06120137 (2) ------------
CITY OF CUPERTINO
BUILDIN DIVISION PERMIT CL1N'TRA.CT 'lRIFi'k�UX?'MATI0 , :
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: A
01, M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
SANITARY NO. CONTROL NO.
(408) 536-0420 ,
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
tic
op LICENSED CONTRACTOR'S DECLARATION .
wF 1 bunchy aRrm that I am licensed under provisions of Chapter 9(commencing Jab Description
:Za with SOction7").(Divimcm3ofdxBusiness ciPlefescmuCode.andmyliecnseis REROOF MFDWL GARAGES— TEAR OFF EXISTING INSTALL
< in full fore and a ec
i�? License Clue Lie.# �O 14 NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
i a-p Dau: Ceramicr
tp ARCHITECI-SDECLA I & GRAVEL BUR.
i C i 1 u rstand y plans shall he used as puhlic rmarJs
IdU
C m Licensed Pmfcssianal
OWNER-BUILDER DECLARATION
I0 Z 1 rccm affirm Wm 1 I. exempt from the Conwaaft :License Law for the
:p O following massa(omhon](D L5,Business and tie,de um Code:Any city or county
tn which squires i permit m cnnswct,alar,improve,h permit t ri repair any awmum
tn prior m its issuance,also Mind=tuims the provisions
for such permit m cc a signed statement
-i-athat
melicensed puuuant71WeprovisionoforeContractors (Chapter 9 Sq.Ft.Floor Area 2 Valuation
«�
that
(commencing pttScrefromon and
oebasisofr the
alleged
essandon.Any
Code)or381
that io ts exempt therefrom and Ne buns for the alleged pplicmon.Any l lemon of
Section ID31.5 five
mry applicant for a permit subjects Ne applicant to a civil penalty of Number Occupancy Type
not mom Inas Rva nnmdmd aanam(gsro). 3 2 652 0 09!��
0 1,As owner of the property,or my employees with wages az their sole compensation,
will do the work,and the swctum is not intended oroffemd far AM.(So..7W,Business Required Ins eCt10R$
Add Pretensions Code:The Contractor's License Law does not apply m e an owner of q P
properly who builds or im pmves thereon.and wha does such work himsel f ar deraugh his
own employam,provided thatsuch improvements are not intended oro@red formic.IL
however,the building Or improvement is said within one you of completion,the Owner.
builder
will have the burden of proving that M did nm build ar improve for purpose of
sale.).
1,as Owner of the Property.am exclusively contracting with licensed mntr'acmm At
construct the pmjem(Sec.7004,Business and Profession Code:)The Commences U-
ceme Law does not apply of an owner of property,who builds or improves themon,and,
whoconracu for such pmjects with a conaactorn)licensed pursuant m the Conmemfs
License Law.
❑lamexemprunder See .Ba:PCforthismazan
Owner Dam
WORKER'S COMPENSATION DECLARATION
Iby affirm under penalty of perjury one of the following declaration:
re nand will maintain a Ce ficaa of Convent to elf-insumfor WorkeYsCampan-
cation,An provides for by Section 3700 of the Labor Cade.for the performance of the
work for ich this permit is issued.
tie end will maintain Worker's Compensation Insurance,az squires by Section
00 of the lahor Code,for the Performance of ftwork for which this permit is issued.
My Workers Compensation sonnet Carrier add Policy mummer as:
Carrier: !� Polity No.: 7 �3'Q S' V�
C.C. I�PTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section decd oat be completed lithe Permit Is fm me hundred doll.(5100)
Carless.)
1 certify War to the performance of Ne work for which Nis permit is issued.I shall at
employ any person in any murder m az to become subjecuo the Workers''Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.arta,making this CmiRCaa of Exemption,you should
become subject An the Workers Compensation previsions of the Lahr Code,you mut
.J z foMwith comply with such pmvislorts or Nis permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[—t I hereby affirm Out Wert is a construction lending agency for the performance of
the work fur which this Pewit is issued(Sec.3097,Cih,C.)
W� A Leader's Name
z Lender's Address
U 0 1 certify that 1 have rood this application and seam that the shout information is
LL F Conect.I agree to comply with all city and county ordinances and smm laws slating to
0 U building construction,and herby authorim aPssantativcs of Nis City to enter upnn the
6Wi show-mentioned ue,rty(Or inspection pOrpume.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
sFa h liabilities,judgments,costs and expenses which may to any way accmc against set d City
Uz in consequence of the granting of this permit.
F-t APPLICANT TJNJJERSTANDSAN ILL LY WITH ALL NON-POINT Issued by; Date
SOUR R
tg mum olA can ontrxtar Da Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fates building occupant store ar handle hvardom maxrial
az defined by the Cupertino Municipal C ,Chapter 9.13.and the Health and Safety '
Cade,Sochan 25532(a)? All roofs shall be u inspected prior to any roofing material being installed.❑yes
Will the applicant or future building occupant sex equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil hazardous air conmminants u r d Id h he Bay Arca Air Quality Management all new materials for inspection.
District?
E]yea
Ihave&SafcL thehazar massa 505. m33and 55 under Charter 6.95 of the Wilding '� V VV_ V7
nta Hmlth&SafctyCode.Seeuom 25505,35573 and 25534.11.notnd that iu set
docs n t c nen h a ananL Nat it is my ihilily eo eroul'y the seri ret of
mgai ka is Ibemetp' ¢der Cemrmamora Signature ofApplieant Dat
o naroranmo .e agarol Date 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 . . . . . . . . : 32652009 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000071
REFERENCE ID # . . . : 06120137
SITE ADDRESS . . . . . : 10331 MARY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1339
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 OFCUPERTINO
cuhh,TINO PERMIT APPLICATION FORM
APiJDate:
12- ail -G
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OxvjmIN'
.-) L/
In
col I itinctol License 4:
6� 1–ho i D
Contact:
j Cupertino Business UCCII.�CU:
Ci.
Type of Roof Covering:
ist i 11 Prop�osTl:
.1 5a Built-Up roof
E) Asphalt shill2des U Asphalt Shingles
WoodShnkes El Wood shakes
wood shillujus 0 Wood Slihl.,des
❑ 011m ❑ 0dicl (spucily)
emslim, coverings0 Provide I.C13.0. Report 0
Umov�cd LJ Provide Mfgi. Installation
• I FLIVe,RCad. Understand and-Will Comply With Cupertino's Tell]. Oil Policy �
lob Description:
Commercial El '
Fire- Zone Yes ❑ No ❑ C0111-11-med with planning Dept. if
there are any restrictions: El
Cost �hProlecl' Fype of,Construction: OCCLIJ)aIlCy `I-OL11):
I v. i I'
Appl icahlc Fee 11) Fee Description Pee Group
11 P F R N/1 F—FF—E —
Bid, I)e-11it Pecs BUILDING UILDING
Ener ;y BUILDING
Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
3PLANCHK Plan Check Fee BUILDING
BUSLIC BLSiICSS License BUILDING