06120128 (2) G?TY OFCUPERTINO 'aa.-q> �*' '� fir'.
BUILDING DIVISION PERMIT C®NTRAGTQR INFORMATIIQN...:
.,,
BUILDING ADDRESS: PERMIT ND.
OWNER'S NAME: UEDA
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
r c c SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
goo LICENSED CONTRACTOR'S DEcuRATION lob Description
�s C 1 hereby affirm Nal 1 sm lire cd wider provisions of Chapsr 9(cemramme ng p
tJ
with Section 70[(R.d Division 3.f had Buthicia and Professions Code,and my license is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
in full force and L
l}�,g
License 11
— a NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
iF Dow GonlDECL
ARCHTIECTS DECLARA ds & GRAVEL BUR.
1 un ernand my plans shall be reed as public menthe
ayU
'off LIaCM1f[J PmfCSalppal
5 OWNER-BUILDER DECLARATION
ConTION
I hereby tlLrm on I e1.exempt(tore the Contrsctora License,Anyc taw for Ne
00 following reason.(Section 703 1.3,Bmineu and Pmf.iom Cole:Any city or county
which do,no.a Permit to commua6 altar,improve,demnlisb,nr older any stmetum
:Z< prior m its issuance,em requires the applicant for such permit to File a signed summed
Nal he is licensed pursuant to the provisions,of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area $2381 Valuation
2�B (commencing wish Secuon'/0the 00)of Division Sof Box.anfe
d Prossions Code)or
5— Nat he u exempt therefrom and the be s for the alleged esempdon.Any violation of
Section 7031.5 by any applicant fm a permit subjects the applicant d a civil penalty atNumber Occupancy Type
not mom than rive hundred&IT.($500). 32652071
❑1,u owner of die property,or my employ.wish wages u Heir talc com,.do..
will da the work and Jd structure is not induced or offered for sea sec.7016,Buismas Required Inspections
and Profession Code:The Candidacies License law d.ret apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own emplay.,pmvlded that each improvements are not indMed oroQered for Bak.If.
however,lie building or improvement is mid within aro year of completion,the owner.
Wilder wW have the burden of proving that M did rat build or improve for purpose of
mkJ.
❑1.as owner of the property,am exclusively conuaming with licensed cunumhors to
construct to Project(Sec.7(T44.Business add Prof.ians Code:)The Comnctors Li-
eec law d.not apply in an owner of property who builds or improves thereon,and,
who conuacts for such projects with a commuctorts)licensed pursuml totk Contra les
License U.
❑ 1 am exempt under Sec •B k P C far this damn
Owner Dad
WORKER'S COMPENSATION DECLARATION
I he by slam under peachy of Perjury cine of the foildwing d larstiome `
w endwill morineCion37M of CacmmCode,mdhe Performance
of -
salon,ss provided far by Section 7700 of the labor Code,for the per(ormmce of Ne
work for ieh this permit is issued.
zw and will maintain Worker's Compensxdan Insurance,as required by Section
3700 of the labor Case,to,Ne performance of Ne wmk for which this permit is issued.
My War ,Compem olein Into as anise and Policy number art:
Cartier. aliN O da I
E T C OTE OFMPE SATION7I EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE '
(Thissemlon need not becomplemd if the permit is foronc hundred dollars($100)
at lea)
1 certify Nat in the perfonnanec of the work for which this permit is issued.I shall not
employ any parent ire any mmacrm as to Ix core mbjat to rex Workers'Compmwtion
Laws of Califarau.Dad
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject to the Worsens Compactors,..provisions of the Lahnr Cade,you must I
.J z faMwith comply with such provinces or Nu permit shall be lamed revaked.
zCONS RUCnON LENDING AGENCY
F-"�" I hereby allure Oat there is a construction lending agency for the performmce of
Cls, the work fur which this permit is issued(Sec.3097,Civ.C.) '
QLender's Name ,
D z lenders Address �
(.3 Q I anify Net 1 haw mac Nis appliaricn arc sena Nat Va.bow informatiun is
T. F" coral.l agree to comply with all city and county ordinances and slow laws dealing to
0 U building construction,and hereby awhodre representatives ofshle city to enter upon the
�a abovementioned property for Inspection purposes. ,
(We)agree to save,indemnify and keep harmless the City of Cupenme against
pr' liabiliues,juegments.costs end expenses which may in any way acetol against said City
V z in canicquenc aI agdnf go(Nis Tdrmit.
a--'
APF :A DER NDS A MPLY WITH ALL NO POI Issued by: Date Z.�Z ti•-r
SOUR[ LAT li
/ Re-roofs
<; gn d ofAppl HAZAoUS MATERIALS DISCLOSURE Data Type of Roof
RDO
Will the applicant or future building Occupant now or handle hasasdoue material
as defined by the Cupertino Municipal C par 9.11.and Ne Health and Safety
Code.Seeded,25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes
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 hanninus air contaminants as dcfi1 ' the Bay Area Air Quality Management all new materials for inspection.
District?
Yu u
I have real the hvsNous reaadals requiremcna under Chapwr6.95 of the Celifar- /
ria Health&SioetyCode,Sections 25505,15533 and 25534.1 undcrsund thatifthe Wilding b
does not cum LI haw a anent,Nat it is my mapansiludiy to daddy the Occupant of the
rtyuim nes ¢h Mmes r 'ssu o Cenifxaa OfQwpaQcy Signature of Appl D2I '
All roof coverings to be Class"B"or better
Owner or authomed agent as
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652071 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000061
REFERENCE ID # . . . : 06120128
SITE ADDRESS . . . . . : 10457 MARY AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . ... . -
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SAN FRANCISCO CA, 94116-
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 CUJI'ERTINO
a YE V"0()11"
I y f)F
Cu4,.RTfN0 PERMIT APPLICATION FORM
-71 Date:
dhlM' Ad(ilCSS-
Owilel
Phone
-�—T - c)
/-)b�-�d5 c
Contractor: License #:
o'-
cownct Cupertino Business Liccnsc—t� -
`�k
Type of Roof Covering:
Existing:
lL1i1[-ljl)10()f
LJ Asphalt shill"Icq 0 Asphalt Shingles
Shakcs 0 Wood Shakes
`:J Wood shill,--Ics D Wood Shingles
-1 (Wicl (Spmfl') E) Otha(Spccif*y)
Ntplhcl olfc,Xislilmg coveroesU Provide I.C.13.0. Report
he Relmoved
LJ Provide I'vIlgi. histal1a[j()II Specs.
Lj"C'C'Sia11d and Will C01111)1Y With CUIM-tillWS Tear Orr Policy Cy
oil
C A4oflilllercial ❑
Fil-c—T),in-7—Yes f-1 No 7 Confirmed with Planning De)t. if
Cott—-- 7 1-_1 1--
1 C)10 c I '1)'j)C OF COI)StRICti011: there are any restrictions:
OCCUI)EI11CY g1-01-11):
Qtv. it
Applicable FCC 11) Fee Description 17CC GI-OLIJ)
11 p F,R 1\4 F E,E Bldg Permit Fee's BUILDING
BEN ERGY Energy BUILDING
_ __ BSE15�gICRE Seismic 17ce Res BUILDING
—13SEEPSi\/11COM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
RUSLIC Business License BUILDING