06120162 (2) CITY OF CUPERTINO __� rt..a * ,f - '� "'' fi' `°'� '""
-BUILDING DIVISION PERMITCCINTRA 0f1R"INFORMATION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: - UE ATE
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
Npoox rrnnn
(408) 536-0420 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
0 0 0 0
Gj LICENSED CONTRACTOR'S DECLARATION Job Description
wF I hef(O
thereby am ural I am liccmed ummr provisions of Chapter 9(commencing
�:i,y with Section 7")ofDivision 3 of the Business and ProRssium,Code.and REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
j in full forte and
�qz Lm=nse, Lm.aAtO NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
Contractor
ivq,p Dam ARCHIl heTECTS DECLARATION =� & GRAVEL BUR.
i a 7W7W� I understand my plans ahalused as public meords
Oi
Licensed Pmfeuional
Oat I am exempt
from
m the Com ION
ta 1 I hereby Slim that I am exempt from sur Committees :License Law for my
:❑O following mason.(Seddon 103 L5, t,add, and improve.
Professions Cod=:Any city or county
$ which mgvses a permit re comwcr alar impmvq h permit t.r mash any twmum
.Z< Iprior ta M,Witscumana,also men,to ms um spplieao for such permit rile.Law(stammenO
sec (comma cingwidpSectiosmmepmviviomoftheConusiness llanseddimChapter9 Sq. Ft. Floor Area Valuation
S52 (coma,is exempt Section and 000)
basis for
theleegedmssnnd Professions Ctde)of 2381
-. Nn io b exempt Therefrom and Ne bub for me alleged erempuon.Any v(aladon of
dSectiono,.. Mas by any red dont fora permit objects me appleant p a civil Penalty of Number Occupancy Type
nos mart dun fins hundred dollars(SSW} 32652034��
I,a owsur of the property,m my employw with mgea a the'v sole ampenauon.
wBldoth=w.rk and me svucwm b not Intended or offered forsake(See 70".Business Required Inspections
and Pro(essi.m Codc:The Contraemrs Liana Law does Opt apply m•o owner of q p
property who builds or i mprona thereon,and who does such work himself or through him -
own employees,provided mat such improvements are not inmMe t moRered forsak.If,
however.Ne Wilding or Improvement is sold within esu year of compkeon.the owner-
builder will have the WNce of proving Nat he did out Wild or Improve far purpose of
sale.).
0 1,as owner of the property am exclusively contracting with Iianand mnu•=m
mOuwct Ne project(Sec.7044.Business aM P ulmeosu Cod=:)the Contractors U.
ansa=law dw not apply to an owsur of property who Wilds or improves thetcon,and.
who commeta for such projects with a eonuactor(s)licensed pursuant In the Commctrh
License Law.
❑I not exempt under Sec. .B 9 P C for this mason
0. Dam
WORKER'S COMPENSATION DECLARATION
I he affirm under Formal,of perjury onto of em following decimations:
sin and will maintain is Cuefimu ofCmuent to self-inxum forWorkers Compen-
sation,as provided for by Section 3709 of the labor Code,for the performance of me
workfar hieh this permit is issued.
vc and will maimain Worker's Compensation resonance,a required by Section
3709 of me Labor Codc,for um performance of Me work for which this permit is blued. '
My Workers Compensation laxigoome earn.and Policy numberam:
Carrier. AIV Policy No.: -?/3—O0is pr 2
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectim sued not he completed IItW permit is roronc hundred deism(Sl W)
or less)
I certify roes In me perfamanee Of the work for which this permit Is issued.I shall tat
employ any person In any manncrso a to become subject o the Workers'Cmnp=nsaeon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT.If.after making this Certificate or Exemption,you should
hecdme subject to the Workers Compensation provisions of the Labor Wr Code,you must
.J. z foMwith comply with such Provision ar this permit shall W deemed immune,
Z '-' CONSTRUCTION LENDING AGENCY
I"t vim-, Ihembyaffirm the them is•mavuctitn ending agency for me perfurmamc of
C me work for which this permit b issued(Sec.3097,Civ.Q
W� 0 Lender's Name
7 z Lenders Address
U 0 1 entry mat I have mad taus application mW sue mu One move informed..is
ly P comer I agree to comply with all city and county eminences and seem laws misting to
Q U building eonswctiou,and hereby aumonne representatives or this city to enter upon the
a ah.vcmcmiUmed pmpcny or,i.,,euun pugOnacs.
(We)agree to save,indemnify and keep haminss me City of Cuperem againat
iF.y Iiabilitia,Judgmcnts,costa end npcn...which may in any way accme agaiatsaid City
U z in consegmnce of the granting of this pcmit.
^ APPLI UN ER NDS AN WILL C WITH ALL NO
Issued by: D [e
SOUR E S.
Re-roofs
Signamm of App r Dam ��//I�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof I(J
Willy t e Cupertino
or future building m Char Bore or handle hmardow material
a deRmd by de Cupenlno Municipal Ca Osapmr 9.12,and me Health and Safety
Cale.Sccti..2553I4)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes u
Will me 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 111440100 air commotion nu a Jcuned Bay Arca Air Quality Management
District? inspection.,SII new materials TOC inspection.
O Yes
Ihavemloy ComnNxwsmamrialsmyuimmenu under Chrstand medium
Califon �
.in HraI have
a anal Cam,Secures 25505,25533requirements
nos under understand mmif me Willing
dw not cu eney New a indent,met It b my responsibility to notify me occupant of me
rcquim m mcspdormia facwrcamoroccupancy. Signature oYApplicant Date
Own r.nuthorir agcm 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 32652034 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT#. . . . . . . . . : BS000000096
REFERENCE ID # . . . : 06120162
SITE ADDRESS . . . . . : 10383 MARY AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER M & C ASSOCIATION MGMT SERVICE
ADDRESS, . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1342
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 (409) 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
8 CITY OF CUPERTINO ��—� l
• m�Qif 1IEROOfF
CUPf.RTINO PERMIT APPLICATION FORM
Date �_I �l o
L
Builclin; .Addres:: --
1 -- —I
Owner',, Name: ) Phone #:
�.. F�.�c use�1» �� �ctt,',Id << l vt�o� ��c �e�5- 9 ono
Cunuactor: License #:
60
Contact: j �) 1 Cupertino Business License #:
Type of Roof Covering:
Existing: ProposTl:
] 1tuill-lip Roof 6d Built-Up roof
U Asphalt Shingles ❑ Asphalt Shingles
.] W.iod Shakes ❑ Wnnd Shakos
U W'md Shingles ❑ Wood Shingles
J (hher(specill'1_._ ❑ Uthcr(Spccil}•)-- _
iJulnhar ol'u.eisiing cnvcrings_ __ ❑ Provide LC.B.0. Report 11
U7 l'u he Removed ❑ Ihovidc Mfgr. Installation Specs. —
• -- — / _
I I-hnc Read. Undertan
sd and Will Comply With Cuperlino`s 'I car Olf Policy:
lob Description:
Residential l - Commercial ❑
Fire Lune: Yes ❑ No ❑ Confirmed with Planning Dope. if
there iue any restrict ioils: ❑
Coo of Project: 1)'pe of Construction: Occupancy group:
--
Applicable Fee ID Pee Description Pcc Group
_ BPI'RMI-E,I- Bldg Permit 1'"ces BUILDING
13 ENERGY Ener ;y BUILDING
13SI 1S�IICRI Scismic Fec Res
BUILDING
BSFiIS\IICONI Seismic Commercial BUILDING
BPLANCHK Plan Check Fec BUILDING
BUSI..IC BUsiness License BUILDING