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09050094CITY OF CUPEKYIN0 �� STT BUILDING DIVISION PERMI l BUILDING ADDRESS: OWNER'S NAME: D TMTTA CT AA -V ARCHITECI7ENGINEER: Z O O LICENSED CONTRACTOR'S DECLARATION UI hereby affirm that I am licensed under provisions of Chapter 9 (commencing z with Section 70(10) of Di ' 'on 3 of the Business and Professions Code, and my license is ny in full force and effect. ` C7 R z License 2n C tractor a I Dale RCHITECTS DFCLAR ON ��r_ J tt ; -t l understand my plans shall be used as public records ' u 4 IL G y Licensed Professional OWNER -BUILDER DECLARATION < 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county 3:o m Pi which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires tic applicant for such permit to file a signed statement - ^ < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Y. F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or f R $ 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 not more than five hundred dollars ($500). 0 1. as owner of the property. or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law docs not apply to an owner or property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: � O z0 �.r aQ Z UO_ OU U W Uz Job Description SHINGLE; SIDING REPAIR. Sq. Ft. Floor APN 316440:2.00 Required Inspections I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- .ation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ] I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker'scompeption Inprimcp carrier and Policy number am: artier I` %~ Policv Noll t a t < - 1 �- COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) or Icsa) 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, atter making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lenders Name Lenders Address 1 certify that I have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby autharize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, toss and expenses which may in any way accrue against said City in consequence of the 'ng of this permit. APPLICANT UN ANDS AND ILL COMPLY WITH ALL NON -POI S C GU ONS. Q / U Si ature Applicant/Contractor slate HAZARDOUS MATERIALS DISCLOSURE Will are 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)? 0 Yes Will the applicant or future building occupant use equipment or devices which :t hazardous air contaminants as defined by the Bay Area Air Quality Management strict? DYes ° 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 75534.1 understand that if the building d nqq�� curtc9have a tenant Jou s my responsibility to notify the oc t of the illnfracns Irhidh must be met/prioeto issuanc;of a Certificate of Oc cy. f authorized Issued b, : Re -roofs Type of Roof Occupancy Type Date —C—/ 'F`6% All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. $ignaturl; of Applicant All roof coverings to be Class ". " or better Date PERMIT NO. PERMTT ISSUE DATE SA R CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a o 0 0 Job Description SHINGLE; SIDING REPAIR. Sq. Ft. Floor APN 316440:2.00 Required Inspections I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- .ation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ] I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker'scompeption Inprimcp carrier and Policy number am: artier I` %~ Policv Noll t a t < - 1 �- COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) or Icsa) 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, atter making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lenders Name Lenders Address 1 certify that I have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby autharize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, toss and expenses which may in any way accrue against said City in consequence of the 'ng of this permit. APPLICANT UN ANDS AND ILL COMPLY WITH ALL NON -POI S C GU ONS. Q / U Si ature Applicant/Contractor slate HAZARDOUS MATERIALS DISCLOSURE Will are 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)? 0 Yes Will the applicant or future building occupant use equipment or devices which :t hazardous air contaminants as defined by the Bay Area Air Quality Management strict? DYes ° 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 75534.1 understand that if the building d nqq�� curtc9have a tenant Jou s my responsibility to notify the oc t of the illnfracns Irhidh must be met/prioeto issuanc;of a Certificate of Oc cy. f authorized Issued b, : Re -roofs Type of Roof Occupancy Type Date —C—/ 'F`6% All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. $ignaturl; of Applicant All roof coverings to be Class ". " or better Date A CI t7Fr CUPEkTINO CITY OF CUPERTINO GENERAL, BUILDING PERMIT APPLICATION FORM Oq C)5 C)C>q APN # Date: Building / d'r c Zc- L(.0 jJ lig, Mailing Address (if different from building address): Owner's Name- c �� � ; S d, tQ OL J w� �Cl or ( &-+,1 ♦ fN Phone #: V� HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter .from HOA Contractor: Phone: �1 U — S `c� ie — 0 '6(4 e _W Fax: 3 (- U y -- Contra for License #: 6176/0 Cupertino Business License #: Contact: �'� � � „�� C� Phone: Fax: Residential Commercial ❑ ' I e S,d.A_� Job Description: S�I-V Building Permit Info: Bldg 9 Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-13 Valuation: Squar ootage: #97 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 CI7 Y 0 CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM IPARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard (up to 50 ft) B 1 RETSP310 Special L esign, 3-10' high (up to 50 `) B IRETSPIO Special L esign, over 10' high (up to 50' B 1RETCRB< Gravity/Crib Wall, 0-10'high (up to 50 ft B 1RETCRB> Gravity/Crib Wall over 10' high (up to 50 ft B SIDING 1 SIDEST/BK Siding, Slone & Brick Veneer interior/Exterior B 1 SIDEOTHER Siding all other B SKYLIGHTS ISKYL<10 SF Skylight I --ss than 10 sf B 1 SKYL>1 OSF Skylight greater than 10 sf or structural B 1STAIRS Stairs -firs: flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage R icks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage R icks over 8' high (up to 100 st B 4 of 5 I w 0 c� m Cr ertino iflage Parish P1,ace 0201 �T- r t s «f. ..L r-� L • a too �� o taa o N `1 0 10193 .. N •A � W N ..i o . N � - _. _. - N N 10121'-1F10123 i �u 1 r1i 'I � Swimming Po.oI 101 10133 10173 10103 ro 10141 c c _ , w L101011 10143 �..-_ 10171 _] Parish Place &I 7 U1 b4 10182 10174 TC -=10172 May 15, 2009 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014-3202 Re: Building Permits for the Cupertino V! llage Homeowners Association 10101 —10251 Parish Place, Cupertino, CA Authorization for Draeger Construction, Inc. to obtain Permits on our behalf To Whom It May Concern: The Board of Directors of the Cupertino Villagv Homeowners Association hereby authorizes Draeger Construction, Inc., 605 Commercial Street, 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 h ;sitate to contact me. Ve truly yours, Diana Johnson Association Manager 01c, e + 0-f +�'c Cupertino Village HOA