09050109 CITY OF CUPERTINO � � � .. �� �
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10221 PARISH PL DRAEGE PERMIT ISSUE DATE
OWNER'S NAME:
ZNI7UN 14JA��� TG f_MIN _71 - 605 GO S CONTROL NO.
NE:
(408) 535-0420
BUILDING PERMIT INFO
ARCHITECT/ENGINEER. BLDG ELECT PLUMB MECH
0
WOO LICENSED CONTRACTOR'S DECLARATION Job DCSCflptlOn
Q
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z Wwith Section 7000)of Division 3 of the Business and Professions C aced QtY license is
'may in full fame and effectrA U STUCCO REPAIR
j 12? License Class Lle-N
Date Contractor
IP TARCHITECTS DECLA N
I understand my plans shall be used as public mconta
�yU
;u.y Licensed Pmfessional
C OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
o O following reason.(Section 7031.5,Business and Professions Code:Any city or county
,c 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 Sq.Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a g a that he is exempt therefrom and the basis for the alleged exemption.Any violation of
AAPN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars($500). 31644007 . 00
❑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.70".Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,Provided that such improvements we 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 Law does not apply to an owner of Property who builds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
C]I 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:
have and will maintain a Certificate of Consent to self-insure for Worker's 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 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.
My Workers�CFI�CATEO
Insurance
carrier and Polity number are:
Cartier Policy No.: Y 1
FROM wbRKERs,
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.)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
,Z forthwith comply with such provisions or this permit sha11 be deemed revoked.
Z 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(See.3097,Civ.C.)
,
i Q Lender's Name
aZ Lender's Address
1 certify that 1 have read this application and state that the above information is
LUL" correct.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
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
E
U Z in consequence of the granting of this permit. Date
►-r WAPPLICAUN ANDS AND LL COMPLY WITH ALL NON-POINT Issued b):
U S• Re-roofs
Plican °"tractor a
HAZARDOUS MATERIALS DISCLOSURE Type Of 1ZOOf
Will the 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)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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
hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
strict? `e
❑Yes 0e,
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs no nil We in that it is my nsibility to notify the occupant of the
requ' men w m x prior toils fa crtirrc rOceap O SignatureofApplicant Date
All roof coverings to be Classor better
Owne auth ed agent Datc
C)Cto-S>(v l oct
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
J APN# ! <A Li J L c�Q_ O Date:
Building Address:
t
Mailing Address (if different from building address):
Owner's Name: Phone#:
h t3whv.a 4 /d �n � k�my
HOA: (Exterior world only) Yes ❑ No ❑
If yes, provide letter.from HOA
Contractor: Phone:D�-a /Q w. (/LL Fax: �(� ` J 3� — v Ll �S
Contrac r License
Cupertino Business License#:
Contact: rv—(3r\ Phone: Lel
Fax: — J
Residential [� Commercial ❑
Job Description:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
3
I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B S
Valuation: 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.buildit een.orLy
Revised 02/05/09
CITY OF CUPERTINO
cox GENERAL BUILU,ING APPLICATION
cuFE��INO
FEE SCHEDULE
Q antity/Sf Fee ID Fee Description Fee Permit Type
j — Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door ea 3 windows
1 WINMEWSTR New Win low-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
IMPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK 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/1\4/P) B
when not over counter) hourl -st;ind alone
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
1TRAVD0C Travel&Documentation B
IBUSLIC Business License B
5 of 5
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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
1
Authorization for Draeger Construction,Inc.to obtain Permits on our behalf i
To Whom It May Concern:
The Board of Directors of the Cupertino Villages 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.
Should you have any questions,please do not t esitate to contact me.
I
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V truly yours, i
k � r
Diana Johnson
Association Manager 01c,e n
Cupertino Village HOA
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