06120129 (2) CITY OF CUPERTINO
BUILDING DivisioN PERMIT „ C,�NTRA.GTnOU INFO,RCMATION -
BUILDING ADDRESS: PERMIT NO.
1045-3 MARY AVE DR A ET' UL_GQN&TRU�
OWNER'S NAME:
g11,M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
IV NEFns rTnno SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
l� l� E 0
Op LICENSED CONTRACTOR'S DECLARATION
;� I hereby affirm dust 1 un lewd under prombbns of Clupua 9(commencing Job Description
Z withSo.,mm7IX10)ofDivison3afdmBotineuadPrafossioa ade,admyrmmci, REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
w, in full forte and [(ec lQ
Y�z L,,:emec Lie.I NEW 3/8” CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
iF Dow J Contractor C_
qq ARCHITECTSDECLARAN &, GRAVEL BUR.
i W I undcrsund my plans shall Ix used as public mounds,
u
'ot LiccmdPmfmional
1<3 OWNER-BUILDER m Ce CmurtON
2 I hereby alum Nm I a.5 acmpt from the Cssions o License Law for to
:00 following rcaon.(Section 703 L5,Business and Professions demolish.ac:Any city or county
$ which hes issa a permit m enosuvcs.alcor,impmaPermt1nr repair any structure
primws luensedprso requires Unammaimf renames pennitto tilt.Law(suxment
:r< a.atmeni gwit puraam at be of Division
u(tW Conuscwr's Littre law(Chapter Sq. F[. Floor Area 2 Valuation
N� thammcnc ttempt Section AYIO)of D osis f r of tee B ed exampt Proon.Anyavi Cak)or $2381
S 9
that be h exempt nhemfrom and ae per far the Subjects
bac
eaemaut ho Any violation of
Scutari than by any applicant far a permit the applkant to a civil penalty of Number Occupancy Type
not more than siva hundre0 dollars(5300). 32652 0 4 9 !�l�
0 1,u Owher of nlle property,m my employm wi0 nga u deb sale ammpemdon,
will do the work.and the structure is not Intended or offered ronak(Sec.RM4,Business Required Inspections
and Profession.Cole:The Cmetractoh License law don not apply to e ns an owner ad q p
pmpeny who builds orimprom demon,and whodaasuch work himself ar drought his
own employees,provided am such improaremats are not intended orolRreG for Safe.If.
however.the Wilding or impmvemmn is cold within am year of completion,the Owner-
Witder .will have tee burden of proving teal be did non build or improthe for purpose of
sale.).
0 1,as Owner or the,property,am exclusively contracting with licensed contractors to
construct the project(Sec.7060,Business and Professions Code:)The Contractors U.
came Law does not apply m an owner of property who Wilds or Improves acmon,and
who conuscu for such projects with a mntracnar(s)Ike and peasant to the Contractors
License Law.
❑I am aempt under Som .B&PC for aid mason
Owner Data
WORKER'S COMPENSATION DECLARATION
]be y aIDm oder pealty of perjury rhe o(dte following dalentioa:
m and will maintain a Cer ifateo(Cansseat m self-intim for Warker's Camper-
s cion,u pmvidcd far by Section 7700 Of the ISWr Code,for the perfamence of am
work for ch this permit is Issued.
ave and will maintain Workers Compensation Insurance,u required by Section
3700 of the Lahar Code,far the,performantt Of the work for which ads permit is issued. '
My WmIan's Co r s aaaan!Wwnnce anter and Policy number art:
Cartier: r`lAN�Polity No.:
� pa-�
CE FICATE OF EXEMPTION FROM ORKERS'
COMPENSATION INSURANCE
rfhis section heed not W complctcd i(d,e permit Is forone hundred dollen(5100)
or leu.)
1 certify Not in the Performance of tee work for which this permit Is issued,l shall not
employ any person in any manner so a w become subject to ae Warkers'Compensation
Laws Of c.lifmad a.Dam
Applicant
NOTICE TO APPLICANT:IL after making his Certificate of Esemption,you should
became subject m de Worker'.COmpemdan provisions of the Labor Cade,you most
.J O fortewid comply with such pmvisioa ev
or this permit shall be dccmed roked.
z''-" CONSTRUCTION LENDING AGENCY
[•+ I hereby which thi bust than is cons sec.3097.
Cir,
agency for dx Performance of
a the woes for which this permit Is issued(Sec.7097,Civ.C.)
lLl�z Landers Nam.z Lender.Add.
U O 1 certify that I have mad this application and sum but are above information is
D, F COMM 1 agree to comply with all city and county oNinsaca and sum laws relating to
0U building construction.and hereby authorize mineacmatims of obis city to enter upnn the
r W abuvc-memiunea property Inc inspection purposes.
(We)agree to save,indemnify and keep harmlm the City of Cupeaino agaiat
rF-t fq liabilitiu.jutlgmcnu.<osu ad apcnsa which may in any way accrue agaiat aid City
U z �GU
nsequence of the gffDS
't.
LIC UN LLLY WITH ALL NON-POINT Issued by: Dale R
Re-roofs �/�
,gnawreof Appli unaactoram
HAZARDOUS MA RIALS DISCLOSURE Type of Roof
Will has applicwns or future building Occupantnorc ar Mndle huallous manurial
as defined by the Cupertino Municipal C .Chapter 9.11.and the Halt and Safety
Cde.Sationu531(a)± All roofs shall be inspected prior to any roofing material being installed.
Dy.
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
mit havudna air emiumirot; u dcfncd the Bay Arca Air Quality Management all new materials for inspection.
Disuics±
0y.
I have mad the Woodnsn materials requirements under Chapmr6.95 Of de Califor. /)
nia Hnite&SafctyCatic,Sections 25505,25533 md25534.1 undcriandthnifthc Wilding O/', /YJv
oars,wt eurten0y ve a n4 Nati ' y res ity to testify the Occupant of the
myuire c m met ' w' O ertirxam oraca Signature of Applicant Date
owner ar eamomd agent D„ 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 . . . . . . . . : 32652049 ..00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000062
REFERENCE ID # . . . : 06120129
SITE ADDRESS . . . : 10453 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
CITE' OF CUPERTINO
�.�eii►1 9=�IE ll�:�u O It'
CUPER,TINO PERMIT APPLICATION FORM
AP
Date:
13uildin . \ cr' s:
Owner's Name:
t b`� _S_Inv� JL
,. I hone n:
Con_trnctor:
License
Ccminc.l: Cupertino Business Licensc 4:
1'ype of Roof Covering:
Esislin.`,: Propose I:
'.j 14uilt-IJP Rtl If ®' 13uilt-U11 roof
U Asphalt Shim=les ❑ Asphalt Shingles
J AVaud Shakes ❑ Woad Shakes
❑ Wood Shincles ❑ Wood Shingles
L] UthcrlSpccilbl _-- -- ❑ (hhm (Spccil'y)--
NLJu Ither ul czisting cuvuriogs— ❑ Provide LGI3.O. Report i! —
tli o he Renm'"I ❑ Provide \Ifgr. Instal latinn Spccs.
ave Read, Unclerstancl and Will Comply With Cuper6110's "fear Off POlicy' ❑
.lob Description: ` n' l y —
Irl '
Residenti;tl 0� Commercial ❑
—ITrl: ZtiIc: Yes ❑ No ❑ Confirmed With Planning Dept'. if
there are any restrictions: LJ
cos[ of Project: Type of Construction: Occupancy group:
_x381 DO 0( "�
Qn. if
a\ppli=able Pee ID Pec Description Pce Group
3PIiRiVll=1 6 131c1g Permit I"ccs BUILDING
_ 13ENERC.Y Energy BUILDING
BSEISt\,IICRL' Seismic Pec Res BUILDING
BSI:IS\IIC0VI Scismic Commercial BUILDING
BPLr\NCI-IK Plan Check Pec BUILDING
� _ RUSLIC Business License BUILDING