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07030304 -7777777777777, �777777777777777777777777777771.-.1. CITX OF CUPERTINO BUILDING DIVISION PERMIT00NIRY •GTO�INFORMATION. BUILDINADDRESS: PERMIT NO. (_', //) BRAEGE PE T A OWA;? E: N ERVICES TIMERCIAL ST SArI&3R� 2(8/ CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH j p LICENSED CONTRACTOR'S under DECons ofC Chapter INSTAL] NEW COMP SHII4�gcription F., t hereby affirm that I am licensed undo provisions of Cha ter 9(commencing � with Section 7000)of Division 3 of the Business and Professions Code,and my license is =o. in full force and effect. / //0 / //�� l En License Class 19-(-3 Jr •c 33 Lic.N G /��.J �(" � /!/ 7�// ��35 /GCS�� /�� tp Date 3--,>}?-0 7 Contrac y ARCH[TECI S D L�ARA /b&, jL /Q��f� /C)��, l��'//��73. /l?3 7!; /03/ C-a 1 understand my plans shall he used as ecords �/ �'"/` F- Licensed Professional 7, n a OWNER-BUILDER DECLARATION I hereby affirm that t am exempt from the Contractors License Law fort the jO following reason.(Section 7031.5,Business and Professions Code:Any city or county o which requires a permit to construct,alter,improve,demolish,or repair any structure r prior to its issuance,also requires the applicant for such permit to file a signed statement 3 .Ft.Floor Area Valuation =G that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 �] -$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My r'Worker's Compensation Insurance carrier and Policy number arc: Cartier./ '-(-1 -3;FJS'e� Policy No.?)WC M k I0Y00 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of �"� the work for which this permit is issued(Sec.3097,Civ.C.) zLender's Name Lender's Address 0 1 certify that 1 have read this application and state that the above information is 0-+ correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. P4 (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City 1 Z in consequence of the granting of Date �+ APPLICANT UND S AND PLY WITH ALL NON-POINT Issued by SOURCERE 3 -67 Re-roofs ! y Sig ore ofApplicanU for °oto Type Of Roof AZ RD( ALS DISCLOSURE ill the applican or fur uLlding occupant stoic or handle hazardous material as define unicipal Codc.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? �� 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 i3 installed without first obtaining an inspection,I agree to remove hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr,aterials for inspection. District? ❑Yes bkN I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirement-%which must a certificate of occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better toner err a cd a c Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI" RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: B11L: Lot: APN . . . . . . . . : 32652036 . 01D DATE ISSUED. . . . . . . : 03,128/2007 RECEIPT #. . . . . . . . . : BS�)00000811 REFERENCE ID # . . . : 07)30304 SITE ADDRESS . . . . . : MA:ZY AVE BUILDING D SUBDIVISION . . . . . . CITY CU?ERT INO IMPACT AREA . . . . . . OWNER M&C ASSOCIATION SERVICES ADDRESS MAZY AVE BUILDING D CITY/STATE/ZIP . . . : CU=TING, CA 95014 RECEIVED FROM . . . . : RE_'EIPT INTERFACE CONTRACTOR DR%EGER, JOHN EDWARD LIC # 21895 COMPANY DR%EGER CONSTRUCTION INC ADDRESS 605 COMMERCIAL ST CITY/STATE/ZIP . . . : SAJ JOSE, CA 95112 TELEPHONE (4)8) 536-0420 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 60, 000 .00 604 . 80 0 .00 604 . 80 0. 00 BSEISMICRE VALUATION 60, 000 . 00 6 . 00 0 .00 6 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 610 . 80 0 . 00 610 . 80 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 610 . 80 129395 --------------- TOTAL RECEIPT 610. 80 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 REROOF CUPS NO PERMIT APPL, CATION FORM D � - _ -� 5a o► D 7 �� APN # Date: Building Address: k'(l� /0379-1(7377-/0.375 "1037,3-Al 371- 03c-,'- 1 u36S'- 03 kJ-21 b36 0 o353 Owner's Name: Phone #: M L �s�,a�s� �;ceS tog-gSS-�Il�O Contractor: License #: DMR Corllsky�c7k-01� (0 Contact: Cupertino Business License #: - C) o2(()-q c2 (bq5 Type of]Roof Covering: Existin Proposed: i9' Built-Up Roof u�- wilt-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: Qn 1 Residential Commercial ❑ ' Fire Zone: Yes ❑ No E3-' Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Constru-,tion: Occupanc group: �_ 3 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -.UPEKTINO Building Department JOB ADDRESS: to7'7R -10377- 1�37s-lo 37;;r- io=-)I - /o3b9 PERMIT# �to31b?- /U3GS' lu3l-1- 1o35- �t� �" r D 70�0� ib3S7- 1u3SS- l�s3f3 /��'T" /Tv�-- r�u,�C��"r OWNER'S NAME: PHONE# 9&s Z I (D -`loC,C/ GENERAL CONTRACTOR: (L k4,_ FAX# I am not using any subcontractors: E7g re-7 Date Please check applicable subcontractors an alete the followin information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/C tr ignature Date