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06120127 (2) CIsY-OECUPERTINO BUILDING DIVISION PERMIT �hG'b1�I tR.A.IK (II2IN 'UILM.I I©1V' q:. BUILDING ADDRESS PERMIT NO. OWNER'S NAME: A M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006 Tal yTnD0 (408) 536-0420 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ' joo LICENSED corrrRd..do,soFLLARAnoN JobDescri tion U FF 1 hereby emrm Nm 1 am lice"cd under provisions of s Ca,mr 9(commencing F with Sectiamly" omdo,Ia ofNc Business and Profcuions Cade,aM mylkcnsc is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL ,gym in full lorteand DOW n ' Can NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR EE I ARCHITECTSOECLARION & GRAVEL BUR. W [understand y plans shall W used a public reenrds a 'Oq LIeCnSCd PTrC93101181 g OWNER-BUILDER DECLARATION CanumON 1 O j I hereby affirm that I am exempt from the Ceshom ra License Law for the 0 o following moon.Permit i 703 1.5,B"imaa and Improve, de nm Code:Any city or county m which rcquirns a permit re cures the almG nt(or demolish,or repair any swnure 4 z 0 hatph.,Ice its issuance,pursuant ossa requires thovisio s of the Con permit w cic a ense Law(hlemem ;�c Natmis ecing it tion7 d)provisions of of Comer's License taw(s Code) Sq.Ft.Floor Area $2381 Valuation r`j $ (hot M is with Section Tgnd of basis r of tW Business axsand.n.Any Cade)or 2 3 81 Natio u Dumps therefrom and the burs for the alleged eumam,in Any l mada.of Section 7831.5 five mry applicant fors permit subjects dm applicant m a civil penalty of 3 2 6 5 2 0 5 7 -V64 Number Occupancy Type not mart Nan five hundmd dollars 500). ❑1,as owner of the proparty,or my employe"with wages az their sole compensation, will do thework.ands: swnumisnot Mendedarawdos,wt in Bulinus and property W cod The me me mrs and Law dos not apply lf en owner is Required Inspections propertywhobuildsiticeproveseb improvements and who doessuchwork mmmlf edthrough his ownemployees,provided that webhimps old within not intendedmplcded far owner however,the building or improvementIsmid within ane Wild ore prove for the owner builder will have the burden of proWng Nal M did Out Wiw ar improve far purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed convenors In conswet Ne projen(Sec.7044,Business and Pmfnsions Code:)TW Con swor's Li. cause law da"not apply to an own"of property who Wilda or improves Nemo.and who comets for man projects wit a mnmcmr(s)licensed punmal In the Contractor's Lwenu Law. 0 I am exempt under Sec. B dr P C for this moon Owner Dam WORKER'S COMPENSATION DECLARATION 1 rebyaMsn under pe"ity of perjury mm a(Ihe folwwing dedaratians: are and will maintain a Cenlftam of Couenl w self-insum forWarkcrs Compen- soian,az provi d for by Secdan 3700 of One labor Cade,for the performance of the work for this permit is issued. ve and will maim in Worker's Compensation Insurance,az required by Sccdon 3700 of Ne labor Code,for the performance al the wmk for which this permit is Issued. ' My Workers Cramiamodado�n lou comer and Policy number raam- Carrier. e ///GPolicyNa,:�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thusechon need not k complcmd lithe permit is froom hundmd dollars($100) or lcsa) 1 cenify that in to performance of the work for which this permit is issued.I shall not - employ any person in any mannerm as 0 Wcome subject to dm Workers'Compenotion Lawa of Califoroia.Dam Applicant NOTICE TO APPLICANT:If.after making this ccniftam of Exemption,you should become subject in the Workers Composmdon previsions of the Labor Code,you most .J z forthwith comply with tech provisions car this permit shall W deemed revoked. Lz.,� CONSTRUCTION LENDING AGENCY [•+ I Wmhy affirm that them i, wastruetwo lending agency fm the performance of rr! .moi the work for which this Permit Is issued(Sec.3097,Ci,C.) Q Lender's Name z Lenders Addreas U Q 1 certify that I have mad this application and sum that NC aWve information is fL carted.I agree to comply with all city and county ordinances and sum laws relating to �U building construction.and hereby authoriyy representatives of this city to enter upon the W ahovc-mcnuonedpmpeny fond expenses porpawhich ms. (We)agree to save,indemnify and keep hannlcu dre City of CoNnmo against sFih inconsequence ud'gmc thagran endexpcnsesrait. may in anyway accrue against mid City U z in conmgmnee of Ne granting of Nis permit. APPI,C ND STANDS WILL CO WITH ALL NO POINT Issued by; Date �2 SOU UL ONS. igna tare of AuGr t fD.m 1 Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding c,Chapter or handle Hcardaua material O dented by Ne Cupertino Municipal 4 Chapter 9.12.and the HCBIth and Safely cav,sc❑cdon 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 41 Yu a Will the 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 harardnus air conmminants a defined by the Bay Area Air Quality Management all new materials for Inspection. District? ❑Yes Nu I have mad the hoardom mweriab mquimmenu under Chapwr6.95 ofd¢Califon- �s ria H"INg:safctyC ,Sccdou25505,25533and25534.1undcrsand thatifthe building C�1� docs am rte y a ren 4 Nm pondhility m notify the scup t of Ne reyuirc n " If, mi3:can aracenirrcamofa c -Signature ofApplicant Date Owner tar au mnacd agcn 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 . . . . . . . . : 32652057 . 00 DATE ISSUED. . . . . . . : 12/22/2006 RECEIPT #. . . . . . . . . : BS000000060 REFERENCE ID # . . . : 06120127 SITE ADDRESS . . . . . : 10429 MARY AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . : : M & C ASSOCIATION MGMT SERVIC ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1345 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 • CITY OF CUPERTINO fy )) ClJ4.RjTlN0 PERMIT APPLICATION FORM Date: Buildin-, Addruss Owiiei Name: . I'llolle 4: License 4: 0� Comm.- Cupertino Business License 4: Type of Roof Covering: F I!;t I I 1p, -j 1111i1'.-Up Roof 6d Built-Uproot' U Asphalt Shingles ❑ Asphalt Shingles \Vnod Shakes 11 Wood sjlakcs d shim-,les 0 Wood Shingles Othcr(Sp"il.v) D 0[hul (Specl ly) ,!umber of csisling cn�crinss [.C.13.0. R o [IQ L❑-j Provide 0 I'lovidu Mlgi. histalHatioll Specs. [\"C, (jll('CySLalld and Will C'01111)IY With CLIPCI-till()'S Tcar Off Policy: lob 6c'scriptloll Commercial Pirc-Tl-- 7K,�)—E] "Lone: Yes E] Confirmed with Planning Dept. if there are any restrictions: ❑ -- TYI)C of Construction: OCCUIX111CY III-OL11): 1 06, Qtv. if Applic;dble FCC 11) Pec Description ["cc GI-C)LIJ) RPIERIMFEE Bld", Permit Fees —-----—1 BUILDING 13 EN1--IIR IG Y E ne-l-gy BSI isivilu'L Scismic Fee Res BUILDING BSI---[S\/IICON/I SeismicCommercialBUILDING BPLANCI-IK Plan check Fee BUILDING RUSIA" BLISillM LiMISC BUILDING