09050108 CITY OF MARTINO '
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10211 PARI D E E CONSTETICTION INC nqc)-,ni ng
OWNER'S NAME: PERMIT ISSUE DATE
NNJUNG jANG 909 AND
S A CONTROL NO.
408) 56-0420
ARCHTTECC/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u p C LICENSED CONTRACTOR'S DECLARATION Job Description
U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
m with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and eff (p SIDING STUCCO REPAIR
j rn Z License Class Lle•N -�
M Date Contractor Li'l U^
CHITECTS DECL O
1 I understand my plans shall be used as public records
D0.
CH Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
O O following mason.(Section 7031.5,Business and Professions Code:Any city or county
<.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 rile a signed statementz< 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 7
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 rive hundred dollars(SM 316 4 4 0 C:9 . 00
❑I.as owner of the property.or my employers 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 Conuactoes License Law docs not apply to an owner of 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.).
❑1,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-
ccnse Law does not apply to an owner of property who builds or improves demon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
C]I am exempt under Sec. B&P C for this mason
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 Workers Compen-
sation,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 Workers ompensau n Insu�nce/carrier and Poli number am: �'(
Cim. f a-�^ //" Policyxo G L
CERTIFICATE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z 2CONSTRUCTION LENDING AGENCY
(~i ria I hereby affirm,that there is a construction lending agency for the performance of .
fx> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lenders Name -
? ss
Z Lenders Addre
U 0 1 certify that I have read this application and state that the above information is
VL 1- correct 1 agree to comply with all city and county ordinances and stale laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f>~ (We)agree to save,indemnify and keep harmless the City of Cupertino against
0_4 col liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z APPENDE
ence of the grantio of this permit.
r"r SAND OMPLY WITH ALL NON-POINT Issued b): Date '—�
L�2&t
^
in, — 6
5 Re-roofs
Si of pplicant/Conuactor Efate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and are Health and Safety
Cole,Section 25532(x)? fir,o All roofs shall be inspected prior to any roofing material being installed.
❑Yea / If a roof .s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
L hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
.strict?
❑Yes L$(u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505.25533 and 25534.1 undcrstand that if the building
docs not cuimllidy ha ant.that it is my responsibility to notify the occupant of the
mqui cn ich bmetpior toi of a Ccriis of Occu � U Signature of Applicant Date
All roof coverings to be Class or better
owr6f or aut 'zed agent Dato
C) c>
rc CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLI=CATION FORM
J APN# Date: �d
oc>q . 1S
Build' Add ess:
;fit,, o�►r,s � �AGe..
Mailing Address (if different from building address):
Owner's Name: Phone#:
�o 5 � S � �U�- �, S� — � 3
• Ext for work only) Yes t] No ❑
HOA. ( � Y)
If yes,provide letter from HOA
Contractor: Phone: y�J�- _
Dfat ��w• Fax: �--5
Contracfor License#:
Cupertino Business License#:
Contact: ✓N Phone: U
Fax: Owf — _ J
Residential [� Commercial El
Job De pt � Ct o f> A ^
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type: P---3
1-A, 1-B ❑ II/III/V-A ❑ II/111 B,IV-HT,V-13 J
Valuation: s Square Footage:
Project Size: Express ❑ Standard ❑ Large[] Major ❑
Green Building: Please complete relevant portion A the Green Building/LEED Checklist& attach it
to the application or if applicabl(!,include in plan set&the sheet index.
Points Achieved:
For help,contact Build it Green at www.builditp_r4,-en.org
Revised 02/05/09
CITY OF CUPERTINO
�7Y GENERAL BUILDING APPLICATION
cuPE�TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Desc 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
1 RETSTN Standard up to 50 ft) B
IRETSP310 Special D-sign, 3-10' high(up to 50 `) B
1RETSPI0 Special D,-sign, 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
1 SIDEST/BK Siding, Slone&Brick Veneer B
interior/Exterior
5 1 SIDEOTHER Siding all other B
KYLIGHTS
1 SKYL<10 SF Skylight ess than 10 sf B
1 SKYL>10SF Skylight ;renter than 10 sf or B
structural
1STAIRS Stairs-firA flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage hacks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage P acks over 8' high (up to 100 B
st
4of5
CITY OF CUPERTINO
ANO GENERAL BUILDING APPLICATION
CUPEkTFEE SCHEDULE
Quantity/Sf Fee ID Fee Des--ription Fee Permit Type
Group 1GENRES or
1 GENCOM
Q' �, 1STUCOAP Stucco Applications (up to 400 so B
(� additional stucco application
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/mas:)n includes plan ck fee
1 EPERMITFEE Electrica Permit Fee E
IMPERMITFEE Mechani,,al Permit Fee M
1PPERMITFEE Plumbing;Permit Fee P
IELCPLNCK Stand Al)ne Electric Pln Ck(hourly) E
1MECPLNCK Stand Al)ne Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand AI)ne Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/1\4/P) B
when not over counter) hourl -stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic 1Zesidential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
IBUSLIC Business License B
5 of 5
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Cupertino 'Village
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10143 - -- _ -10171 --1_--
Parish PIace _10164-
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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 Concem:
The Board of Directors of the Cupertino Village Homeowners Association hereby authorizes f
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 l Hesitate to contact me.
i
Ve truly yours,
C
Clfi�2li
Diana Johnson
Association Manager (,4e,-enf
Cupertino Village HOA
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