06120123 (2) CITY OF CUPERTINO -
BUII.L`INC DIVISION PERMIT ANTRA@ OR INFORMt TION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NtVnT TTnoc SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECrRENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oO LICENSED CONTRACTOR'S DECLARATION Job Description
hcmby affirm that 1 am licensed under PROVISION of Chapter 9(commencing
WE wiNScnian]11D0)afDivislon3of�ACBusirtwandProfcuiu/v�Codel,andmylkenuls REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
in full forces a 1t3I V
y DamnuCss Canlramr NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
ARCHITECTS DECLARATION i& GRAVEL BUR.
I understand my plans shall be used as public records
myU
C Liccnud Pmfcssional
g OWNER-BUILDER DECLARATION
)n c I lumby affirm Nos 1 1. exempt from the Contractor's Co :Any c Law for she
p o following mason. emit t 7(131.4 Business and P,..dame Code:cin oily at county
3 m Pi which reyuims a permit t"contract,slmc improve,h Permit t ri mash any iwcture
Z i prior w its issuance,pursuant sa mgoiros lhnyisdo cans far Coh p ctor's icense rile a igmd smmmem
`e tied lace(commencingudmtfim7 th)ofDisisim3ofc aStio Contractor's adPnocLaw(Coast) 9 Sq.Ft.Floor Area 2381 Valuation
3 $ that he is seemwith Sediona and the
basis f r the
al eged ecompt on.Any vi GadCJ of $
r3.. Net io u exempt tmm(rom and rite basis far be alleged uemant on Any II Penalty of
Sadao 7031.5 by airy red dont for a permit objects the applicant Ie a civil Penalty of y�}t�Number Occupancy Type
not more Nan five hundred dollars(M). 32652049 :Vl7'
❑I.ss owner of dts property,ar my employee with wage u rhes uleeompenadan,
will do thework,and the structure lsnminmnded or offered Russia(Sec.7061.Business Required Inspections
and Professions Co&The Conu¢mr'r License Law does not apply to an Owner of q p
property who build.or improve thereon,and who dace such work himself ar tluough his
awn emplayeu,provided that such improwments are notinusndad oroRered forsale.If.
however,the building or impromment is mid within oto year of completion,the mvmmr-
builder will haw the burden of proving that m did nos build or improv far P.M.of
sale.).
❑1,as owner of Ne property,am ueiusiwly contracting with licensed avntracmrs to
consonce,be project(Sec.7061,Business and profusion Cade:)The Comrumr',Li.
cease law dura not apply in an owner of prepare,who builds or improve thereon.and,
who contracts for such projects with a convactor(s)licensed pursuant to the Canvacmr's
License Law.
❑I am exempt under Sec .0&P C for this mason
Owner - Date
WORKER'S COMPENSATION DECLARATION
mhy affirm under penalty of perjury ane of the fallowing declaution:
have and will maintain a CaniBum ofConenl m self-inum far WarketsCompen-
mitum.as provided for by Section 3700 of the labor Code,for the performance of the
wor which this permit is issued.
I haw and will maintain Worker's Compensation Insurance,as requited by Section
37110 of the)ober Code,for the performance of the work far which Nis permit is issued.
My WmkkaessCCamppervatioA Immoure.carrier and Policy mother
ruse: �(�
Cartier:71 g.yr, Us 5 Policy NO.:�=tsd paw
CERT7FlCATE OF EMF170N FROM WORKERS'
COMPENSATION INSURANCE
(Thu means need out becompleed Uthe permit is farm=hundreddullars(SIM)
less.)
1 modify that in the performance of to work for which this Permit is issued,1 shall not
employ any person in any manneran as an become subject o the WoramY Compensation
Laws of C.hf.ou..Data 1
Applicant
NOTICE TO APPLICANT:If.after making this Ceniricau:of Exemption,you should
became subject to the Worker's Compensation provisions of the labor Cade,you most
,J O s foMwlth comply with men provision a,this permit shall be deemed revoked
zCONSTRUCTION LENDING AGENCY
IZI(-s I hereby dorm that them I.....wcdnn lending agency(=the pe,Co..of
C4> the.,it far which this permit is issued(Sec.3097,Civ.C.) m -
W�Q Lender's Name
M 2 Lender,Address
U Q 1 cenify that I haw mad Nis application and suis del the ahem im'.an.do.is
carted.1 agree m comply with all city and county ordinances and state laws relating to
building construction,and hereby authorim representatives of this city to enter upon the
W ahavc-mentioned property tem.p
r codon pa,.aca
gy (We)agree to saw,indemnify and keep harmless the City of Cupenino against
mF'y TA liabilities,judgments,costs and expenses which may in any way acemc agdet said City
V Z in consequence of to granting of this permit.
APPLICA U IDERSTANDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date 2r PL
SOUR E ION . /Oa^ J
P / Re-roofs
Sig
atumol'ApplimmICIfinumselor ithoo
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Room building mcupam store or handle hamrdaus material
as dcfl and by the Cupertino Municipa ado.Chapmr 9.12,and dm Health and Safety
Code,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑yes a
Will the applicant or future building amupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hamnaus air mauminanu a def y to Bay Area Air Quality Management all new materials for inspection.
District?
El Yes ^
I have mal the haxedous materials requirements under Chapter 6.95 ofthe Caliper. �-'1 —la
nix Health A,SafetyCode,Secomm 25505,25533 and 25534.1 understand that if the building O�" VV V'
docs not curtcmly mnen4 that it is my r Iswnigility m notily dm mcupantof the
rcyvim tswh stbcmelpdarmis ccofa erti0 t spoo=r. Signature ofAppican Date
60 Owner tar authadrsdagent o to All roof coverings to be Class "B"or better
'r Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
• 6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 104
L3 Ma" alt
Roofing Company Name: 0(0
Applicant's Signature:
• Greg Casteel /
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
't ✓'` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: jn(,� eS ekil PERMIT# 41 TOM
io413 Ma Ave ►ts W)W123 -avi2oi(n3
OWNER'S NAME: M61VVt. -&erVICO PHONE # -53(g-a4 C)
GENERAL
j -
GENERAL CONTRA R: FAX #
I am not using any subcontractors: / Oda
Signature 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
c�
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot: .
APN . . . . . . . . : 32652049 . 00
DATE ISSUED. . . . . . . . 12/22/2006
RECEIPT#. . . . . . . . . : BS000000056
REFERENCE ID # . . . : 06120123
SITE ADDRESS . . . . . : 10413 MARY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER M & C ASSOCIATION MGMT SERVIC
ADDRESS. . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
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
~� ocal20►23
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 3� _ �, Date:
Building Address-
Owner's Name: I Phone #:
(p 0
Co License #:
tractor:MCL fi(U 1-nc - to I D
Contact: Cupertino Business License #:
0,l
Type of Roof Covering:
Existing: Pro �:
❑ Built-Up Roof P osfBuilt-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu ber of existing coverings ❑ Provide I.C.B.O.Report#
�To be Removed ❑ Provide Mfgr.installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri tion: , 3 n 3C
1 t_
Residential Commercial PLy Tf'c2t G2e%�JEt_ ukYZ.
Fire Zone: Yes ❑ No Confirmed with Planning D,.�ePt. if
there are any restrictions: u
Cost of Proiect: Type of Construction: Occupanc 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
•