06120159 (2) CIT OF-CTJPERTINO -77-777777777,
BUILDING DIVISION PERMIT 8�� A OAMAT
BUILDING ADDRESS: PERMIT NO.
i n39-i MAPV A17 DRAFr �R (-()NST_RTJGTJ1(DN 1NC Q-1�QnQQ-
OWNEWSNAME: _KEM�UA
ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
nnxzTnao
(408) 536-0420 SANITARY NO. CONTROL NO.
ARCHITECT(ENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
�iop LICENSED CONTRACTOR'S DECLARATION Job Description
�dEI hamby affirm War I am licensed under previsions of Chapter 9(commencing
with Section 70M)olDivision 3 oftless Businessland Professions Coulk.and my licesse,is REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
In Iforce.mit
eel -7 ( CDX
Lm:nac Lk.as 6 e NEW 3/8" OVER EXISTING 3/8" CDX NEW 5 PLY TAR
iI- DateContractor
=AR(C;PHmiCTS DECLARATION -Z4� & GRAVEL BUR.
I understandany Pmon.h.11 hemad oxpublic mend
ly
1at; Licensed Professional
ion OWNER-BUILDER DECLARATION
:21 1 hereby strum War 11. excloin from We Contractor's License Law for bw
0 Following (Section Nn 1.5,Business and Proreasions Coda:Any city or county
w�i which mquirre a Permit to construct.altar,improve,demolish,or repair any stsucture
i;to emor u)it issuance,also requires the applicant for such Permit no rile.signed statement
wit pursuam 7011) Valuation
(e.arommins with Section 7011)of Diveloa 3 of the Business and Proletarian,Code)or
Nal he is exempt themilorn and the basis for the alleged exemption.Any violation an of
Section 7031.5 by any applicant for a permit Objects the applicant to a CIVIL Penalty Of Number
_T2652039 Occupancy Type
not mom man five hundred Well.($500),
will do We work and the structure is net imendoxim.fforad fb,,WO(See 7644.Business Required Inspections
and Profession Cade:The Cmdraturrs License Law dom at apply to an owner of
property who buildsorimproves dremben,and who does such work himself orthrough his
.n employ..provided then each improvements are not udenced oroffenad forsam.If,
however,We holding.,improweracruL is Old whin ts.year efourilla...We owner-
builder
a'builder will have the burden of proving that sm did net Mid or improve for purpose of
Ole.).
[:]1.as ow.of We property,.m exclusively contracting with licensed coarrommor,I,
consumer We project(See.7044.Business and Profession Cade:)The Contractor's Li.
cause Law does not apply to in Owner of praparty who Wilds or improves Lemon,and,
who common for such projects with a commelons)licensed pursuant to ded Contractor's
License law.
0 1 amexempt them,sw, B&P C for this reason
Own,, Dow
WORKER'S COMPENSATION DECLARATION
unity affirm under Pull of perjury One of We following declarations:
have and will assumed..Certificate of Consent 1a adf-insure for Workers Coreque.
Indian,an provided for by Section 3700 of We Labor Code.for the performance of We
work fo'w this permit is headed.
work
maintain Worker's Compensation Insurance,as required by Section
,W of the
Le
Ortiz Labor Code,for We performance arrive,work for which this permit is issued.
My W.rkjQ Compensation lrxxugawce calrom,and Poll,num liFram:
Carrier. 11`16400�alicy No.; Z/ 3'00 0 ig aCERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sail.head hat kco.pl.wd if the Panath is for.a hundred dollars($100)
or[as.)
I certify Not to We perfin....of tho work far which this permit is island.I shall Out
employ any person in any maturarm as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this CcItificam,or Exemption,you should
loccome,subject to We Workers Compensation provisions of the Labor Code,you meet
Z forffiondle comply wife such provisions or his Permit shall he decreed revoked.
z 0
E�! CONSTRUCTION LENDING AGENCY
I thereby affirm We,them is a construction lending agency Car We performance or
Ne work for which this permit is issued(Sec.3097.Cm C.)
1-cerloWs Name
:D z Lenders Address
Q 0 1 comfy that I have mad this application and sum,that In.shove!III.ma.time is
conect.I agree to comply with all city and county eminences and awls laws ralaing to
OO building construction.and hereby authori m representatives or Nis city to enter upon the
shun-mentioned p.,,ty m,im,cu.n
nin
gl� (We) grew to saw,indemnify and keep harmless the City of C.Lat .against
F' r, Liabilities,judgments.costs and express which may in any way accrue against said City
U Z in consequence or We granting of this Permit.
APPLICANT UNDERSTANDS AND WILLJZGMPLY ALL NON-POINT Issued by: Da
OUPr�EC ��
11 Re-roofs
Signature of ApplicaLUCcruselor Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof Vz/400
Will We applicant or future building caturnam store or handic hanandous material
as defland by We Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cattle,Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed.
r-you
41 Will the applicant or future building I InculNent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
suit hu.mmu air emHordirants as dcflacdby the Bay Aum Air Quality Management all new materials for inspection.
District?
ri Yes
I Is.ntaxt We hazardous materials raquinarrouns under Chapter 6.95 of We C.1fifto,
mnHnIffi&S9etyCade,Sccdi...25505,25533 and 25534,1 mWelatuard dot if We bull ms
desnot cumendy how.accoul,Out It Is an bit to urythaox.'amorthe af—t
mean. Law do,lc��( III am or VC
Led. Signature of Applicant Date
Oulner or authorized ag'1111 no
dnr� Dow 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 . . . . . . . . : 32652039 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000093
REFERENCE ID # . . . : 06120159
SITE ADDRESS . . . . . : 10393 MARY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M ,&- C ASSOCIATION MGMT, SERVICE
ADDRESS . . . . . . . . . . : . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1343
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
•
r7k CITY OF CUPERTINO oullojfq
IIEROOF
CUPFRTINO PERMIT APPLICATION FORM
Date:
d i ."W dress:l D3 ,
0\ Nallie: Phone 9:
C)
Cone actor:
License fl:
.1",J, A (0
col Cupertino Business License 9:
Type of Roof Covering:
E,xislilw:
I Prop�oTsl:
J Will-IJP J,0()l Fla Built-Up roof*
AspiwIt Shim'Ics 0 Asphalt Shingles
D wood Shakes
U Wood shill'-des 0 Wood Shingles
CJ Othcl (spQci 1,y)
uovcl EJ , Provide I.C.B.O. Repoll,il
W, '1'o )Q Removed EJ Providc Ml'gi, 111SLI11lition Specs.
• 'Vc INQL)d. Understand and Will Comply With Cupertino's Teal. OfT1,01icy:
Job Description:
Commercial
Piro Zane: Yes 0 No 7 C0,11-11-med with Planning Dept. if
there are anyrestrictions: 0
Cost.n�tQProjecl: T)'j)C 0f'C0llStl-LlCti0l1: OCCUI)aIlCy C"l-OLIP:
Ow. if'
Applicable Fee 11) 1-ce Description Pec 31-01.11)
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BENERGY y BUILDING
BSE1S\f1CRSeismic Fee Res BUILDING
BS%E[SMIC0M Seismic Commercial BUILDING
BPLANCHK Plan Check Pee BUILDING
BUSLIC BLSi )CSS License BUILDING