06120142 CITY OF CUPERTINO •� 2 '' -
bJILDIN-, DIVISION PERMIT C®1W,TRriC,T()IixNk'URMATION.
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: D
M & C( ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NEF'n5 sTn4c SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
HLDoDo EO PLO MEOCH
1gzLICENSED CONTRACTOR'S DECLARATION - Job Description
1 webby affirm Nat 1 am licensed under provW-a-of Chapter 9(commencing
Mitt Seders 700D)mfDivision 3 of the Bunn...and Prmfossiuns Cade,and my Bceme is REROOF MFDWL GARAGES—„ TEAR OFF EXISTING, INSTALL
in full force and 1 V1
Lmenecl a Lm.x NEW 3/8” CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
• Dpi Dao; CHl'rECTSDECLARATIO & GRAVEL BUR.
i a< 1 on Mand my plans shall he used is public records
iyU
c LiccnaJ Pnsfcssionai
1 OWNER-BUILDER DECLARATION
f 0 I hereby.(Sce un I sI.exempt from the Cantracmc License law forme
.p o following reason.(Sccuun](13 1.5,Business and Profcssnns Cole:Any city or county
7: which mquira a permit to commuct,eller,improve,demolish.at repair any structure
prior wits issuance.also requires the applicant for such permit to file asigned sentiment
C that he is licensedpursuanttotheproviaiomoftheCmntracmr'cLicenseLnw(Chaptm9 Sq.Ft.Floor Area $2381 Valuation
i� (commencing with Section 7000)of Division 3 of the Businrssand Profanation;Code)or
dial he is extmpl therefrom and the basis fa the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of yp�Number Occupancy Type
not more than rim hundred dollars($50]), 32652081:Vl7'
1,n owmr of the property,m my employeo with mges u Noir sole compensation,
will da de work and Ne svudureunot inteded oroRemA fon a1e(See.7044,1hutmas Required Inspections
end Professions Cads:The Ca mands's License Law don dot apply w an owner of q p
Property who buildaorimpraves Ncimsm.nd who dcessuch work himselfar Waugh his
own employees,provided Nat such improvereanu are,not intended oroRerrd fmsale.If,
however,the building or improvement I$acid within ore year of completion.Ne-11
builder will have the burden of Proving that M did act build or improve for purpose of
ale.).
71 1,as owner of the proPory,am exclusively contracting with licensed contrsewrs to
construct the project(Sec 7044,Beaman and Prefeasmu Cade:)The Conmewr's Li-
ccnse Law docs nal apply in an owner of property who Milds or improves Nercon,ad
who common,for such projects with a conmctor(s)Became it puauant w the Contractors
License law,
❑1 am exempt under Sec. .B 3:P C far thiorecon
Owner Date -
WORKERS COMPENSATION DECLARATION
1 y aID n under penalty of perjury rete of Ne fallowing deelaadmns:
are and will maintain:Certificate of Consent to self-intim for Worker$Compen-
seems,az provided for by Section 37W of the Labor Code,for the performance of Ne
ark fo/r ydrtell this permit is found.
[94luve and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of Ne work for which this permit is issued.
My We CamPeasat. a 1 wmce curio ad Policy number ^
Cartier. Policy No.:
CE IT TE OFEXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(Thissection amid rwtbccompleted lithe permit is(mane hundred dollars(SIM)
or less.)
1 certify than.in the performance of the work for which this Permit is Wood.1 shall not
employ any person In any manner an as w become subject o the Worker$Compensation
Lam.(California Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject W the Workers Compenation provisions of Ne tabor Code,you must -
.J z fmMwith comply with such provisions or Nis permit shall be deemed invoked. -
z'y CONSTRUCTION LENDING AGENCY
[ti I thereby aifum that Vert is a construcudn lending agency for tM performance of
�i de work for which this Permit is issued(See 3097,Civ.C.)
131 Q Lender's Name
z Lender's Address
V Q 1 certify that I have rad this application and On that the above information is
ty " correct.I agree to comply with all city and county collimates and slate laws relating to
Obuilding construction,and hereby authorix representatives of Nis city to enter upon the
Umabove- entiuned property for inspection purposes.
(We)agree to ave,indemnify and keep handles,the City of Cupcnmo against
„E"„ N liabilities, costs and expenses which may in any my name against said City ,
U,Z in consequents of grantin8 R
S0 ERS( S A OMPLY WITH ALL NO -POI Issued by; Date
SOU G TIONS.
Re-roofs /�---
SlgnaureofA icanwCmamaetorDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de appliant or future building occupant stare or handle hvardau m.what ,
as defined by the Cupertino Municipal/Coda,Chap or 9.12,and the Health and Safety
Code.Section 2553x.) V✓� All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or forum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit lotommus air camendments as defined by the Bay Arca Air Quality Management all new materials or inspection.
District?
Yce
I have mail W ha aNmu materials requirements under Chapter 6.95 of Ne Califon /
nim Heuldh&SafetyCade,Sections 25505,25533 am125534.1 notation4 that if Ne building
dura not cu my M e AL Nat It ism ai " notify Nc occas ant of
require Which fat wi an ficamON igna ofAppicant Date
ow mraammrindag t Ddtc 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 . . . . . . . . : 32652081. 00
DATE ISSUED. . .". . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000076
REFERENCE ID # . . . : 06120142
SITE ADDRESS . . . . . : 10477 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION 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 VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF - 602 ROOF PLYWOOD NAIL -
603 ROOF BATTENS 604 ROOF IN-PROGRESS
CIT'VOF CUPERTINO
CLJPF.R'fiN0 PERMIT APPLICATION FORM
m-;-J,\[ j� Date:
Building Address:
Owlic] Namc: Phone 4:
)1 t , /)-�, I(,-(� �(-n 1,`, -� -- Q- i u c)
Coil if nctor: —4
I'll I :7Licensc #:
A�
C011
Cupertino BLISiness License 4-
,-A
LLdL, D� cl,
Type of Roof Covering:
Exist i nu: Propos 1:
huill-Up Knof 2' 1hilt-IJI)10(o'
❑ ASI)hL111 Shincles 0 Asphalt Shingles
Shakes Wood SlMk� 0 Wood Shakes
f-1 Wood ShinLlcs Q Wood Shingles
cl 0111cr(spccify)
jlfl)LJ 01 CNIS[illi-, LOVel illi-IS0 Provide I.C.13.0. Report 11
A I o Pc kcllloved Q Providc Mfgi. Installation Spucs.
—Understand and Will Comply With CLIPCI-til O'S TCffl- 01'1'I)OIiCy:
lob Description:
Ptioll:
Commercial ❑
Fire Zone: Ycs 7 No F Confirmed with Planning Dept. if
Ilicre are any restrictions: El
Cnst ref Project: I"ype or construction: OCCUIX111CY C('1-01.11):
Ij
rApplicnblc
Fee ID 1700 [)CSCl-jptj0lj Fee GI-OLIJ)
13 P F R F E E- BId() Permit
-�c—es
BUILDING
BEN -RGI' Enci-y BUILDING
BSEISNIICP - Seismic Fee Ices BUILDING
BSEIS\IIC0VSeismic Commercial BUILDING
B )LANCHK Plan Check FCC BUILDING
BUSLIC BUShICSS LiCCISC BUILDING
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