06120153 (2) CITY OF,CUPERTINO M
BUILANC DIV(61ON PERMIT 91CONTIUC C1R�IiYFOIRMATIOt�i
BUILDING ADDRESS: PERMIT N0.
1035)'1 MARY AW
DR A GER
OWNER'S NAME: UE TE
AOL M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
pEznvTnnC
(408) 536-0420 SANITARY NO. CONTROL NO.
ARCHITEC rENGiNEER: BUILDING PERMIT INFO
BLDG ELECT 0MB PLUMECH
t� I� 0
1C" LICENSEDCONTRACTOR'SSDECLARATION
w g Jab Description
1 MrebY affrm that I am licensed under revisions of Chapte 9(commencing
:z with Sudan 70M)of Division 3afthe Russ.and Nafedme,Code,andmylicense u REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
! y is full fame
q= fame and fe— —7 (T
License Class Lic.x
NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
mm Comsefor
A ITECTSDECLARA & GRAVEL BUR.
< I undemand my plans shall W used as public records
e Us.
�C9 Licensed Professional
1 7 OWNER-BUILDER DECLARATION
f 0 F 1 hOrchy.Ilium that 1 em cBumpt from the Cssions c License Law far the
c following moon.Permit
o 103 L5,Business and sae. ainm Code:Any city or county
— which requires a permit w recruited
die atter.Improve,h permit
e m tt or repair any tWcmre
Jou he
its lensed e.jobar mquims lde i.dimnanl for awhpeam'torile a t...Law(swemem
fio that heiscantwdpursuantwNeofDiviousofthusCamsiness Licenselaw(Chopm9 Sq.FL Floor Area $2381 Valuation
f $ (eat he is
(commencingwithominn?and the
Division f r of NC egad comps and on.An Professions;Code)of
—
that he u exempt thertfmm and an bash far the alleged eremant to Any violation of
Section shad five
any applicant far a permit subjects the applicant to a civil Penalty of Number Occupancy T),p
nor more manfre Wndred aathm(gsook y 32652019 � Occu ane e
0 I,u owner of the progeny,or my employees wild wages as men We compensation,
will do the work and the swclwe u Mt Intended or offered Ra hale(Sec.?(s14,Business
and Profcctious Cade:The Convenors License taw duet set apply as an owner of Required Inspections
property who Wilds orimproves dadmon,andwho doessuch work himselfarthrough his
awn employees,provided mm such imprevueenss art not intended oro@red for We.It.
however,the Wilding or Improvement is sold within one year of completion.the four.
builder will have she burden of proving that he did not Wild or Improve for purpose of
sate.).
0 I.as Owner of he property,em exclusively contracting with licensed anoactoss to
conswct the project Sic.7(144,Business add Profersaus Cade:)The Colossuses U.
cone law does not apply Of an Omer of property who W iid or improver thereon,and
who contrum for Such pmjecct who a con rvelmis)licensed pursuant In,the Canvacter'$
License Law.
O lamerempunder Sec .B&pCfarmumaon
Owner Date
WORKER'S COMPENSATION DECLARATION
amity affirm under penalty,of perjury one of the following declarations:
have and will maintain aCerffieam of Canelo,w self-infum for Weaker$Compon-
sation,as provided far by Section 3700 of the labor Code,for me performance of the
work foryme hurispeaditisisatted.
a/sae and will maintain Workers Compensation Insurance,as required by Section
3700 of the labm Core.for tW performance of the work Ror which thispemeit is ivad.
My Workers Co petu nd,rd hpachas artier and Policy mummer are:
Cartier. `uN�Poliry No.:Z/ 3
CECE�FICATE�E virnuN FROM WORKERS
COMPENSATION INSURANCE
(Thu orlon need not W completed if tle penton is fmonc hundrtddoilan(SIM)
or ler.)
1 certify that in to pvformance of the work for which this permit of issued,1 shall not
emploY any pardon in any..he,se a Or become subject Ice tie Worken'Canpenatim,
Laws of c,dironsiti.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Certifies¢of Exemption,you Should
become subject in the Wofkce$Compewdon pmvisioer of the Labor Code,You most
.Jz foMwim comply with such pnovisiasu or this permit shall W canted revaked.
z Q CONSTRUCTION LENDING AGENCY
f+ I herehy aRrm Net there is a condonation lending agmxy I'or the,pada rn ene,of
a r7 the work fur which this permit a issued(See.3097,Civ.C.)
QLender's Name
Z)z Landers Address
U 0 1 certify that 1 have read this application and sum that the aWvc information is
U., (•" contact.1 agree to comply with all city and county ONinames and state laws relating to
�U building constmetion.and hereby authorise mPresematiesofthis city to enleuupnn the
above-memiagm property for epenses hichms.
H
P. (We)agree 1"save,indemnify and kap h 1.the City of Cupertino agaiust
liecosequenc orthe comm of this
they in any way accmc against mid City
C_)z in consequence of the gnnung of oris permit.
^'
APP LICA U NDS A IL OMPLY WITH ALL NON-POINT Issued by: Dale
SOU E S.
J
Signature of AfFlignUCantaator Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding axupant store orhandle heardous material
U defined by the Cupertino Municipal Co c.Chapter 9.13,and the Health and Safety
code.gcnim 355334)?
❑Yea All roofs shall be inspected prior to any roofing material being installed.
40 a
Will the applicant or Room Wilding occupaat use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emtt harusdaus air conteminu ff as dc0 y the Bay Arta Air Quality Management all new materials for inspection.
District
❑Yes u
Ihave afet thehvSNnus materials mquiremc5534,1under Chapmrd.95oNte Wilding
me Heal"cur Safety Code,Su often, 33505,35573and35Silil understand61,1moil the Wilding
War trot currently have a tenant. u my m 'bility m notify the upant of Uec
rcyuirom whi a prior iu ccefa mofOc pm 'Signature ofAppican�
_ Date
Own rror aumorincd age 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 . . . . . . . . : 32652019 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000087
REFERENCE ID # . . . : 06120153
SITE ADDRESS . . . . . : 10353 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 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 "60.2 , ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
owl 9-0 10
Uill 1 1,
CUPFRYINO PERMIT APPLICATION FORM
Date:
IFIF, -lil-I rb Addrces
Owner's Name: -j 1311011C 4,
LY) \ Vo
License
0 11 lil Cupertino Business License A
Type of Roof covel,1110t,:
x i!; i I I V: Propo�I:
H(J[1-1, h
p Roof 2 ilt-IJ11 ()
� ()f
CJ Asplult Shin 0 Asphnit Shingles
'D Wood Slmkus Cl Wood Shakes
,j Wo"d Shinulcs EJ Wood Shingles
D ()thcl (SpCC I C\
U Other(Spccify)
I �ilno coverings 0 Provide I.C.13.0. Report 1/
C[ 0 e,\]sung 111"s
LUQ l
o he Rc111m,Qd D I'lovidu vilgir. Installation Sjpcm
-R c a d, Understand and Will Comply With Cuputillo's Tear 0 CC Pol icy:
lot) Description:
p1cS1dCn1J;11 Commercial
7ir-c Tn,11—e: —Yes ❑ No—[:] Confirmed With Planning Dept. if
there are any restrictions: ❑
Cost oh Project: Type OfC01ISti-LIC6011: Occupancy "roup:
Qty. if
Applicable Fee 11) fee Description Pec Group
MCI(, Permit Fees
0 BUILDING
BENERGY Energy 0 BUILDING
13 S 17-1 S\4 I C R E Seismic Fee Rcs
BUILDING
BSESMICUM Seismic C0,11,11crei',-11 — BUILDING
BPLANCH111' Plan Check Pec BUILDING
BUSLIC BUSillOSS UMISC BUILDING