06120154 (2) CITY OP CUPERTINO ` ° r', e '' .
30JILDING.DIVISION PERMIT CON: 'RACnI2XNF`UR'�'IATION *-
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: M U A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006 '
R'T"r,z,C, SANITARY NO. CONTROL NO.
(408) 536-0420
ARCH] ECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Op LICENSED CONTRACTOR'S DECLARATION Job DescriptionU C 1 hereby afRrm de,I am licensed under provisions of Chapmr 9(commencing
b w,MSection7")ofDivision3oftheBusinessandProfessionsCode,addmylicenseis REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
in in foil rarer and�free4-� p
;'q_ Lt....Class _Ltd.# NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
;t-qq Dam r"-1--�1'1_ (Contractor
qqW TSO-�gRl'Ftf1ECTS DECLARATION & GRAVEL BUR.
i 2< 1 undcntand my plans shall he used ss public remoda
ty
:o In Licensed Professional
5 OWNER-BUILDER DECLARATION
i1 hereby offirm that I am exempt from Ne Con"cler's License Law for the
.p o following..a.($¢tion 7031.5,Business Md Proposal..Cade:Any city nr C..my
7$ftii which acquires a permit in mm-1,alma improve,demolish,at.pair any sward.
prior at its issuance,also acquires Ne applicant for such permit to Ille a signed statement
:?x< thatheislicensedpursuantintheprevisionsofMeContractor'sLicenseLaw(Chapter9 Sq.F FlFloorArea $2381 Valuation
lk'a (commencing with Section 7D00)of Division of she Business and Professions Cade)or
$ Nat he is exempt therefmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant fora permit subjects the appllcaul to a civil pcnafty a( 3 2 6 5 2 017 Number Occupancy Type
not mae than five hundred dollars($500).
0 I,as owner of Ne property,or my employees with wages as their sole compensation,
will collie work.and destrucmmusot mmndeaornffnnd rorsale(Sm.71344.Business Required Inspections
and Professions Code:The Contractor's License Law dors act apply man owns,of q p
property who builds or impravus thereon,and who does such work Mmulf or through his
own employees,provided Net such improvements are not intended ar offend for kids.If,
however,Ne building or improvement is sold within one year of completion,dm onam,
builder will have Ne burden of proving Nat M did not build or improve for purpose of
sale.).
0 1.as owner of the property,am exclusively containing with licensed commetora to
contract the project(See.7004.Business add Professions Code:)The Contractors Li.
cents law docs not apply to an owns,of property who builds or improv Nenon,and
who caneas for such projects with a contncmKs)licensed pursuant in the Conoman's
License Law.
O l and exempt under Sea .B&P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
Vha1 y aRrm under penalty of perjury one of d.(allowing declen ions:
m and will maintain aCenifiam of Continuo self-maure for Worker's Camped.
sound,u provided for by Section 3700 of she labor Code,for Ne performance of Ne
Zwark
far w tch this permit is issued.
ve and will maintain Workers Compensation Insurance,u acquired by Section
3700 of the Labor Code,for Ne performance of Ne work for which this permit is listed.
My Warke Compddfion Iman5gap artier and polity number are:
Cartier.
alley No.: 72-3—00
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Miseection decd oathecomplemd if lbs permit is future hundred dollars(SIM)
or less)
I codify Nat in the performance of Ne work for which this permit is Issued.I shall not
employ any parson in any manner ao.at income subject m the Wmkers'Campensadon
Laws of California.Dan
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become suhject to Ne Workers Compensation provisions of Ne labor Code,you must
., O forthwith comply with such provisions or Nu Permitshall be deemed invoked.
y� CONSTRUCTION LENDING AGENCY
F Thereby affirm Nat Nen is it comwnion leading gency for Ne performanceof
Q! r>-u Ne work fur which his Permit is Issued($ec.3097,Civ.C.)
4 (a Lender's Name
z Lender's Add.
U O 1 ceAfy NBI I haw read this apphcadon and ale.that Ne have information is
lL Fcored.I agree m comply with all city and county ordinances and atm laws misting to
U building construction,and hereby authorim mpresentativu or Nis city to enter upnn the
Ls7 above-mcmiuncd propcny for inspcctimi tumneas
(Wc)agree to save,indemnify and keep harmless Ne City o(Cupertinu against
faA dindihies,judgmems.com and expenses which may in any way accrue agalnatnid City
U Z in consequence of the Standing of this Permit.
^s APPLICA N R ANDS AND WMPL LL NON-POINT Issued by: Dat
SOUR G
Re-roofs
ignaw of Appli_ _tor HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant at forum building orcupanLrore or handle hima nous material
as dented by the Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety
Code,Samoa 25532(4)? All roofs shall be inspected prior to any roofing material being installed.
Ya I�
Will the applicant or future building occupanttau equipment sir devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hit"MMk it contaminants u dcOtmd y the Bay Area Air Quality Managcmenr all new materials for inspection.
District?
0 Yes
I have mad the htiamausmatarialsrequirements under Chapkr6.95 cilia Califon
nisi HcalN&Sorely Code.Sadom25505,2533 aut l ornamentalthmUNc building / 0(
las not curmn0y has:a tenant.Nati m rasped ly to notify Ne occupant of Ne
mgtim ta a ren mm pd mi are a nifictire0d •SignatureofApplicant Date
Owner or audantif.ed ahem Dam- 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 32652017 . 00.
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000088
REFERENCE ID # . . . : 06120154
SITE ADDRESS . . . . . : 10347 MARY AV -
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . : .
CITY/STATE/ZIP . . . : LOS GATOS CA, 95030-1364
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
---------- ------------- ---------- ------7--- ---------- ---------- ----------
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
--,-------- ---------7 ---------- ----------
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" Oh CU13ERTINO
C U P F.Rj IN 0 PERMIT APPLICATION FORM
011 12-)L�h7�,)
FFIL ii i—ch 1-1-,-A c I ci IQ s s
Phone #.
License fi:
Col
CAlpertinc, Business License�9:::
Type of Roof Covering:
Prop�oTsl:
j HmIl-Up Roof D Built-Up roof,
t.] ,Asphalt ShinJes U Asphalt Shingles
J Wood Shakes Cl wood Shakes
❑ Wood shim'Ics 0 Wood Shingles
Othel (specily)
,vuinhur cif C,\jStjjj�� coverings 0 ProvideI.C.B.O. Report ll
heI o � Rclllov�ccl 0 Provide MCgir. Installation Specs.—_
1
—ilvc Pend. uncleislaild and Will Comply With CLII)CI-til 0STUr ()ITPOJjCy: ❑
lob [Duscriplioll:
7
I ll—esCTC I zi I ' Commercial
F—irc-Toll—C7—Ycs n--No—[] -- Confirmed with Planning Dept'. if
there are any restrictions: ❑
Cost ol,Project: Type of Construction: OCCUINHICY 0('1-01.11):
_Applicable Fee 11) Pec Description Fee Group
lipi- Bllclo Permit Fcc's
BUILDING
Q
BENERGY Energy BUILDING
BSI 1S N/l I CRE Seismic Fee Res BUILDING
BSEISMICOINVII scismic Commercial BUILDING
Bill-ANCHK Plan Check Fcc BUILDING
Iccj
llusi,lc: BusinessBusinesss J�LiCCIISC BUILDING