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09050095 CITY OF CUPERTINO BUILDING DIVISION PERMIT �. « . BUILDING ADDRESS: PERMIT NO. 10171 PARISH PT, DRAEGEIR CONSTRUCTION INC 09050095 OWNER'S NAME: PERMrr I�UE DATE ')NWGNG S CONTROL NO. (408) 536-0420 ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH apZ LICENSED CONTRACTOR'S DECLARATION Job Description m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z,, with Section 7000)of Division 3 of the Business and Professions Code, my license is 'may in full forecand efrect (� SHINGL SIDING REPAIR Z License CJpq WRrMCrSDEC Lth•M Contractor oll- Date LARA O 1 undcrsund my plans shall he used as public records �yU LO in Licensed Professional y 3 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county 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 z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation YH (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($500). 316 4 4 0 L 7 . 0 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 Required Inspections and Professions Code:The Conuictoes License Law does not apply to an owner of 9 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.). ❑1,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 Contractors License Law. ❑1 am exempt under See .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARAMON 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 Workers Compen- ,ation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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'sm �t�on roe carrier and Poli number r arc: Qy Carrier rV'C, � Polity No.: w Cr I-I.—X U p V Z CERTIFICATE OF EXEMPTION FRO WORKERS' COMPENSATION INSURANCE (this 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.1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:it,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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of �.h> the work for which this permit is issued(Sec.3097,Civ.C.) WCI.Q Lendces Name Lenders Address U 0 1 certify that I have read this application and state that the above information is LL h-r cormcL 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 CL (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 V Z in consequence of the granting of this permit. Date A IC ERSTANDS WILL COMPLY WITH ALL NON-POINT Issued bt': U ATIONS. ^ 1J,sbRe-roofs C7 �- Si fApplicant/Conuactor 1581c HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as deftned by the Cupertino Municipal Code.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 lo 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 laterials for inspection. .,strict? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc.Sections 25505,25533 and 25534.1 understand that if Unc building d�dythat it is my responsibility W natty Une occupant or the rePriv aaeeofa ifiateoraea� Signature:of Applicant Date All roof coverings to be Class or or better ner or thorized agent 62tC aloF CITY OF (,UPERTINO CUPEkT1NO GENERAI. BUILDING PERMIT APPLICATION FORM APN# �? �O 1 T Date: J,/ Building AddreV 10t :7 ) &k e) Mailing Address (if different from building address): Owner's Name: Phone#: C�,.e Mct' K e,t (S R-, 517 d7 go HOA: (Exterior work only) Yes ❑ No If yes,provide letter,from HOA Contractor: Phone: y o t-- f�-- 'Z�(-rk eitv C"t6-u�LLV\- v"-L Fax: /VU- 5 3 U L/ Contra for License#: 6,17 6'/p Cupertino Business License#: Contact: -�'� � � G►� Phone: Fax: Residential Commercial ❑ Job Description• J�^ Building Permit Info: Bldg X Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ 11/11IN-A ❑ 11/III B, IV-HT, V-B M �;�� )��c Valuation: ar �?�; - Squar ootage: Project Size: Express❑ Standard ❑ Large [l 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 ree n.or Revised 02/05/09 CITY OF CUPERTINO Ci Ya GENERAL BUILDING APPLICATION CUPER,TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Irterior Commercial B IPARTICOMM 1PARTIR Partition Irterior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard(jp to 50 ft) B 1RETSP310 Special De sign, 3-10' high(up to 50 `) B 1 RETSP 10 Special Df sign, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/C-ib Wall over 10' high(up to B 50 ft SIDING ISIDESTBK Siding, Stone&Brick Veneer B interior/e Kterior 1 SIDJ�OTHER Siding s�oth�r � B SKYLIGHTS 1 SKYL<10 SF Skylight 1,-ss than 10 sf B 1 SKYL>l OSF Skylight€treater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st 4of5 <F Cti ertino . Village Parish P1,ace _...... 10202 0201 10194-1 •� -___ ._..__. N w t0v N N N o 10193 -_. .. __ _ Ln -� W 10192 - ... - 10191 - 10121 10123ch ' I ► II 1 Swimming Pool ! -�.: --� - `10184 17 o '3013! 10131 �, 14182 < 10111 . 10133 ' 10-174 10103 10141 �-` 0 10173 M w -� 1x172 10101 10143 -- - 10171 Parish Place 10164 I I i t E E E 4 i i May 15,2009 1 i E City of Cupertino Building Department 10300 Torre Avenue Cupertino,CA 95014-3202 Re: Building Permits for the Cupertino V11a a 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 Villagc Homeowners Association hereby authorizes Draeger Construction,Inc.,605 Commercial S'reet, San Jose,Ca 95112,to obtain permits for miscellaneous remedial repairs to be performed in the common areas of our complex as f mis ePrs P ,. referenced above. r Should you have any questions,please do not h-'sitate to contact me. I V truly yours, c Diana Johnson Association Manager � �en+ Cupertino Village HOA E i