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06090115 (2) CITY OF CUPERTINO //}} �t�� . BUILDING DIVISION PERMIT axb9;ik'.S#I'k=m ah xa a..Y"�TiS.�•:��«.z.0 dis.ae C y=, BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMRNO.06090115 10413 MARY AVE BLD F OWNER'S NAME: PERMIT ISSUE DATE PACIFIC STATES ASSOC SERVI ES605 COMMERCIAL NE: SANITARY NO. CONTROL NO. (408) 536-0420 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMBO MECH O o o LICENSED CONTRACTORS DECLARATION heraffirmIb Description u I Worthy that I am licensed under Provisions of Chapter 9(comO mencing P wt Schon7IX )of Division3ofN Busies WProfcLi=Cado,Wmylicenseu 0foil morevand off 3 ls.g es 17 (010 REROOF— UNITS 10413-10443 BLDG: F Li.Dam CO"Metar _PAT TEAR OFF EXISTING, INSTALL ' 2 LAYERS OF 30LB FEL ARCHFTECTS DECLARATION Id Iunderstand myPima shall heused upublic reewde UNDERLAYMENT, 40 YEAR COMP SHINGLE & BUR. 100SQ G Licensed Pmfcssional OWNER-BUILDER m Ce Conn ON 0 0 1 here.y affirm o that 1A.1. ,xemptBeat.from the Canon LicenseCode: c Law for the o G Which re moron.(Schon 7tD 1.3,Business Mtl Pmfcadnm ch.oAny city tar county f$� which requires a Peemlt t...stmet.alcor.Improve,demolkh,or rePoir any ewetum -Z< Prior w its issuance.also requires the applicant forsuch permitm file reigned statement C than he isllcevcdpursuant mNepnvisimuafNcconuacmrsLicense aw(Chapmr9 Sq.F[. Floor Area Valuation (commencing with Sermon 7000)of Division 3 of the Busimssand PrnfeMom Code)w $104000 .• that he it,Attempt therefrom and the basis fw the alleged esempdon.My violation or Seeman 7031.5 by any applicant ra a permit subjects the.wlkM,m a civil penalty of APN Number Occupancy Type not mom Nan five hundred dollars($500k ❑I,uowaeof Napropwy,mmywployceawithwagesuthkukeampenuadon. will do theworkandAuawmamknotintendedorofferedforsak(see.70",Buwnus Required actions and PmfesaanA COON The COMAM fs Umw law does not apply In an owner or q P Avon property who ,Provdmprovothermroveme is AM not aroffeedexedfor tfor ughWe his �� awn employees,provided that v eh improvemw t art not year Ofc araRated for sale.X, haweva,the building or Improvement is Mid within one yw o(comPletion.the owner- builder will have the burden of proving that AO did Act build or improve for purpose of ��fJgy�--,��jf`^p sele.l. Pf"�(� �� ❑1,ssowner ofa Sec.eny,Business Professions CIN;)shedcenaaaonm �^'-Tf��'� cents La the es not (See.o x4,wner Of and Property won Cade:)The Cetacort Li cove law dors not apply je an ownu of property who builds or improves thereon,and 500 who contracts Lace far such pojeeu with aemwnortO licensed Pursuant to AM Cantruto(a TMS p C Licen NG Owner law. Cf ,,7�� ❑lam exempt undo See .B hPC fa Nu moron IJfyV![Jf Owner Dau WORKERS COMPENSATION DECLARATION 1 thereby affirm under penalty of perjury arc of Jre following declarations: I have and will maintain a Certifiau of Constrain self-Insure for Workers Compen- sation,as pmvidcd for by Section 37M of the labor Code,for the performance of cone work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,v mquired by Section 3700 of the Labor Code,for Ne performance of the work for which this permit is issued. My Workers C�ompe�mamon Insurance cams and Policy number am: Geier.?fRTT- �La_sY. ION OMWO-K]Ot Sash CERTIFl CO OF SATION I N FROM WORKERS' COMPENSATION INSURANCE ' (This rection need not x completed if con permit k rwooe Amdmd moan(slue) nness) I anify that in the performance of the work for which this permit is issued,l shelf Oat employ any person in any Answer an As to become subject to lh Workers'Compensation - Laws of Califoroie.Dam Applicant NOTICE TO APPLICANT:IC AMr making ON Certificate of Exemption,you should become subject u the Workers Compensation previsions of the later Code you must Z foMwith comply with such lu.v moa sir this permit shall be deemed revoked. „z„O CONSTRUCTION LENDING AGENCY P Ihemhy Art..that Nen is.roneu ncdnn kndwgagevy for core mifnevemea C > the work for which this permit Is ksued(see 3097.Ci,C.) O] 0 Landers Name Z Landers Address U O 1 sonify,that 1 have read this appllea im.and sum that the above information u L[. F correct.l agree to comply with all city and county ordinances and state laws relating m QU Wilding conswctian,andherebymOnn.uprsert.,res of Nis ditty,.cnmr upon Oe r a above-mentioned property for inspection pugwses. f-t (We)agree m save,indemnify red keep harmless the City o/Cupertino against y imbilides,judgmenb.eosu and expenses which may in any way same against Mid City U Z in consequence of the iranting of this permit. ,�/r a'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /—jf SOURCE$EfjU�TION_ S. ///� xAIA/�,/1 / J��/ Re-roofs Signature of ApplinDid HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII mu Applicant or fortune building occupant amu m handle Health And Seely as donned by mm Cupertino Mumri Code.Chapter 9.12.Md Ne Health and Safety Code.$c y. No 2ss3xan ❑Yue All roofs shall be inspected prior to any roofing material being installed. 41 Will the applicant at future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ..It hazardous air wnuminann u donned by the Bay Am,Air Quality Management all new materials for inspection. District? ❑Yes o / Ihavemad die thehallomaterials re nJerun.95of Ne C Ola tuSaetyCa .Scti.m25M5,25533W25534.1undertutl Natifthbuilidfiwng dosomeuruny haw a anent.sour k k mY uapamlAlliaY w notify Ne o¢upant of Ne _� regm Anot be met ' issu UsccrYficiea aw.focrPosey Signature ofAppint Date '6wrlGroravthot rc agem 9 Dam All roof coverings to be Class eBe or better - Community Development 10300 Torre Avenue Cupertino CA 950 4 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4JUPEI�TINO Building Department JOB ADDRESS: PERMIT # 10 -10O OWNEWSNAMETACAEJCISUNTIVS PHONE #Yog-$j{rj-ry/CoQ GENERAL CONTRACTORS �VV _ FAX #yo - C,-8 If GL5- m I a 'not using any subcontractors: yz—& 911 s / Signature 4 Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO !m 3 of 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32652049 . 00 DATE ISSUED. . . . . . . : 09/15/2006 RECEIPT # . . . . . . . . . : 36055 REFERENCE ID # • : 06090115 SITE ADDRESS . . . . . : 10413 MARY AVE BLD F SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PACIFIC STATES ASSOC SERVICES ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : DRAEGER CONSTRUCTION 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 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - --------- ------------ - ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 104 , 000 . 00 868 . 32 0 . 00 868 . 32 0 . 00 BSEISMICRE VALUATION 104 , 000 . 00 10 . 40 0 . 00 10 . 40 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 878 . 72 0 . 00 878 . 72 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER --- - -- -- --------- ------------ ------------------ CHECK 2636 . 16 123701 TOTAL RECEIPT 2636 . 16 • ROUT I �6 CITY OF CUPERTINO - REROOF CUPEkTINO PERMIT APPLICATION FORM I-AP� ?a 1w _ -5N — 049 t I9 Date: -I e Building Address: D"I I3 0-Aq �+ "1 Owner's Na Phone #: c�rf� yq 885— 1l00 Contractor: License#:%n Ir' !l_ 10 C 3q Contact: .Cupertino'lBusiness_LiccJ ' 1 � � � - --� Type of Roof Covering: a Existing: Propos : ❑ Built-Up Roof Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles //// ❑ ood Shingles ;may-�+�� (,�(��,,/) ` �O her_r—of istiH ) Q�� El Provide I.C.ify)R°�p J�� 1 `11 I , i Numt�er of existing coverings ❑ Provide LC.B.O.Report 1� _ - U � G✓To be Removed -' U Provide Mfgr. Installation Specs. ti • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 02, Job Description: a �Ay� r 3o a� F—C ale, QJCis}l tl SIO Q, Residential Co ercial I t90 Tire Zone: Yes-E]—No-R.—�.� Confirmed with Planning Dept. if there are an restrictions: Cost f Project: ob Type f C truction: Occupancy group., Qty. if ! Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING i 1