09050092 CITY OF CUPERTINO
OMANI
BUILDING DIVISION PERMIT � � '
BUILDING ADDRESS: PERMIT NO.
10151 PARISH P1, DRAEGF MN-qTRT1("TT0N INC
OWNER'S NAME: PERMIT ISSUE DATE
GARY 695 eG�mEReiAh sT 2009
S CONTROL NO.
')N
408 5` 6-042
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
c a LICENSED CONTRACTOR'S DECLARATION Job Description
v I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)o *vision 3 of the Business and Prof, *ons Code,andcense is
=y in full force and eff (D LI1 ( SIDING REPAIR
License Class Lm•8
F- Dam Contractor
HITEcrS DECLArATfOPTV
1 dcrstand y plank shall be used as public records /
yv AA
L.0 U. Licensed Professional
OWNER-BUILDER DECLARATION
j<x I hereby alTirm that I am exempt from the Contractor's License Law for the
p O following mason.(Section 7031.5,Business and Professions Code:Any city or county
K m 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
n"- prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
—?< that he E licensed pursuant to the provisions oC due Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
xFes-a (commencing with Section 7000)of Division 3 or the Business and Professions Code)or
y that he is exempt therefrom and We 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). 31644021 . 00
❑I,u owner of the property,or my employees with wages as their tote 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 dries not apply to an owner or q P
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.).
❑I,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 Caw 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.
❑1 am exempt under Sea .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workces Compen-
•,ation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑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.
Carries.My rkees � lmsut;rrcC er and
Policy number /C Qin
((/t�nYl Poli No.:? �� CJ
CERTIFICATE OF EXEMPTION FROM W 0 ERS'
COMPENSATION INSURANCE
(Chis section need 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
f'+ I hereby affirm that there is a construction lending agency for the performance of
p!> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
�Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
Lir corxt.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 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
„H„to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in co uence oC a granting of this permit. Date
m"m9LONT N RSTANDS ANDL COMPLY WITH ALL NON-POINT Issued b;':
RE TIONS.
Re-roofs
i rc of Applican contractor °a T Of l zOOf
HAZARDOUS ATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and time Health and Safety
Code,Section 25532(a)? 44.., All roofs shall be inspected prior to any roofing material being installed.
1:1 Yes ty''o
ry If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r Iaterials for inspection.
.strict? C r
❑Yes gl No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Code,Sections 25505,25533 and 25534.1 understand that if the building
d o y avc a ant,that it is m responsibility to notify the occur ant of
e ts W__
h be met prior ce o a Certificate of oecypan Signature of Applicant Date
JK Datc `r All roof coverings to be Class"Jor better
mer authorized agent
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APP=LICATION FORM
APN#�t � � , � � Date:
Builg Address: S
Q
Mailing Address (if different from building address):
Owner's Name: Phone#:
(s CL sq/
HOA: (ExteAor work onlid Yes ❑ No ❑
If yes, provide letter.from HOA
Contractor: Phone: f1g" 5
/Q"e �•�' Ct)9WV-t-�LX& y` Fax: qUe- (2 -- e-,)
Contract r License#: (P `7 (e j v
Cupertino Business License#:
Contact: �'v hyo �..��rwcs r Phone: L�
Fax:
Residential Commercial ❑
Job Description: S r- — � -�
GCJ��j
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B 0 I1/III/V-A ❑ IUIII B, IV-HT, V B S
Valuation: t Square 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 applicab.e,include in plan set&the sheet index.
Points Achieved:
For help,contact Build it Green at www.buildit •een.or
Revised 02/05/09
CITY OF CUPERTINO
CUPEkTENO GENERAL BUILDING APPLICATION
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
WALUCONCRETE
OR MASONRY
1RETSTN Standard ;up to 50 ft) B
IRETSP310 Special Design, 3-10' high(up to 50 `) B
1 RETSP 10 Special Design, over 10' high(up to B
50'
1RETCRB< Gravity/C rib Wall, 0-10'high (up to B
50 ft
1 RETCRB> Gravity/C rib Wall over 10' high(up to B
50 ft
SIDING
1 SIDESTBK Siding, S:one&Brick Veneer B
interior/f-xterior
S1 SIDEOTHER Siding all other B
� r
SKYLIGHTS
1 SKYL<10 SF Skylight ess than 10 sf B
1 SKYL>l 0SF Skylight treater than 10 sf or B
structural
1STAIRS Stairs-fir.A flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Packs 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Lacks over 8' high (up to 100 B
st
4of5
Cux ertino .Vi lag+e
Parish P1,ace
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ci 10194
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0192
. .._ -� 10191
10121 10,23 �y 4 r%-4 f,M
1 ".�.�� 101 a4
1=., -� Swimming Po.oI .-c _�`
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11 , b 10133
10174
03 ro 10,4110173w -10172
101 10143 -- — '10171 _Z -
10164
Parish Place
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May 15,2009
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City of Cupertino Building Department
10300 Torre Avenue
Cupertino,CA 95014-3202
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 c treet, 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 l.esitate to contact me.
t
Ve truly yours,
C
Diana Johnson
Association Manager (Al
Cupertino Village HOA
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