06120145 (2) CITYi?F CU$ERTINO
BUILDING DIVISION PERMIT CON. TTR,AGTOR INF,OI2MATION -
BUILDING ADDRESS: PERMIT NO.
104(;r) MARY ANT ING ncl oni A&
OWNER'S NAME: TT MUEDATE
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
prEct017T nnc (408) 536-0420 SANITARY NO, CONTROL NO.
7AICHITECT/ENIGINEER: BUILDING PERMIT INFO
BLDG EI-ECT PLUMB MECH
oLICENSEDCONTRACfOR'SDECLARATION Jab Description
U1 hereby affirm that I t m licensed under provisionsofchapter 9(commencingSeeman 70W)orDivision3afthe Businevand Preessiona Code.mul mylkcnse is REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
ll rtaImenwCl Lk.g NEW 3/8u CDX OVER EXISTING 3/811 CDX NEW 5 PLY TAR
Da¢ Contractor `_
CHITECI'S DECLARAT ON & GRAVEL BUR.
1 < 1 undemm�J my plans shall he used as public rteorda
i V
.a Licensed Profcsai...I
OWNER-BUILDER DECLARATION
( 1 hereby ahem Me I em exempt from the Contneroes License Law for Me
e e O following mason.(Section 703 1.5.Business and Professions Code:Any city or county
$(Li which requires a permit to ennswct,altar,improve,demolish,or repair any structure
prior to its issuance.also mquimr theapplicam for such permit to Rleasigned sutmoum
ro Nat he is licensed pursuant 1.MepmvisionuafMe,C.ruwimiL3carm,Law(Chapter 9 Sq.Ft.Floor Area 2381 Valuation
e r-g (commencing with Section 7000).(Division 3 of me Box.and Profeminv Code)Or
— Nat be,u exempt thensfrom and the bait for Ne alleged exemption.Any violation of
Section 7031.5 by maty applicant for a permit subjects the applicant a a dull penalty of Number Occupancy
not more then frac hundred d.11as(5300). 32652075 P y Type
I,ss owner of Ne propsny.O my emplayw calm wagesssthe'v sok compewdon,
will do Ncworkanddeswnurt 6 mainknded moffaeE formthesec.7W.Bufitxss Required Inspections
and Professions Cade:Th.Commander 1^.s.Comder Law doer nal apply M an owner of 9 P
property who builds O impmtes thereon.and who doea such work himael f or through his
awn employes,provided Na such improwmmu the,not intoMW moRered forces.IL
howe wr.Ne building or Improvement is wed within one year of complamon,the owner,
builder will haw the burden of proving Nat he did not held w improv for purpose of
rale.).
❑I,as Owner of the property,am exclur(wly contracting with licensed centrwtars to
construct the pmjcct(Sec.7W,Business and Professions Cade:)The Contractors U.
cove Law docs not apply in in owner of property who builds or improwt thereon.and.
who conmwts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sac .B&P C for this maven —
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 by tlRrm under penalty ofperjury mas of the following declaadoes:
aw and will maintain a CenjOeare of Consent o self-ivum for W.rlaes Corrine.
Mich.as Provided for by Section 3700 of the Inbar Code,for the performance of me
work far this permit is Wood.
ave and will menuin Workers Compensation Insurance,as required by Section
300ofine Labs Ce ,fof Nepedormwccortheworkforwhlch Nispemtitisicued.
My Wor 3Compensationl race catrierwd Policy num rge: /
Cartier.�;Paltry No.:
CE CATS OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Rhin mutton wedme he,tune ud ifthe Permit is fmone hundred dollars(SIM)
or less)
1 centry Nat in the performance of me work for which this Permit u Wood.I shall out
employ any perwn loony manner.as m become subject i.the Warkeri Compendimon
Laws of Cm irm,ne.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should
become subject m Me Workch Compensation provisions of me Labor Code.you mum
.J z forthwith comply vim such provisions or this permit hall he dwmed revoked.
zCONSTRUCTION LENDING AGENCY
om Ihereby.M.dutthere u.cOutmcdnn lendingagemry forme perfurn.of
W me work for which this permit is issued(Sec.3097,CN.G.)
W q Lenders Name
z Lemdees Add.
V Q 1 cunify that 1 haw read this application and state Me me above information Is
W PCOMM.l agree to comply with all city and county ordinances and sum laws hitting 10
O V Wildin g construction.and hereby authorre represcnutiws or this city to cnu:r u pan tem
r W ahuvc-mcmi.ned'.Party for hmimcion Purposes.
06 (We)agree to saw,indemnify and keep harness the City.(Cupertino against
tifA liabilities.judgmenu,costs and expenses which may in any way accmc against said City
V z in consegecncc of M granting of this permit.
APP A N RSfANDS WI LY WITH ALL/ON. 0 NT Issued by: Date
50 NS.
Re-roofs
SigmxureofAppn VCamne! Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building became store arhandle hauddous thermal
as de0ned by the Cupenum Municipal Code.Chapter 9.11.and the Health and Safety
Code,Section 2.5531(a)7 at�w All roofs shall be inspected prior to any roofing material being installed.
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
.mit hawardow air conuminanu ss de0ned h Bay A..Air Quality Management all new materials for inspection.
DisuiO?
❑Yrs
1 hewread mehmardnmmamfialamquim Z55under Chapmrd.93if0te Ci ug
ria Hvlth&Safety Cme,Sections15503,13337 mW25 hil"un nuamandeoccup building 11
dos scat cunen haw nand, iv my ihilily to testify the occupant of the
myuim ich ::mAl aCcrtifcamaroccupw . ignature o Applicant Date
Owner or .gem Dam 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 . . . . . . . . : 32652075 . 00 i
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000079
REFERENCE ID # . . . : 06120145
SITE ADDRESS . . . . . : 10465 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SUNNYVALE CA, 94087-4914
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 1307 INSULATION
601 ROOF TEAR OFF ' ,602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
re
ciTy OF CUPERTINO
41 c U PEkTINO PERMIT APPLICATION FORM
APN Date:
32 P4- 2-r�!5
Buildill., Address:
0 w I I c I Name: Phone 4:
ce
LinsC 1�li:
License
Cupertino BL1,Si,1lCpq I-i(;CIISC fi:
Type of Roof Covering:
Fxislilw: llrop�osTl:
J Vuill-11p 2 hilt-IJI)1*00f
U Asphalt Shingles LJ AspJwIt Shingles
D
\Vo(,jSjmltcs Cl Wood Shrikes
ij Wood shim-Ics 0 Wood Shingles
Other(SI)CCify)
iiugthcr ul t2NI.S111111 COVe[111gS U 'Invide I.C.B.O. Report 11
LVA Tu he Relllovecl 0 I'lovicic VIIgl. Installation Specs.
• I I lova Reed.—tJodClStRJlCJ—Mld Wili ComplyWith—CLlj)el-6ll0'S Teal. Of'['I)()Iicy: 21- z
.lob Description:
Commercial ❑
F—ir c Zone:—c: Yes ❑ No ❑ collf-11-illed With Planning Dept. if
- there are any restrictions: El
t o F-P-1-o I t�c 1: Type of Construction: OCCLIJ),111CY ('['C)Lll):
Q(v. if
Applicable Fee 11) Fee Description Fee GI-OLIJ)
B 1)E R\4 F E G BldgPermit1"Ces BUILDING
BUIL
DI
N
G
Ener,;y BUILDING
BSEISiMICRE Seismic Pec Res BUILDING
Bs EIs1\1Icom Seismic Commercial BUILDING
3PLANCHK Plan Check Pec BUILDING
BUSLIC BLShICSS License BUILDING