06120147 (2) CIT.y OF CUPERTINO V'
BUILDINC'DIVISION PERMIT CUNT'R['1CT1�I2INI' ?RMt1.`X'I )`1 `'
.'
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: I�UE DA15
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
pEpo�rrnnc SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH '
�oC LICENSED CONTRACTOR'S DECLARATION 7b Description
U C I bemby affirm Met 1 am limp05Ci1P
nscd under provisions of Chapter 9(commencing
Iu with Section 70M)ofDivislont 3 offt Business and Pordfuraimis Cade,and my license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
ie. nfullfamcaW ee
Z LicensLk. NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
e #
F p Dam Conract.,
ARCHITECTS DOC[A & GRAVEL BUR.
{ < 1 understand my plans shall he mad us public nmenda
ae.0
°Qy Licensed Pmfcoianel
3 OWNER-BUILDER DECLARATION
Contractor's
(< 1 hereby a(Trm that 1 1. exempt from Ne Canins Co :A License Lew for me
D o following mason.(Section 703 mu Boioeus and Professions Calc:Any city or county
m which mgvima a Permit re cnr swa,alma improve,demolish,nr repair any ned statement 3zy pnarmiucensed ctivunito Me the
ovisiosofcant far such Connetoiuoiensle a eLaw(tammem
< mm he is licensed pumuam tome of Division
3 the a Business
License law is Code) 9 SG.Ft. FIOOC Area l 3 81 Valuation
l F C Mem a is axe exempt
Section]000)of Dlvrion r M the Bolnessand Professions I.&O,of
Met Section
r e¢mpt aerefrom and me beer for be alleged exemption.Any violation of
not mo 7031.3 by hundred
applicant for a pennft subjects Me applkant m a civil penalty of Number Occupancy e
oar mom man neo hunama anllars 135007. 3 2 652 015� P Y�'P
❑1,u owner of the propetty,or my cmployw with wages es Heir tale compenaatlon,
will dothcwork.and Me structure is notimended oraffered forsam(Sac.7W.Business Required Inspections
and Professimin Cade-The Contractees Liesne Law does not apply m an owrme nsr of 9 P
property who builds or i mprovp memon,and who does such work himself or through his -
awn employees,provided that such improvements see trot intended oOBem l for sale.If,
however,me building or improvement is mid within one year of completion,Me owner.
builder will have me burden of proving mel he did not build or improve for purpose of
sale.).
❑1,as owner of me property,em exclusively contracting wide limmed mnu¢tors to
convect the project(Sec 7044,Business and Profession Cade:)The Con istemr's Lt.
cents Law dam not apply to an owner of property who builds at improves thereon,and
who contracts for such pmjects with a coronations)licensed Forecast m Me Container's
Litems Law. _
❑ I am exempt..it.see .B h P C for this mason
Owner Dam
WORKERS COMPENSATION DECLARATION
I by affirm under pemity of perjury one of the fallowing declarations:
am and will maintain a Car ifimu,of Consent to self-insum for WorkersCompcn-
sae& u prpvi thi for mi Section 3]00 of me Labor Code.for me performance of me
"I irk"i"I m this permit eissued.
3
haw and will maintain Workers Compensation Insurance.as required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued
My Workkcor'ss^Co�m_pensation�pyumnce artier and Policy number are:
Carrier.J//rT� y(.//4� Policy No.; e57
e5 Po`
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seedien need not be compicmd if the Permit Is foram hundmddollao(SIM)
or Ims.)
I cerdfy mat in Me performance of Me work for which this Permit is issued.l she]nal
employ anypctson in any manners as to become subject to the Workcrt Compensation .
Lava of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject in the Worker]Compensation previsions of Ne Labor Coca.you mot
.J z forthwith amply with such provisions at this permit shall be deemed muton.
,zr51 CONSTRUCTION LENDING AGENCY
fa I hereby aRres Mu More is a construction lending agency for me performance of
rt..mss Me work for which this permit is Issued(Sec.3097,Civ.C.)
W�Q Under'a Name
a z Lender's Address
(„)0 1 certify that I have read this application and sum Mn the above information is
D. correct.1 agree to comply with all city and county ordinances and state laws relating to
U building construction.and hereby authonrz representatives utters City in enter upon the
>+ a above-mentioned pmpeny for inspection purposes.
(We-)agree to save,indemnify and keep harmless Me City of Cupertino against
r�-a fn liabilities,judgmcnu,casts and expenses which may in any way accuse against said City
U in consequence of the grunting of this permit. �1
^^ APPLI NT UN RSTANDS AND COMPLY WITH ALL NON-POINT Issued by: Date 'Cr 1z
SOU R U ONS,
Re-roofs 2.
Sigature ol'Ap'plicanKlintrelor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occup ntslore or handle haxandous material
as d.r,.d by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
cam,SceOon 35532(a)7
[3 Y. U � All roofs shall be inspected prior to any roofing material being41
Will The applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanocous air cootsminam m d�he Bay Area Air Quality Management all new materials for inspection.
District,
El yesft G���2—��
Ihavemad Code.Sem na 25505.2553 and2runticr ChaPmrdMnof Me Calding /^ ��
ar-
nice HcalMaveniaSafety Code.Secdau 75505 nexpiand3ss cock, hapten .95 fthc building Oa) l/../
docs nor tune he moan it ism niM1ilirY w notilY dm oxupant aide ��
reyuirc ie et lm roi ofaCertifiamof ancy. Signature of Applicant Date
—
Own raraum 'rcdagcnt 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 32652015 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000081
REFERENCE ID # . : 06120147
SITE ADDRESS . . . . . : 10343 MARY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . ... . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1340
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
--------
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 0(01ED141
mo
CUPFIRTINO PERMIT APPLICATION FORM
Dale:
0-3--q-3—j163LYS�
C,
License
ccminct CHI)CI-til10 Business License t4:
Ci —
Type
ofRoot'Covering:
It
Existing,: Proposal:
l] 111111t-Up Rooj 11Ldj[-IJp loot
;.I Asjphu1[ 10in"Ics ❑ Asphalt Shingles
A Wood S]Mkcs
0 Wood Shakes
Tj W"od Shiilulcs U Wood Shingles
LJ ()LhQ1 (specit\)
cJ 0 t 11cr(S pec i Cy)
Cms(inla, coverings w-S
D Provide I.C.13.0. Report 11
LU To oe Rewo,"'i Q 11mvidu 'VIIgi. Installation Specs.
eve Read. Understand and Will Comply With CulDcl-tillo's Tem. off,Policy:
Jo) -15 CSS C1 11)110 11:
Residential 0 Commercial
Fire Zone as ❑ No ❑ Confirmed with Planning Dept, if
there are any restrictions: El
CIN A Project: Type 0f'C0IlStI-UCti0lI: Occupancy group:
Fee 11) Fee Description Pee GI-OLIJ)
13 P F I t M Bicio pel-lijit 1ccs BufLDING
-3 E N I-E R G Y Energy
BUILDING
Seismic Fee Res B U 11
BSE1 SN/11CON/1 Seismic commercial BUILDING
B111-ANCIK Plan check FCC BUILDING
BUSLAC Business License BUILDING