06120151 (2) CITY OF CUPERTINO /}
BUILDING DIVISION PERMIT u�L\ �5 �� �vATIO
a..�,h Y' '
PERMITNO.
BUILDING ADDRESS:
nTZAFrFRA
OWNER'S NAME:
M & C ASSOCIATION 'MGMT 605 COMMERCIAL ST 12/21/2006
aPiJS rTO V C, SANITARY NO. CONTROL NO.
(408) 536-0420
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
IneO, LICENSED CONTRACTOR'S DECLARATION Job De$Ci1pllOn
UE I Noun,air,.mel 1 am licensed under provisions of Chapter 9(commencing
m witSued..70lk))ofDivislo.3onto Buareassand PrefesslehCott,and my]team I- REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
yimNil fame and eace_J
nse a Ling t /O NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
Lice
H Dau i-sD CL
qq AR GTS DECLARATIO & GRAVEL BUR.
i 2 1 understand my plain shall be used As public mrnrJs
IdV
G Licensed Pmressional
5
OWNER-BUILDER DECLARATION
<ix I berehy.133rd mat I am exempt from he Contractors License Law for the
a O following mason.(Soman 703 LS,Basin.and Pro@b snoCode:Any city car county
$ which requ res a permit to construct,altar.improve,demolish.or repair any atructue
iy 'dorm its issuance.dsu requires not applieam forstri pcnnitmfilcasigned.0 anim Valuation
<
that he is licensed pursuant w me provisions of he Contractor's Licence low(Chapter 9 Sq.Ft.Floor Area $2381
21- (commencing wit Section 7000)of Division 3 of to Business and Pra2ssions Csldm)or
`i mat lis u exempt temfrom and Ou basis for to alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects We applicant to a civil Penalty of �,�,�t Number Occupancy Type
not mom man fiva hundred dollar(5500). 32652023 tl l7'
❑L u owner of the property,rainy employees wit wage a unev une(See.
70mpeesaness
will dolluwmk.antic he Com entLndedmaRertd fontapply.W a4.n Owner
Required Inspections
and property
obis Cade:The me the cera nd whomassis Law doh int apply lf an my lle of q P
moncro who s,pmirimprot ealheman,and aha Mesamhwarkl imselfcr trough his
howeer.to WiprovidedmutsuchimProMmouare not intendedmoRered for Gale. r-
however.to building m improvement is sold a did ON yw of improve f r to owned
builder will have tbe burden of paving Nat be did at Wild or improve(tar purpose of
sale.).
1,as comer of to property,am exclusively initiating wit licensedecmur ears to
construct to project(Sec.7044,Business and Protessiem Code)The Contractor's Li.
cense Law does not apply As an owner of property who Wilds or impmws teswn,and
who contact for such projects with acon recros(.$)licensed puranam to IN Contactors
License Law. ,
❑I am exempt under Seo ,B Be P C far this oma"
Owner one
WORKER'S COMPENSATION DECLARATION
I y affirm under Penalty of perjury one of mu fallowing declarations
ave and will maintain a CeniOeate of Consent self-imam for WorkeraCompen-
color,As Provided for by Section 37M of We labor Code,for We performance of We
work fa M1ieh tis permit is issued.
have uW will mainuin Worker's Compensation Insurance as required by Section
3700 of ac Isbq Co�,far to penarmence of he work for which tis permit is iuued.
M Worker f sada.Inti ca ' IPoli no
rash
Comer. Policy No.: ✓— 0
C TIFICA (EMOTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is fora..hunted netters(EI00)
or less.)
1 certify Wt in We Performance of the work for which this permit is Issued.I shell not
employ any Person in any mannerse an b become subject to to Worked Compe.sadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,alter making this Cenifhu of Escmption.you should
become subject to We Worker's Compemauon previsions of to Labor Code,you must
z instant comply with such previsions or tis permit shall be deemed ranked.
CONSTRUCTION LENDING AGENCY
F+ 1herehy affirm Nat Were is a construction lending agency for to performance of
�i > 0u work fur which Ibis permit is issued(Sec.3097,Civ.C.)
W�Q Lender's Name
.7 z Lender's Address
U 21 cenify,Net 1 have mad his application and soon mar de above infomution is
U. F correct.1 agree to comply with all city and county ordinances and sou laws relating In
0U building construction,and hereby authentic epmernarives of his city to enter upon the
W ehovc-mcnuencd pupcny,for inspccuen pugwses.
gy, (We)Agee t.save,indemnify and keep harmless We City of Cupertino against
eHi TA InIniliuh,judgm roe,costs and cape..as which may in any way act.ag.last said City
V z in consequence of the granting of this permit.
-i APPLICA UNDE DS A LL C LY WITH ALL NON-POINT Issued by: Date29 /
SOUR GU S.
Re-roofs
ignaturcol'ApplicanU omeamer f Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me Applicant or firme Wilding occupant store or handle hmamous material
as defined by the Cupertino Municipal Code.Chapter 9.11.and to Health and Safety
Cuda.Section 255320)7 ��� All roofs shall be inspected prior to any roofing material being installed.
❑Yh
Will the applicant car future building intentional uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Neutrons air...=!donu az JcOned the Be,Arca Air Quality Management all new materials for inspection.
Disom?
Yes
I have mad We haiandous materials requiumcn¢under Chapter 6.95 orae Califor-
nia Health&Sarcty Colo.South 25505.25533 and 25534.1 undcnund amiftc Wil ding
dins not cure Y h a un it u rt mihllity m noul'Y We me pan of he
regm h nal -p- r1 as of a Certificate ar "', Signature of Applicant Date
Ower or...h rized agent 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 32652023 .00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000085
REFERENCE ID # . . . : 06120151
SITE ADDRESS . . . . . : 10361 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . .-. . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1341
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
I�
CITY OF CUPERTINO 0(m.0
41y
CUP R'TINC) PERMIT APPLICATION FORM
9—-;0913, Date:
394 5
Address:-
Phone 4:
ro ��-03 It—i U5- 9 (J)
_Contactor:
I
License 41.
to
Coill�l
P"otc '-'l -
1-1c"lls"
CUIlUtil'10 Business License fi:
CfL�
Type of Roof Coverina:
Proposf1-
❑ Ilklilt-Up Root loof,
A s p l Li It S,I i ng I Cs LJ Asphalt Shingles
'j Wood Slmkcs C1 WoodShakes
;-j \V'wd Shingles 0 Wood Shingles
I I cr(SpCCiI\ Q 0111cr(Spccify)
)I em'stim-1 W\ul IW-S Provide LC13.0. Report 8
Al l'u he RC111ovQd 0 Provide mfgi. Installation specs.
av-c Read- U Stalld and Will C0111PiY With CLJI)eftillo'S Tear Off'I'oliCy:
Idel
.lob Description:
lzc.SIdCj11.1ilj Commercial
fireZone: —YesEl No F-1 Conrit-mcd with Planning Dept. if
—there are any restrictions: ❑
Cost :�hProiccl: TYPe OCCOIISIRICI,i0o: OCCUIX111CY -I'OLII):
51 - co ;r),
Qw. if
Fee 11) Pec Description Fee GRAII)
f3 p 1--,11F-L 17- Bldg Permit
—
Fe
c
s BUILDING
BEN �RGY Eic1 v BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEIS01COM Seismic Commercial BUILDING
3PLANCHK Plan Check Pee BUILDING
BUSLIC Business LiLcISC BUILDING