06120132 (2) CITY OF CUPERTINO
BUfLDING DIVISION PERMIT CONTRACT()RgINFpRMATI( N a.
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: E ATE
AEkM & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
Nina,Trane
(408) 536-0420 SANITARY NO. CONTROL NO.
ARCHI3EC'T/ENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
pp LICENSED CONTRACTOR'S DECLARATION lob Description
u 1 Wreby affirm that 1 am licensed under provisions o(Chancr 9(commencing P
.z1 with ScctlanJIX1B)ofDivielon 3orNC Busincsr and Profrssium CoJc,and mylicenx is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
m ran tome ane r¢
uanseClw Lm.A NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
qqqq Dam Chair r C
iqmqVARCHfEcr,DECLAR IONS- & GRAVEL BUR,
i g I understand my plans shall Ise used As public recnrda
idu
°off
Licensed Pmfcssionel
OWNER-BUILDER DECLARATION
Conu ON
1<@ I hereby alum thus 1 1. exempt from the Contras;Co License Law far the
:00 following reason.(Section yfll LA Business and ere,de Professions;Code:Any city or county
'$� which requires a permit m enmwct.else,,improve,demnlLSM1,or repair any structure
;xi pilarea its issuance.Alan regn.the Applicant far such Permit rile asignedstammcm
< ,hmMislicensed puwanuotheprovisiomafthe ConummrsLicanselaw(Chamer9 Sq. Ft. Floor Area Valuation
(commencingwihSccdon?0DO)o[Divhion3af Nc OusinmudPmfemiom Cmh)or $2381
$ Nat he Is exempt therefrom and the bash for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecu Ne applicant to a civil penalty ofNumber Occupancy Type
Am mom than rave hundred dmlan(3500). 3 2 6 5 2 0 6 3
❑L asownsr of tW property,or my..piaycm with wage asthew mlewmpensei
will de the work and theatmmure ism,namaed oraffeaed forsake(Sec.?044,Business Required Inspections
and Professimu Cade:The Cantraner's License Law does not apply as an awns,of 9 P
property who builds oc ire proven thereon.and who does mase h work himself ar through his
own employees,provided that such improvements art not inm ural oraRared fm Asia If.
however.the Willing or impmvemant Is mid within am year of eempledan,the owner.
builder will have Ne burden of Proving that he did not build ar improv far purpose of
seas.).
❑I.as awocr of the property am exclusively contracting with licensed mnuacmrs as
construct the project(Sec.7044.Business And Prof nations Cade:)The Commuch's U.
roue Law doe not apply to a"owner of property who Wilds or impmvcs ftexan,And.
who contracts for such pmjecu with a contncmKa)licensed punuam to the Contractors
License Law.
❑lamexemptunderSee .B&PCforthishsson
Owner - Date
WORKERS COMPENSATION OECLARATION
1h by affirm under penalty of perjury one of the fallowing deiaraanc
sus and WI munuln A Cerdfrcare of Consent as self-imam for Workers Comkmn
samer.u provided for by Scrtion 37W of the labor Code.for the Performance of the
ork far Is h Nis Permit is:wase..
and will maintain Worker's Compensation Insurance,As inquired by Borden
37W of the labor Code,for the Performance ofthc work for which this Permit is issued. '
My Workers Compensation Ince.sakni-var And Policy number
Ca nic rO/V JPolicy No.:
CERTIFI,ArEOF�PION FROM ORKERS'
COMPENSATION INSURANCE
(Tris section heed set ho compbun!tribe pmmit is furans hundred dollars LSI W)
or loss)
1 certify thus in the perfomranc.of the work for which Nis permit Ice issued,1 Ahall not
employ any person in any manner an As to Become subject as the Worked Compensation
Laws of C.1iromis Dae
Applicant
NOTICE TO APPLICANT:If.after making this Cenifrcam of Facmpdon.you should
became subject as the Wmkeh Compensstlon Provisions of tie i Coda.you must
.J 0 forthwith comply with such provisions or this Permit shall Be deemed revoked.
CONSTRUCTION LENDING AGENCY
(-�� Iherehy affirm Nat Vert h a construction lending agency for ft Performance of
CL.moi dm work far which this permit is Wood(Sec.3097,Civ.C.)
Q Lendefa Name
Z) Z LAaders Address
J Q 1 certify that I have read Nis Application W sue Nat the shove information is
LL,F cancer I agree to comply with all city and county ordinances and sum laws relating to
�U building constmetien,and hereby authorize representatives ofmis city to enter upon the
W shove.n,,mionrd proPcny far inspection pugwsea.
(We)agree to save,indemnify and keep harmless the City or CupeNno agaimt
tiN Iiabili0u.JWgments,<osu end rope•....which they in any way xccme agaimt ssid City
C)z in consequence oiFhe rating of this permit. /
�••� 0 NT D ST S AND CO LY WITH ALL NON POINT Issued by: 6i Date
SO R L
Re-roofs
Si um afApplian✓Conuac r Am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanutom he handle hnardoas mammal
As dcOned by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code.Bectian 2553:(.)?
❑r All roofs shall be inspected prior to any roofing material being installed.
40 o
Will the applicant or future building occupant use equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants As&fined by the Bay Area Air Quality Management all new materials for inspection.
Du0ict?
❑Yen U�aby
Ihave real the acardom materials mquimmencs antic,Chapter 6.95 of the Cali foo-
nia Health&SalelyCodc,Sccueu 25503,35533 and 25334.1 undcnund Nat if the building O
dose not cu sly A e Net It h my en 'iuloy as nodfY the pantal'
mgaire n ire.. Certirmamor IgnatureofApplicant Date
Owner or
author....Ag cm Da 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 . . . . . . . . : 32652063 . 00
DATE ISSUED. . . . . . . : 12/22/2006 .
RECEIPT # . . . . . . . . . : BS000000065
REFERENCE ID # . . . : 06120132
SITE ADDRESS . . . . . : 10441 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
---------- -----------7- ---------- ---------- ---------- ---------- ----------
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 W1415dL
CUPFRjlNO PERMIT APPLICATION FORM
AI'V' Date:
Building '\ddress:
-- -DAVO �►X13_YYY�
Owucr'a Name: _) � Phonc I .
r'
Cunoactor: License 4
Conluct: Cupertino Business License #:
Type of Roof Covering:
Existing: Propose l:
.J Iluilt-I Ip Rool' 6d' ;uilt-IJp roof
* Asphalt Shln_Jlas ❑ AsMwh Shingles
❑ Rawl Shakes ❑ Wood Shakes
tJ Wood Shingles ❑ Wood Shingles
U Uthcr(Spccil.`')— _ ❑ Othcr(Spccify) _
:''ugt her ofesisIing covering ---- ❑ Provide I.C.LLO. Report
N 'fo hv
e Remoed ❑ Provide Mhgr. Installation Spucti._ _
• -- / _
I I la�c Read. Understzuxl and \\/ill Comply With Cupertino s 'fear Off Policy: ❑'
.lob Dcscnp�ti�o�n:`
� '�T
I:csidenl.iul [� ) Commercial ❑ -
Fire Tone: )'CS ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost t,l ProjecC 1 ype of Construction: Occupancy group:
Qty, if
Appli_uhlu Fee ID _ Fee Description Fee Group
_ IIPERMFEI3 Bldg Permit Fees BUILDING
_ — BENZ RGY Energy BUILDING
BSEISNCCRIc Seismic Fee Res BUILDING
u 13SLISIN/IICOM Scismic Commercial BUILDING
BPLANCI-IK On Check Fee BUILDING
___ i3USL.IC Business License BUILDING