09050086 CITY OF CUPERTINO
BUILDING DIVISION PERMIT .0 €` JE� TC? �t +
BUILDING ADDRESS: PERMIT NO.
10103 P ;R (-QNS
OWNER'S NAME: PERK& ISSUEDATE
N SAN CONTROL NO.
ARCHrrECf/ENGINEER: BUILDING PERMIT INFO
STUCCO REPAIR BLDG ELECT PLUMB MECH
u o p LICENSED CONTRACTOR'S DECLARATION
affirm m I hereby arm that I am licensed under provisions of Chapter 9(commencing Job Description
Lu with Section 7000)of Division 3 of the Business and Professions Cade.and my license is
O y in full fora and err 7 / 0
�Z license Cl Lle.><
f Date Contractor
ARCHITECTS DECLARA
UI u d my plans shall be used as public records LW
a
Wy Licensed Professional
O
n 0 3 OWNER-BUILDER DECLARATION
� 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
OO following reason.(Section 7031.5,Business and Professions Code:Any city or county
e$9 which requires a permit to construct,alter.improve.demolish,or repair any structure
y Z'n prior to its issuance,also requires the applicant for such permit to file a signed statement
=C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y .. 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).
❑1,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(See.7044,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employes,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 pmjccts with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under See B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
"tion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have 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 Worker sl?itpM1.pry cprricr and Poli number am: 7 !IQ v
Cartier I/ Policy No.: V
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
(This section need not be completed if the permit is for omc hundred dollars($100)
or less.)
1 Certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws or 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
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
'Z 2CONSTRUCTION LENDING AGENCY
E-t C+4r 1 hereby of iron that there is a construction lending agency for the performance of
tY. 5 the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
0 Z Lender's Address
V 0 1 certify that 1 have read this application and state that the above information is
IL O" correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city m enter upon the
U above-mentioned property for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,toss and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit.
A IC U ANDS AND W COMPLY WITH ALL ON-P INT Issued by: Date —/ �—e fr-
OU E ONS.
(� Re-roofs
gnat orApphcant/Conuactor Date
HAZARDOUS IMATERIALSDISCLOSURE Type of R(.of
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs s iall be inspected prior to any roofing material being installed.
❑Yes IVo
Will the applicant or futurebuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
.strict? ���""""""
❑Yes �yvu
I have read the heard/nus materials requirements under Chapter 6.95 of the Califor-
nia Health&Sart Sections 25505,25533 and 25534.1 understand thatif the building
cure y ha a tenant,that i�='
onsibility n notify the occu t of
re ni enta nit but be mel prior a�e orOcea 6 1 9signature(f Applicant Date
venter authomed agent Dae /_ _ All roof coverings to be Class'JW'or better
Ll
CITY OF CUPERTINO
CUPEkTINO GENERA] BUILDING
PERMIT APPLICATION FORM
J APN# L4 14 0 Date: /
Buil 6-3dress: n Q�l S ) n Q
Mailing Address (if different from building address):
Owner's Name- � � Phone#:
L� C. C r, k D e lir eS
HOA (Exterior work only) Yes ❑ No ❑
If yes, provide letter.from HOA
Contractor: Phone: L(If
Fax:
Contract&License
Cupertino Business License#:
Contact: �'� 1,.� L -LUol\ Phone: IV
Fax:
Residential [ Commercial ❑
Job Description: Sb",-U O ��-
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type-n
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-BS rte,
Valuation: � Square Footage:
Project Size: Ex ress❑ Standard ❑ Lar e ❑ Ma-or ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set&the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 02/05/09
CITY OF CUPERTINO
CUPER,TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
0 — 1STUCOAP Stucco Applications (up to 400 so B
r additional stucco application
1 WINREP Replacem--nt windows/sliding glass B
door (ea:,windows
1 WINMEWSTR New Window-structural shear B
wall/masc nr includes plan ck fee
1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alo ie Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alo le Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alo le Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Ilan Check(when no E/1\4/P) B
when not over counter) hourl -sta id alone
1BCBSC Cal Bldg �.tandards Commission Fee B ALL PERMIT
TYPES
IBSEISMICR Seismic R,;sidential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
1BUSLIC Business I icense B
5 of 5
rw
Cu ertino .Village
parish P1,ace
Y :—.. 10202
----- - '10201
• ____ . .__. 10194
co N 10193 _.... __. ..
N t� N
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1 010
1 t
10121 10123F �r In-IRI f cn-
Swimming Pool 10.184
o
'303- X0131 w ---
0'1 f31 � 14182
10174
10103 10141 10173 _-------_-
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10172
w
10 10143 -- — 10171
Parish Place 10164
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May 15,2009
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City of Cupertino Building Department
10300 Torre Avenue i
Cupertino,CA 95014-3202
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Re: Building Permits for the Cupertino V.11age Homeowners Association
10101 — 10251 Parish Place, Cupertino, CA
Authorization for Draeger Construction,Inc. to obtain Permits on our behalf j
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To Whom It May Concern:
The Board of Directors of the Cupertino Village Homeowners Association hereby authorizes E
Draeger Construction,Inc.,605 Commercial St-eet, San Jose, Ca 95112,to obtain permits for
miscellaneous remedial repairs to be performed in the common areas of our complex as
referenced above. ;.
Should you have any questions,please do not hesitate to contact me.
I
V truly yours,
i
Diana Johnson '
Association Manager Or,e 47-_c
Cupertino Village HOA
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