09050088 CITY OF CUPERTINO
BUILDING DIVISION PERMITilkt;iZ� T � .
PERMIT NO.
BUILDING ADDRESS:
10123 PARISH
PERMIT L95UE DATE
OWNER'S NAME:
At
SAN CONTROL NO.
�N :
BUILDING PERMIT INFO
ARCHn=/ENGINEER:
BLDG ELECT PLUMB MECH
SHINGI, SIDING REPAIR D 0 0
aof pp LICENSED CON'TRACTOR'S DECLARATION Job Description
v I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 70(X0)of D'inion 3 of the Business and Pro[c sioml Codc m my license is
w in full force a d effect.
Z License CI Lic•0
Dam Contractor
tc ARCHI7EC1'SDELLA /�� t
tt -� 1 undcrsund m plans shall be used as public rcco J
;uJ
#
U.F' Licensed Pmfessional
`3 G 3 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
j:00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
R^9 which requires a permit to construct.alter.improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
—z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
Yh (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($500).
0 I,as owner of the property.or my employees with wages as their sole compensation,
will do the work and the structure is notintended or offered forsale(Sec.7044,Busitess Required Inspections
and Professions Cade:The Conuactoes 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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors te
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 conuacts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
[]1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 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-
-eon,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 1 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's mpensa' n In lance carrier and Policy number are:
u
VO PolicyNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section treed not be 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.I shall not
employ any person in any manner so as to become subject to the Workers'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.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
fyh.7 the work for which this permit is issued(Sec.3097,Civ.Q
(�A Lender's Name
Z L.endees Address
U 0 I certify that I have read this application and state that the above information is
LL
corm mx I agree m comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
hF,to liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in consequence of the ranting of this permit Date
t"m LIC UN ER NDS AND WIL PLY WITH ALL N POI Issued b): -
SO R ULA O . �j
(f I Re-roofs
ignature pplicant/Contractor bafif 'I' Of Roof
MA ALS DISCLOSURE Type
Will the applicant or future building occupant store orhandle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0Yes o
Will the applicant or f m
If a roof is installed without first obtaining an
Will the applicant or rrm inspection,I agree to remove
building occupant use equipment or devices which
t hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
strict?
[]Yes flu
1 have read the hazardicors materials requirements under Chapter 6.95 of the Califor-
nia Health&S Sections 25505.25533 and 25534.1 understand thmu if the buikit g
o ntly a tenant that' y responsihilay te noufy the 101
nts 'h must be met pri to issn�yh�c u Ticar of Oc p Signaturc of Applicant Date
(/J D All roof coverings to be Class'n"or better
0 r or thorized agent
CITY OF CUPERTINO
C' GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1PARTICOMM Partition Interior Commercial B 1PARTICOMM
1PARTIR Partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special DEsign, over 10' high(up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft
SIDING
ISIDEST/BK Siding, Stcne&Brick Veneer B
interior/e terior
2 H�.7
r -1 SIDEOTHER Siding all ether B
SKYLIGHTS
1 SKYL<10 SF Skylight le;s than 10 sf B
1 SKYL>1 OSF Skylight gr.-ater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
I SRACKS<=8 Storage Racks 0-8' high (up to 100 sO B
I SRACKS>8 Storage Racks over 8' high (up to 100 B
st
4 c f 5
.y
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y
Cupertino .Vit-lage
Parish Pi,ace T. .: 10202
_0--2_0..1_
_. 10194.
-_
C`co
E� ENO -
1\)
0193
N ..
10192
10191
lu
� -- 10121IF] � �
10123 I n-t
swimming PQ91 , _._...._ .D u , o•-+
o -
. co 10182
< 10111 � 10133 -.._ _..._ _-. _._�..���__.. - '----- ----•-
� -
10173 -f 017
-_.-
10103 ro 10141
n '10172
10101 10143 -- 10171
Parish PIace 10164
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May 15,2009
I
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City of Cupertino Building Department
10300 Torre Avenue
Cupertino,CA 95014-3202
f
Re: Building Permits for the Cupertino Village Homeowners Association
10101 — 10251 Parish Place, Cupertino, CA
Authorization for Draeger Construction, Inc. to obtain Permits on our behalf
i
To Whom It May Concern:
The Board of Directors of the Cupertino Village Homeowners Association hereby authorizes
Draeger Construction,Inc.,605 Commercial St•eet, San Jose, Ca 95112,to obtain permits for j
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
Ve truly yours,
i
� kA�
Diana Johnson '
Association Manager (14c,erg}
Cupertino Village HOA
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J',a� CITY OF CUPERTINO
CUPEkT»v0 GENERAL, BUILDING
PERMIT APPLICATION FORM
APN# OQ J Date: G Jt
Building Address:
Mailing Address(if different from building address):
Owner' ame: Phone#:
�S
�.�� � �
HOA. xterior work only) es ❑ No ❑
If yes,provide letter.from HOA
Contractor: Phone: C — 0 t "1-
'�b(4 e -et/ Fax:
Contra for License#: 6,17 67 Q
Cupertino Business License#:
Contact: �'� � � C� Phone:
Fax: - 3
Residential Commercial ❑
Job Description:
Building Permit Info:
-Bldg 9 Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type: a-
I-A,
1-B ❑ II/III/V-A ❑ II/lI1 B, IV-HT, V-3 14A.
��4
LS
Valuation: &�I � Squar ootage:
Project Size: Express ❑ Standard ❑ Large Major ❑
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