, ❑ No—❑ Confirmed with Planning Dept. if
there are any restrictions:
Cost 7)r1 c I TYPe OCC011SU'LIC6011: Occupancy group:
ApoicaNc BP17 Fee 11) Fee Description Fee Group
R Im F 1:7 6 Bldg 1"mut Fccs BUILDING
BENGRGY BUILDING
)ING
t'
BSEISN11CRE Seismic Fee Res BUILDING
BSEISN/HCOM Seismic commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSUC— Business License BUILDING