06120141 (2) 'CITY OF CUPERTINO
BUILDING DIVISION PERMIT IC�£pix',RAGT('IRINF,O.�t1.11'IpN
BUILDING ADDRESS: PERMITNO.
10-415 MANY A.07
OWNER'S NAME:
Ik M & C ASSOCIATION MGMT 605 COMMERCIAL ST12/21/2006
pEVT,1TT1V C` SANITARY NO, CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLO MEOCH
ni O is LICENSED CONTRACTORS DECLARATION ]Job Description
m 1 hereby affirm that 1 sm lisneed under provisions of Chapter 9(commeain{ P
with Sccdae7000)Of Divisim3afnee BW.and Professions Code,and my hors is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
in full fora and I
License Class,
Lk.N
NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
o Dau: Lic. mr
^� ARCHRECI'S DECLARATION .� & GRAVEL BUR.
i R
1.
dersun my plans shall he used Is public mcords
inV
Licensed Pmfcasionel
5
OWNER-BUILDER ECe ConuaON
<� I hereby elTirm that 11. uempt from the Casional Co License Law for tft
,
.D O following mason.(Section HD 1.5,Business and Professional Cole:Any city n,caumy
5$ which mcuku a Permit to construct,alter,impow,dmeoltah.or repair any avunmt
-2<
prior k) issuance.also Iequim the applicant for Inch Perritt to lite a signed statement
that he k licensed purnour, Ute provision of the ContrxmislJanse law(@apta9 Sq. Ft.Floor Area 2381 Valuation
(commencing with Soman 7000)of Division 3 of the Businrssand Pmfeulnna Code)m
Net he Is exempt themfmm and the buts for the alleged eeemption.Any violation of
Section 7031.5 by any applicator for a permit subjects rhe applicant to a civil penalty ofNumber Occupancy Type
not more than five handled dollars(5500). 3 2 6 5 2 0 01 idff
C]1,as ownerof the property,army employees with wags.their saleeampcuedan,
will do the work.and the structure bnmin¢ndcd oroffeted forsake(See.7044.Bummer Required Inspections
and Ptafessiaus Cade The Contra noes License law does not apply th an owner of q P
property who builds or improves thereon,and whodassuch wart himself or through his
awn cmploycrs,provided that Inch improvement am root intended oroaereJ tarok.If.
however,Ne building or improvement is sold within as year of completion.the owner.
builder will have the bu chat of proving that M did not hold a improv foe purpose of
ask.).
❑1,we owner of the property,am exclusively canuacting wine licensed contrurors to
coutmct the pmjca(Sec.7041.Business and Professions Code:)The Contractor's Li-
ceve law does ata apply m,n owner of pmpaty who builds art impuaes Ihemar,and,
who enamels for such projects with a cantrvamr(s)licensed pursuant on the Contractors
License law.
❑lam tempt under See .BBPCfmrW; on
Owner Date
WORKER'S COMPENSATION DECLARATION
1 he ori,m under peultY of perjury one of the fallowing ealarationx
ere and will mainWna C rz.00,of Consent te self-insurefor WarkeraCampus.
s tan,as provided for by Section 3700 of the labor Code.for the performance of ete
work fo eh this permit is bounce.
ere and will maintain Workers Compensation Insurance,as required by Section
]00 of the
our Cade,far Ne performance of Ne work for which this permit is issued
My WoftessCCompensation
IBiloramce o/rtio and Policy number a m: �g
Cartier. 92M ` jW1Q Xaliry No.: (J ,-
CERTIFICATE OF EXEMPTION FROM C HERS'
COMPENSATION INSURANCE
rrhuseedon need not becompleted if the permit is faane hundred dollars(SIM)
or Ins.)
1 comfy that in the performance of the work for which this permit is basad 1 shall not
employ any person in any manner¢u In become subject m the Warkent Campalauan
Laws of Califomia Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
become subject to the Workers Compensation provision of the labor Code,you most
.J z forthwith comply with such provisions or this permit shall he deemed runled.
z ti CONSTRUCTION LENDING AGENCY
f" I berchy affi m Utas Neve is a couuvctinn lending agency for the performance of
(Z> Ne work for which this permit is issued(Sec 3M,Civ.C.)
W�Q Lan im's Nauru
.7 z Lerd,es Address
V Q I anify that 1 haw mad this application and state thou the above infornatiun Is
earml l agree to comply with all city and county ordinances and sum laws relating10
QU huilding consauaion,and hereby aruhmi.te,macrumives of Nis city to eme,upon the
GId ah n rinnartmod popery fa,im,,,uan pmlases.
fy (We)agree to un,indemnify and keep haass the City of Cupertino apiut
F h habiliuu,judgmcnWeasu and expenses which may in any way accrue against said City
Oz in consequence of the granting of this permit.
^^ APPLICANT IJNURSTAND D L COMPLY WITH ALL N -P01 Issued by: Date 'L ALL-'Z1-
so IN,
/ice
Re'-roofs
-fflgdSdlhc OrA icon onuactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Neapplicant or fumm Wilding occupant srom or handle harardau material
as defined by the Cupnom,Municipal ,Chapter 9.13,and the HealUt and Safety
Code,Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑yu a
41 Will the applicant or future building occupant use equipment or dcvtcu which If a roof is installed without first obtaining an inspection, I agree to remove
emit harardrus oil cmumoinanu asJcfi by the Bay Arca Air Quality Management all new materials for inspection.
District?
0 Ya u
I have mad the huardow materials requirements under Chapter6.95 of the Califor-
niaHealthk Safety Cade,Secumu 25505.25533 vnd25534.I understand thatifthe huilchng
Jas not cwm Jy Aa a... Nat it u m mibit m noul'y tM pmt of
requimm loch stbcme'Pm
an a facurniftcraca- P Signatureo pplicant Date
owner err euNomtd scot / Da All roof coverings to be Class "B"or better t
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652001. 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000075
REFERENCE ID # . . . : 06120141
I
SITE ADDRESS . . . . . : 10315 MARY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1338
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
•
CITY OF CUP'ERTINO
3111
CUPERTINO PERMIT APPLICATION FORM
3 Date:
Building Address:,
- ) Mom
–T— 1,11011C 4.
ColMMOI: License
icense
)-�C1[[ CL )C'tilO BUS
iness License i,�-
I ype of Rool,Covering:
llropoTl:
ffd kill-Ul)1-001'
,.-j Asphalt shingles ED Asphalt Shingles
Wood slinkcs Cl Wood Shakes
❑ W""d SlhjjlLdcs 0 Wood shingles
(SjpcLll\ Q 0 th u]*(S pec i 1p)_--
?:unthcr I)[ C\IS HI" 111\cll 11"
I �.s D I'l ovicle i.c.13.0. Report 11
CJ Provi dc N1 Igl,. Installation Specs.
Understand a11 Cl Will Comply With C LII)CI-ti I o s Tear Off Policy:
job
S C I 11)t I()I I:
Residential E]" Commercial ❑
=ire Ztme: Yes 0 No F7 Confirmed with Planning Dept. if
there are any restrictions: ❑
Cast of —o I c c t: 'l)'j)e of Construction: Occupancy ('t-OLIP:
OG -
0[\. if
Appi C:lhlc Fcc 11) ["cc Description Fee Group
F-- -- --LN' '
Bldg Permit Fe
es
—
BUILDING UILDING
BEN [R6 ' Energy BUILDING
3SL1S\,lICP _ Seismic FLc Res
BUILDING
BSEis\11ICON1 Seismic Commercial BUILDING
BPI-.ANCI-fK Plan Check Fee KiLDING
— — BUSLIC BLSIIeSS LIcjISO BtlLDfNG