06120126 (2) CIT 'OF CUPERTINO
BUILDING blvlslory PERMIT 01�+1., R. a � M�TI !':;
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
sTnnO - SANITARY NO. CONTROLNO,
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIPCf PLUMB0 MECH
0 0 0
Hipp LICENSED CONTRACTOR'S DECLARATION Job Description
1 hareby affirm that I am licuased underm provisions of Chapmr 9(Or re-long
wiNSecticm 7")of Division 7a(theBeat.and Professions Cade,md my license in REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
in full foaeaodc a P /�/ !�
�: Liana LIc.N ( CD NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
Pq, Dam DECLARATION DECLARATN G�--- & GRAVEL BUR,
uadettn my phos shall he used u public marls
lyU
�oLicensed Professional
Oat I am exempt
from
DECLARATION
aI 1 herchy affirm Net 11. exempt from Ne CortractCo License Law for the
;00 whicfollowing moan.(Schon 1(171.5, t. inceM Profc ..a ,m, Any city or county
1=0 which rets iss a a Permit re cores W e Inc.a .improve,dcmlli it t nr epsir any structure
'Z e pear m it censed e.pursuant
requires the lhovisia applicant acne Permit Reesle e sew(Chapter
.
thaIte t licensedputuamroNcofDiviauafdmContrBusincess ndProeLaw(C Code)
Sq.Ft.Floor Area $2381 Valuation
7��
(commencing is exempt
pt dunaioo la and
of basis o 7 Mthe alleged
essard on.Any
Code)of
Nat he t exempt any applicant
li and Ne Eula fm dm alleged eamant in Any vipenany of
Semon 707L5 five
airy applicant fora permit subject the applicant m a civil pcnehy of hely Number Occupancy Type
act...Was five hurtled dollars(5300). 3 2 6 5 2 0 5 5:l7 U'
❑1,u owner of the property,or my employe"with wages u their alceampertsation,
will do Neworkand Westrunue h ratimeaded or offered insole(Sec.1014.Bounteous Required Inspections
and pafessions Code The Commoners Liaise Law do"not apply m an owner of 9 P
pmperty who Wilds m improvea Hereon,and wha does such work himself ar that his
awn employe",provided that such improvement Lie not intended t roRered for sale.If.
however,We building or improvement is sold within am year ofcompietion,the owner-
builder will have the harden of proving Nat Ise did ms build or improve for purpose of
sole.).
C3 1.as Owner of to property,am exclusively contracting with Ilcemed conuscat to
conswet the project(Sec.7W,Business and Prof"siou Cade)The Commmots Li.
cartoon Law does not apply to an Own"of property who builds or improves Woman,ad
who canmet for suet project with a cone uter(s)licensed pursuant as We Contractors
License I.
❑Iameaemptunda Sec. ,B&PCIm WAmuon
Owner —Daus-
WORKER'S
DatWORKER'S COMPENSATION DECLARATION
Ih y M.under peratyof perjury One of Ne following dedatdons:
sm and will main Wn aCerGfieme O(Cooant m self-Issue fartimice iCampen-
smion,as provided for by Section 37M of We lab"Code,far We performs.of We
carte lar bleb Nia permit is issued.
w have and will maintain Walker'.Compeuadon Insurance,as;mquimd by Section
31M of We Labor Code,for the poolmonace of Ne work for which Nis permit is issued.
My Workcts Compensation Inr3yrs-c carri/m� II y Not:number am: _ ^
Carti<c611 !1 /I/ GFI EXEMPTION
iN Not: (y
/1\
CERTIFICATEOMPE SATIONiONPRAN WORKERS'
COMPENSATION INSURANCE
Crussen on need not ha completed if the permit Is forma,hundred dollars(SIM)
or less.) ,
I cenify Nes in We perfmmanec of Ne work for which this permit is issued,l shell not
employ any person in ay manerso u m become subject to We Workers Compasation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject as the Workces Compensation provisions of We Labor Code,you must
.,O forthwith comply with such Provisions or this permit shall Ee deemed revoked.
.zi rterCONSTRUCTION LENDING AGENCY
[•+ I herchy affirm that Were is a construction lending agency far We performance of
fYi the work far which this permit is issued(Sec.3091,Civ.C.)
W� Q Lender's Name
z Lenders Adders
U C) 1 certify that I have mad this application ad state that the shout information is
ly F torten.1 agree to comply with all city and county ordinances and sem laws misting to
0 U building conswction,and hereby authoriseepr-sentatives of Nis city to color upon the
;t^ W above-mcmioned property for ins,-coon purposes.
(We)agree to save,indemnify and keep harmless In.City of Cupertino against
tt'"yy liabRitics,judgmcnt.c"t and expensa which may In any way scene against mid City
C)z inconsequenceof e WasPerAPCDRSTANDS AILL C LY WITH ALL NO POINT Issued by; Date
SOU R IO
Re-roofs
igamure of ApplicamKommotor at
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or fuwm building-spat stem or handle hacummus material
u defined by We Cupertino Municipal ,Chapter 9.13,aM We Hcaith and Safety
Code,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes o
Will We applicant or future building occupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
emit nit havardo"air cot vnuminaJeR
Dtum y We Bay Arca Air Quality Management all new materials for inspection.
C]Yost
I have mad We hatarduus matrialsoequimmcnt underchapmrd.95 afthc Collins.
ria Health&Sof y ,Sadommos1 33and25534.1un&.dthmifdw building
Jas no u ly a mnan4 rs m 'hility m notify Nc--upon orut c
recut c whi ustlsme norm cc of Ccru me rctim-- Sig nature ofApplcant Date
Owner or amharirsd agent 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 . . . . . . . . : 32652055 . 00
DATE ISSUED. . . . . .. : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000059
REFERENCE ID # . . . : 06120126
SITE ADDRESS . . . . . : 10425 MARY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . ... . . . . . : M & C ASSOCIATION MGMT SERVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1013
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
r
CITY OF CUPERTINO
CU4.R TINO PERMIT APPLICATION FORM
Date: )2jLj.
Buildin-, A ddi ess
f)1l0nc #-
-vl�'Vmj u 0
LongtDr:
License fl:
(0
C ol Cupertino Business License P:
Type of Roof Covering: asc
Prop!o!�S�1:
+:j luilt-lip Rol [a Buill-Up roof
U ,Asphalt Shim'Ics U Asphalt Yiimglcti
Ij Wood Shakes D wood shukus
U Wo"d SIlhlujcs
L-J Wood Shingles
!7 Othul Sipmi'v)
0 OtIm (SI)CCi 1,y)
—
?�umher of csisting L 0 Vc I i[I S0 Provide I.C.13.0. Report j"
hr o � Rclmoved U Provide Mfgi. fns[allntioij Specs
tIvc RcncL Undertan and Will Comply WithCLljDUl-til)WS Of'f'13oliCy: /.lob 15-L!-S(A pLioll:
y
Commercial ❑
Fire Zane: Yes—EJ No-E Confirmed with Planning Dept. if
Type 0f'C01lStl'LlC[i0l1: there are any restrictions:
❑
OCCUI)MICY ')1'0Llp:
Cin if
:Applicable FCC 11) Fcc Description Fee GI-01.11)
13 P E IR M F E'E 111(ji, Permit
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BUILDING ING
BENERGy Fy BUILDING
:ESIS\1,CRE Seismic Fec Res BUILDING
BSEISM,C0N1 Seismic Commercial BUILDING
B )LAN"HK Plan Check Fee BUT-DING
BUSLICBLSilOSs License BUILDING