06120146 (2) CITY OF CUPERTINO
VUILDINUv D1vISiON PERMIT R IF Ff�-R, M TIdN , .
BUILDING ADDRESS: PERMIT NO.
OWNER'SNAME: A
jjkM & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NEG m rTno 0 SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
repp LICENSED CONTRACTOR'S DECLARATION ,lob Description
m I hereby Affirm Nat 1 Am Beamed under provlsiom of Chapter 9(aommeneing P
with Section7IXg1)afDivision3ofthe BusinesrandProfessors Code,AMmylicenafs REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
n in roll fora and ec
I'>a3 Licaaaclm Lk.k NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
44a Date RCHTECTSCo.tDECLAR Dr & GRAVEL BUR.
i K 1 int nand my plans shall he omit m public records
iyU
G
� Licensed Profmo ..I
5 OWNER-BUILDER DECLARATION
<y I M.hy M.that I am axampt from the Contramora License Iso for one
100 following rtason.(Section 7031-5,Borings and Professions Code:Any city or county
$ which mquf cs A permit to con enact,Alm,.improve,dcmnlish,m repoir say rwmum
:ZS prior m its Issuance.also RGuirm the Applicant far such permit to flit a Signed 98mrricat
-�O
that he is licensed purmainuo tim provisions of me Conuacmr"U..law(Chapter 9 Sq.Ft. Floor Area Valuation
5 $ (commencing with section 7=)ofDrinsion3oftheBusiness adProfessions Code)or $2381
Net be u exempt therefrom ad the basis for the Alleged eemption.Any violation of
Section 7031.5 by any applium for a permit a JCCIA Ne applkmt m A Civil penalty ofNumber Occas ane T e
not mare man few hundred dollan(M). 3265207317•:0 P y YP
❑1,u owner of tk de eruct or fY employeca mut cages er the'v rile 044.Business milrin,
will trithe
ssion Code:Th.
snmsLicend mutilated fo no,apply 7061.owner of Required Inspections
and property
wh Profession Code:The Comma ass.And
who Law dam not apply lf an owner big q P
pmpenywho Wildsmimpat thereon.andwhodmmtin workwafffmthough hf.
h..,.loyw,providedthesuchifproaid idare not es,ordmoRemG(mala If.
builder the Winingauimprovement4salt within reteyear orImprovfor theose of
r.
builder will have the burden of proving that M did not dtiu m improve for purpose of
axle.).
❑1,as"nor of the property,am exclusively contracting with licensed assn==is
consumer the prole:(Sec.7046,Business and Prefessiam Code:)The Cornerstones U.
tame Law does not Apply As an owner or progeny who Wilds or improms theman.and.
who trimmers for such posters with a eonuacmr(s)licensed punmm an the Conmmors
License Law.
lameaemptunder See ,Bk PC(orthismaon
Owner Data
WORKERS COMPENSATION DECLARATION
1 h y aRrm under Annually of perjury am of the following declarations:
rt and will maintain a Certificate of Consent to self-insure for WorkersCompact.
saw.a provided for by Section 3700 of the Labor Code.for the performance of the
work faro ' this permit is issued.
ave and will maintain Workers Corporation Insurance,AS,required by Section
37W of the labour Code,for the performance of tui work for which this permit is issued.
My Wmkiggs Compensation hasumc�a��rt//ierr�and Policy number are:
Cartier. AZ1,olicy No.:7/3- Qa' pr�
CERT( CATS OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crus section mad nm rte completed if rhe permit is fm ane hundred dmlas nlrll
carless.)
1 certify that in the pmformame of the wart per which this permit I.issued,1 shall nor
employ any person in any mantra a in become subject to the Woken Compensation
Laws or California.Dam
Applicant
NOTICE To APPLICANT.If.after making this Ce tifrcare of Exemption,you should
become subject or the Workeh Compensation provisions of the Labor Code,you most
,J z foMwith comply with such provisions or oris permit shell be deemed revoked.
Z'
te"I r CONSTRUCTION ENDING AGENCY
(—rIMrehyaffirm Ws dram s.immwaunn lerdinggenry far the performameuf
.tea the work for which this permit is Wood(See.3097,Civ.C.)
SO Q leader's Name
z lenders Address
U O I codify mar 1 have read this application AM stem ren the above information is
IL F crineCt.l agree to comply with all City and county ordinances and sum laws Entering to
0U Wilding construction,and hereby authorim reprcrot2ives or this city to enter upon the
r a Stove mentioned property for inspection purposes.
(We)agree to ave,indemnify ad keep harmless the City of CupcmM against
CA Iiabiliues Judgmcn cum adexpe US which ma in any way eccrm agaime.1 City
traU z APPLI gmmco g ANDSthb rmit.
APPLIC E ANDS L PLY WITH ALL NO -P01 Issued by:
Date
SOU A NS. ell
Re-roofs
ign rerifA pl onuec r Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Appticam or forme building aaupantnare an hands haardoa material
as deBmd by the Cupertino Municipal C .Chapter 9.13.and the Health ad Safety
Code.Section 23532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yui o
Will the applicant or future Wilding occupant me equipment or devicm which If a roof is installed without first obtaining an inspection,I agree to remove
emit hantdous air centurion ss u calmed hythe Bay Area Air Quality Management all new materials for inspection.
Disuict7
Y.
I have mad the miumims materials oquirommu,under Chapter 6.95 or to Califon-
niaHwlth&Sa<ctycodc.5auan 29503,25371 wl25514.1 undcntanE thuifthe building C-7J' A_ / /K�/•a
docs ret cu fly h A of Nati mihili 'fy dte occuPat the
require fly
a are pito lam of. mire ram Signature of Applicant Da
owner our iamrirne Agent a ' All roof coverings to be Class"B"or etter
• CITY OF CUPERTINO _
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652073 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000080
REFERENCE ID # . . . : 06120146 '
SITE ADDRESS . . . . . : 10461 MARY AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER M & C ASSOCIATION MGMT SERVICE
ADDRESS
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1349 -
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 cwiQz-
ilgTROOF
CUPEKTINO PERMIT APPLICATION FORM
F Da
by IS Wtc:
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Buildins Addrem
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0\vu,,i Phone
d"'s 2
License #:
LL
Co I I[m, Cupertino Business License !{:
Type of Roof Covering:
Exis(inp: Pro (�)STI:
1,
J Huill-Up kool t HAS UP nmi
J AqAahShmgW 0 Moak Shingles
Wood Shakes 0 Wood Shakes
,LJ Wood Shiuglcs 0 Wood Shingles
(WACI (SJpccifA0 Othcl (specify)
!
:duJnhcr of QN11�1 WVU1JS1111gS EJ Provide 1,C.13.0. RepoitU
lohelkc1moved 0 ),;ovicic N11,gi. Installation Spccs.
I Now Rewnic]L L-nicclearstand and Will Comply With cupertiuWs Tcar off,Policy:
i0l) 5canpu.on:
Residcnt.ial Dij Commercial ❑
Zone: Yes ❑ No ❑ Confirmed with Planning Dep I
there are any rcstHcHony EE
Cost of Prosect: Type of Construction: OCCUIN111CY gI'OUJ):
On. it
Apykahle Fee ID Fee Description Fee Group
L—----- BPERMFEE, Bldg Permit Fccs BUILDING
BENLRGY EncTy BUILDING
13SUS411CRE Scismic Fee Res BUILDING
13SEISN/1[CON] Scismic Commercial BUILDING
BPLANCHK Phil Check Fee BULDING
BUSLIC Business License 13UILDING
13U