06120130 (2) CITY OF CUPERTL-IO �n ,� ?»>K*"� *��'• '� ` � �� '
.BUILDING DIVISION PERMIT CONTRACTOR�INFORMATIQN 1411
BUILDING ADDRESS: PERMITNO.
OWNER'SNAME: A
MftM & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
Ilmpn"'Ocn SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION - Job Description I hereby affirm Nn I am licensed under provisions of Chapter 9(commencing
;Z with Scctian]pkO of Divimion 3ofJte Budr,eu and Profeuian Cade,and myliccnseb REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
p w, m full forte arM ec
License Cl s Lk.g 6 NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
F Dem C.. '
RCHTfELTS DECIAR o & GRAVEL BUR.
< 1 mMcrswnd my plans shall M used as public mccrds
i�
`0t� LittrtseJPmfcuional
OWNER-BUILDER DECLARATION
1 hemhy alum than I em exempt from the Conrtmmrs License Law for Ute ,
i0O following mason.(Section 7031.5,Business and Professions Code:Any city or..aty
'$E which requires a Permit m construct,alter,improve,demolish,or repair any structure
3Zi prior m its issuance,also requires the applicant for such permit m file a signed awmm
te ,
< that he is licensed pursuant o the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
2�ss (commencing with Section 7000)ofDivision S of the Business and Profcsainm Code)or 52381
152 that he b asempt therefrom and one barb for the alleged exemption.Any violation of
Sccdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumbO
tont mart Nan five hundred dollars($500). 32652049 Number Occupancy y Type
❑Lia,twnerof the property.or myempleyces with wages as their tele core'res on,
will do thCwark.and the structure is setNmaded"offered foreals(See.70{{,Business Required Inspections
and Professicommitteese ns Cade:The committees Lt...law dais not apply 0 in o ame,of q IJ
property who builds or improves themes,and who doessuch work himselfmr dough his
own employee,provided dullest improvements are not mounted oro@ted fersale.IL
however,the building or improvement is sold within one year of compledon,the owner-
builder win have the bond.of proving Nat be did not build or improve for puryose of
sale.)
I,as owner of the Property,am moodrevcly contracting with IicevN..=him 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 Wilds or improv themes,and
who contracts for such prejecros with a canuacwr(s)licensed pursuant to the Cmdracui
License Law.
❑1 am exempt under Sc. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION -
1 by affirm under penalty of perjury one of the following declaration:
and will maintain a Condiment of Consent to sel6inum for Workers Compete
so ran,as provided for by Section 3700 of lbe labor Cade.for we performance of the
work for this permit b issued.
ave and will maintain Workers Compensation lesurana,u required by Section
37Wo(Ne Lobar Cade.fortheperformmecofthewarkforwhichthbpenniti3Wwd. '
My War Campcnaadan'�Ins��u�y9aoc�lc�emk/iter and Policy number_am: �
Cartier.�:TEf
. CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652049 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000063
REFERENCE ID # . . . : 06120130
SITE ADDRESS . . . . . : 10449 MARY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVIC
ADDRESS . . . . . . . . . . : ,
CITY/STATE/ZIP ,
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : DRAEGER, . JOHN EDWARD LIC # 21895
COMPANY: . . . . . . . . . : DRAEGER CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 605 COMMERCIAL ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 536-0420
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2, 381. 00 83 .16 0. 00 83 .16 0. 00
BSEISMICRE VALUATION 2, 381. 00 0.50 0. 00 0.50 0. 00
--------- ---------- ---------- ----------
TOTAL PERMIT 83 . 66 0. 00 83 . 66 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 83 . 66 101358
---------------
TOTAL RECEIPT 83 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------ ----------------------------
305 FRAME - 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
aojvj� o
CITY OF CUIIERTINO
CUPFRTINO PERMIT APPLICATION FORM
�NPiv'T Date:
Owilel Nallic. Phone
u
Cunu actor: License il:
colimet. Cupertino Business License i-
C-_
,A
Type of'Roof Covering:
T Propos
�.J ItILlill-Irill Row D' Built-Up loof,
LJ Shilludc's LJ Asphalt Shingles
• Wood ShAcs 0 Wood Shakcs
• Wood shillules 0 Wood Ylin"Ics
Odic] (Slpccllkl) El Otha(spucily)
Hunt her C\lming Co\cl 11"s 0 Provide I.C.13.0. Report
'Yj 'I'o he RcIllovcd CJ Provide Mfg, Installation SpCes.
•
I I DVC Read. Understand and Will Comply With CLIJ)el-0110'S TCM- Off Policy: 2'
Job Description:
-1-L, —LK L
conlincicial
Fi i c Tore, Ycs El No F Confirmed with Planning Dept. if
there are any restrictions: ❑
TYPC OCCOJISU'LlCti011: Occupancy group:
o
Ap 1)1 i C;11)1,2 Fee 11) Fee Description Fee GI-OLIJ)
__ BPGRNIP6E Bldg Permit Fecs BUILDING
BENFRGY Enter iy —BUILDING
BSF--.ISN/IICRI-- Seismic Fec Res BUILDING
B S E-H'l S�i\v'I I CO N/I Seismic Commercial BUILDING
B11LANCHK Plan Check Fee BUILDING
BUSLIC
BUShICSS UCCIISC BUILDING