09050110 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��0
PERMIT NO.
BUILDING ADDRESS:
10233 PARISH
PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
'l0
408 535-042
BUILDING PERMIT INFO
ARCHrmcT/ENGINEER: BLDG ELECT PLUMB0 MECH
0 �
',c ZS CONTRACTOR'S DECLARATION Job Description
m I 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,and m license is
'may in full force and eff �� SHINGLE REPAIR STUCCO ,
Dal License Cla�T.d
Lk•A
2M§ Date ContrxWr
TECTS DECLAR /I't
–r 1 A�phaiiy, be used as public rccortls V
DWU
Gy Licensed Professional
n 3 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
j p O following mason.(Section 7031.5,Business and Professions Cask:Any city or county
429 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 Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
Ytom- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or8975
y�_ that he is exempt therefrom and the basis for the alleged exemption.Any violation o[
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(M). 31644004 . 00
❑I,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.Businew 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 arc 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 contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under See. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
.ton,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 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 Workees C mpensad n Insu race carrier and Policy nube` are:
C OU
Carrier. Policy No.: W
'2—
CERTIFICATE F XEMFnON FROM 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,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
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
F~r 0 1 hereby affirm that there is a construction lending agency for the performance of
pr> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
P., Lendees Address
Z
I certify that I have read this application and state that the above information is
w� coned I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
a (We)agree to save.indemnify and keep harmless the City of Cupertino against
,c to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit Date
" APP A UND ANDS AND W L COMPLY WITH ALL NO -POI Issued b3
Ll If
S E GULA 'S.
Re-roofs
S' atum of pplicant/Contrsctor Dare T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
at defined by the Cupertino'Municipal Code.Chapter 9.12,and the Health and Safety
Cock.Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[:1 Yes 9
60
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
t hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
.trict?
❑Yes Yy.
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health firm
&Safcty Code s 75505,25533 and 25534.1 understand that if the building
docs t c fly a ant,drat it is ponsibility to notify the occupant of the
uim cn hie jg be met prior ca Qf a Ccrtjfwate of Occup I S ignaturt:of Applicant Date
(/Vy\�� C4— 5 V All roof coverings to be Class'`'or better
Ow r o ihorizcd agent Date
CITY OF 4-UPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# ( r
J l �C C7 C�`T v C� ate: la/�/
Building Addre3:
Q
Mailing Address (if different from building address):
Owner's Na ePhone#:
r Y* kfvwr. a. dw-a-+^
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter.from HOA
Contractor: Phone:
®fa V"Pv., Fax:
Contract&License#: '� U
Cupertino Business License#:
Contact: Phone: !-j
Fax: — J
Residential [ Commercial ❑
Job Description:
kuv� Le. S QLD
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/1IIN-A ❑ II/111 B, IV-HT, V-B
Valuation: S^ 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 reen.or
Revised 02/05/09
„ CITY OF CUPERTINO
circ GENERAL BUILDING APPLICATION
CUPEt�TINCJ
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
IGENCOM
1STUCOAP Stucco Applications(up to 400 so B
3 f additional stucco application
1 WINREP Replacement windows/sliding glass B
door ea,3 windows
1 WINMEWSTR New Win Iow-structural shear B
wall/masonry (includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
IMECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
IPLMBLNCK 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 l:esidential B
1BSEISMICO Seismic Commercial B
IT DOC Travel& Documentation B
IBUSLIC Business License B
5 of 5
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CITY OF CUPERTINO
��ryy GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description 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
1RETSP310 Special Design, 3-10' high(up to 50 `) B
1RETSPIO Special Design, over 10' high(up to B
50'
1RETCRB< Gravity/C rib 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, S:one&Brick Veneer B
interior/exterior
3,`m 1 SIDEOTHER Siding a ' other P B
C/ N Ax
S YLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>IOSF Skylight greater than 10 sf or B
structura.
1 STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage I:acks over 8' high (up to 100 B
st
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May 15,2009
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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
k
10101 — 10251 Parish Place,Cupertino,CA j
Authorization for Draeger Construction Inc.to obtain Permits on our behalf i
To Whom It May Concern:
The Board of Directors of the Cupertino Villag-,Homeowners Association hereby authorizes 't
Draeger Construction,Inc.,605 Commercial Street, San Jose, Ca 95112,to obtain permits for j
miscellaneous remedial repairs to be performer in the common areas of our complex as I
F
referenced above.
Should you have any questions,please do not hesitate to contact me.
Ve truly yours,
Diana Johnson
Association Manager ( l-
Cupertino Village HOA
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