09050104 CITY OF CUPERTINO --7777777777
BUILDING DIVISION
PERMIT C(1RE3I2 I� IAtTI� �
BUILDING ADDRESS: PERMIT NO.
1018
OWNER'S NAME: PERMrr ISSUE DATE
1 S A e 8 9 CONTROL NO.
(408) 536-0420
ARCHrrECr/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L___JJ (�
o p LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 7000)of D'vision 3 of the Business and Professions Code,and my license is
=y in full force and effect. a SIDING STUCCO REPAIR
vn Z License Clssa Lic.M
'—^ Date Contractor
C r=S DECLARATION
U I understand my plans shall be used as public records
rL
<.
4 C y Licensed Professional
n y OWNER-BUILDER DECLARATION
I hereby affirm that Iam exempt from the Contractors License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
t m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
F s C that he is licensed pursuant to the provisions of rho Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yI- (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 075
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,ss owner of the property,or my employees with wages as their sole compensation, 31644014 . 0 0
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractors License Law does not apply to an owner or Required Inspections
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,u 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 contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
OwnerDate
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 Workers Compen-
.,on,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' Com dorsi nsurance carrier and Policy number am: `
Carrier. /�S Policy No.: J�`��+b�l , I?v Z
CERTIFICATE OF EXEMFnON FROM WO ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Ices.)
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 Workcrs'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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[~.t tai I hereby affirm that there is a construction lending agency for the performance of
♦Yi> the work for which this permit is issued(Sec.3097,Civ.C.)
WC4 A Lender's Name
Z fenders Address
U 0 I certify that I have read this application and state that the above information is
174 r"r correct.I agree to comply with all city and county ordinances and state laws relating to
O E_*
building construction.and hereby aurhorim representatives of this city to enter upon the
>4 U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the ting of this permit.
�. SPP GU ?`NDS AND LL COMLL NON-POINT slued by: Date T__),�;
`(f Re-roofs
Y1,66
' ofApplicant/Conuutor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by tlto 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
Will the applicant or furate building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
..trice?
Q Yes PENo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Heal tenhich
fcty Code,Sccti 25505.25533 and 25534.1 understand dem if the building
docs not fly have a t that it is my risibility to notify dtc aceupant of the
requ' m be met prier to iaa acru_ficatc or occyp /� Signature t)f Applicant Date
/—`T{L 5 6
Own or out rizcd agent Date All roof coverings to be Class'n"or better
CITY OF CUPERTINO
Cil`'(QF
CUPEkTINO GENERA=L BUILDING
PERMIT APPLICATION FORM
J APN# ( � �� Date: 5100
` 0 01
Building Address-
U 1 �-3 " cep
Mailing Address (if different from building address):
Owner's N � Phone#:
&i,AL:,-(/"Ext,�e'r,ioL'r-'w,To-rL(k only) Yes ❑ No ❑
If es,provide letter.from HOA
Contractor: Phone: L f�f� —"
DLj
f,a Fax: CS� _ Jr 3 o — U Ll �S
Contracf6r License
Cupertino Business License#: rj
Contact: �'� .� . U� Phone:
Fax:
Residential Commercial El
Job De5p`t
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: 3
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-3
Valuation: 7 Square Footage:
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.builditgr�en.orlz
Revised 02/05/09
CITY OF f�UPERTINO
?CUPER,TINO GENERAL BUILI►ING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
g 1STUCOAP Stucco A)plications (up to 400 so B
additiona_ stucco application
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee
1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
lELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourl -st ind alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Lesidential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel& Documentation B
1BUSLIC Business License B
5 of 5
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERT1N0
FEE S(;HEDULE
Quantity/Sf Fee ID Fee Des--ription 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
IRETSTN Standard(up to 50 ft) B
IRETSP310 Special L►esign, 3-10' high (up to 50 `) B
IRETSP10 Special Design, over 10' high (up to B
50'
IRETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
I RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft)
SIDING
ISIDEST/BK Siding, Stone&Brick Veneer B
interior/,;xterior
1 1 SIDEOTHER Siding al other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
I SKYL>1 OSF Skylight --reater than 10 sf or B
structural,
1 STAIRS Stairs-fir,;t flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high(up to 100 so B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
4of5
Cupertino .Village
Parish
Place •
L 1 T------.... 14202
'10201
--- __. 10194
N .a .p CO N �� N o a _ 10193 _.... . __. ..
P O 7 2
-1
1 01 91 -
10121 10123
: 1�, -.t Swimming Pool .� 101 b4
o 10113- 1D131
N - cu 10182
10111 , � 1013i
14174
`10141 1 . ' o 0 0 10173
10.5 03 m � � � � --- -
.� to . o� �, 10172
W w
101{31 10143 -- _.. _ 10171
Parish Place 10164
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May 15,2009 j
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City of Cupertino Building Department
10300 Torre Avenue - !
Cupertino,CA 95014-3202
I
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
To Whom It May Concern:
The Board of Directors of the Cupertino Villag-I Homeowners Association hereby authorizes
Draeger Construction,Inc.,605 Commercial Street,San Jose,Ca 95112,to obtain permits for
miscellaneous remedial repairs to be performer in the common areas of our complex as
referenced above. I
Should you have any questions,please do not hesitate to contact me.
I
Ve truly yours, I
Diana Johnson
Association Manager Oelend'
Cupertino Village HOA
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