06120134 (2) CT.Ty OF CUPERTINO �a,�� ! �:TRAGTQI2INF
+ BUILD:NC DIVISION PERMIT Gi1NOiiMA�ION
BUILDING ADDRESS: PERMRNO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
qlr ens rTrvna SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o0 LICENSED CONTRACT'OR'S DECLARATION ,Job Description ,I
wF I tumor affirm Nal 1 am limned under provisions of Chapter 9(commencing
Xt witSection7")ofDivision3ofdecBeat.audProfession%Code,andmylicenseI, REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL -
orte an (e
;- LD'�acNn in lull fLic.g NEW 3/8" COX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
83 Conuanor
ls' CHITECTS DECLAR ION & GRAVEL BUR, 'I
1 undersand m plana shall W used u pubic meords
t
'off Limned Pmfcssianal
i5 Oat I am eUIIDER DECLARATION !
0 C I thereby.(Sero then 1 1. eumpt from to Connors :Any C Law for tc
:p0 following mssnn.(Section 10]15,Business and Pmfcssinns Code:Any City or County
$4 which requires a permit he construct,alter.Improve,demolish,or repair my structure 'I,
a< priorm its issuance,iturequirm to applicant forsuch permiva file a signed statement i
that hots licensed pursuant to the provisions of the Cont Liam Law(Chapter 9 Sq.Ft.Floor Area $2381 Valuation
O (commencing wide Scaion?000).(Division 3 of M Business and Prefwimu Cove)or
1 9
that be u eumpt therefrom and Ne buts for the alleged attempt .Any vloladon of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of Number Occu anC e
not more than fin hundred dnuars(M), 32652059! Occupancy
❑1.u owner of die pmpeesy,or my employee wide verges a Nob sole compenssdon,
willdodeework,amiduswctumisnotttended orofferrA fanale(See.70M,Businw Required Inspections
and Predications Code:The Confiscates na
ates Llcee law does not apply be an owner of q p
propeny who builds or Ire proves thermn,mi l who dom such work himself or Nmugh his
awn employers,provided dent such improvements are not immaded or offered for aide.if,
however.to building or Improvement is sold within one yeer of core return.the owner- ,
builder will have the burden of Proving Nat be did not Wild or improve for purpose of
Cale.I.
M 1,as owner of the property,am eulunwiy contracting with limned conmcom m
construct the pmKct(Sec.70aa,Bmionas and Professions Cade:)The Contractees Li.
cent Law don not apply no an owner of propeny who Wilda or improves demon,and
who concocts for such projects with a mnuaztur(s)licensed perform,he Ne Cunuacoes
License Law.
❑1 am exempt under See. B d P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I by affirm under penalty of perjury one of rhe following declarations:
mond will maimaln a Cenifeate of Conant to self-Insure far Workers Compere
on,as provided for by Section 37M of the Labor Code,for to performance of We I
wart for ieh Nis permit is Manuel.have and will maintain Warkch Compensation Insurance,a inquired by Stttinn '
37M.(to lab.rFwlc,for Ne performance of to work far which this permit is issued. M Y
My Wor s tfipemation ingymnce artier and Policy numbers \
Grrier liry No.:
ERTIFlCATE OF E%FA1Pf10N FROM RKERS'
COMPENSATION INSURANCE
(Thu section need not W completed If dee permit Is(arctic hundred Milan(SI00) i
or less.)
1 mnify that in the performerea of lie work for which this permit is usmd,l smll rot
employ any person in any me nnerso as in became subject ode Workeri Comp reallon
Laws of California.Dam
Applicantii
NOTICE TO APPLICANT:IL after making dee Certificate of Exemption,you should t,
become subject to the Workers Compensation provisions of the Labor Cade,you muff
rJ z forthwith comply wit such provisions or this permit shall the deemed mocked. +.
'Z'O
ECONSTRUCTION LENDING AGENCY it
om Ihemhy affirm thistem isacammctinn lending agency for ft incursions.of
> dm work for which tis permit Is issued(Sec.3097,Civ.C.)
zLanders Name - y
Lenders Addmas
C-3 Q I certify that 1 have rend this application and sine then to above iws relating is _
[L f" contig l agree ic comply wit all city and county ominnnces and sum laws r upon
m
QU Wildingeonauuttiogand forherebynmutenmmoses. ti�rsofthiacity mcnterupnnrhe
anovcmce)agrepropeny forimpectian keepths.
,rte„gy (Wa7agreeo Cast,indemnify and hep hay in
to City ofc agaimaoagainst 1
h In ortie.judgmcros,Costsnodexpense which may in any wayucsuc against said City P
C),'� in consequence of the granting of Ria permit.
s•.r APPLICA DERS7A AND WITH ALL NO -P01 Issued by: Date /Z Z'L,UC
SOUR E 0
Re-roofs
tgnature of ApplicanuConuamor ate a
T
HAZARDOUS MATERIALS DISCLOSURE f Roof
ype o
Will dte appliant or run.Wilding occupantsmre or handle haanlae mm ctial
u Mfrncd by to Cupertino Mumc pal .Chapter 9.12.and to Health and Safety i
Code.SecMn 2553x4)? All roofs shall be inspected prior to any roofing material being installed,
❑Yu a
Will to applicant or future building occu st cqulpmem ar Mvice which If a roof is installed without first obtaining an inspection,I agree to remove
emit haemo air conuminanussdcnnc Bay Area Air Quality Management all new materials for inspection. a
Distract? i I
FI Yet; � 1
1 how art tohvamuus materialsmyvimmentsunder Chapter thatir dee Wild
nu Hralt&S�Icty ,Satiw E5503,255JJ am1255 sand dwiftW Wilding
dao rot c rad 4 ten at it u m Jily ufy dee omupant of
requite, st et aro' mateafoeap Signature of pplicant Dat
o.11cror+a dred.,.I r Da All roof coverings to be Class"B"or better
I /
• CITY OF CUPERTINO
2 ITEMS OF 2 - PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652059 . 00 '
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000067
REFERENCE ID # . . . : 06120134
SITE ADDRESS . . . . . : 10433 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
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
Oulu [ 1-
�' CITY OF CUPERTINO
lym
• l'GII Ci N?N K:�ICT JI<
CUPFRrINO PERMIT APPLICATION FORM
AP��- 32(0-52-0� Da c:
13uilding.Address
Owner ; Name: _J V Phonc #:
connactor: I-1»c:C tc�t i�� �� nrd Vit:>: . ;wJ �
- - �
License #:
trrr' ( i_al_ r"
;�at',C :�`i�'rVC�.11C.
Coutoct:�l Cupertino Business Liccnse 'i:
tea, ac�
Type of Roof Coverin(,:
t
LS'isIiII: Proposed:
.] 14uih.-11p Roof D Built-Up roof
U Asphalt Shingles ❑ Asphalt Shinplus
O Wood Shakes O Wood Shakes
U W,wd Shingles ❑ Wood Shingles
J Utha ISpecil\ l__ _ ___ ❑ Other(spec ify) _
ri�.pn ber of esisl i n Q corerim_s_ -- C1Provide l.G6.0. Report d _
N� l'o he Removed ❑ Provide Nllgr. Installation Specs.
• — — /
I I lave R.cad. Understand and Will Comply With Ctlpertino's "fear Off Policy: Cy
Joh Description:
ci
Residcntiol Commercial ❑
Piro To—11 Yos ❑ No ❑ Confirmed with Planning Dept. if
_ there arc any restrictions: ❑
Cott .,I'Project: I ype of Constructi0o: Occupancy group:
[v. if
\pphc:d1l,2 Pee II) Pec Description Pec Group
13PE1 1\11FIc.L Bldg Permit Ices BUILDING_— BENERGY Energy BUILDING
BSEISNIICRE Seismic fee Res BUILDING _
_ BSEISMICOM Seismic Commercial BUILDING
BPLANCI-IK Plan Check fce BUILDING
BUSL.IC BUSInCSS License BUILDING