09050111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � � �
BUILDING ADDRESS: PERMIT NO.
10243 PARISH PL DRAEGER
OWNER'S NAME: PERMIT ISSUE DATE
S A CONTROL NO.
(408) 536-0420
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0p LICENSED CONTRACTOR'S DECLARATION Job Description
V I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Di-on 3 of dtc Business and Professions rnde.,and my license is
'oy in full force and effect. 1 STUCCO REPAIR
D ^ U an Cl Lic•X
Date Contractor
= L..Pft LlARCHITECTS DECLARATION
.�
1 understand my plans shall be used as public records
�reU P If-
e.
OH Licensed Professional
y� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a O following mason.(Section 7031.5,Business and Professions Code:Any city or county
R which requires a permit to construct.alter,improve,demolish,or repair any structure
y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
F=`e that he is licensed pursuant to the provisions of die Contractors License Law(Chapter 9 3q.Ft.Floor Area Valuation
Y t- (commencing with Section 7000)of Division 3 of We Business and Professions Code)or $975
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(S500). 31644002 . 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,Business Required Inspections
and Professions Code:The Contractor's License Law does 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-
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 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 Worker's ompe uon In trance amu and Policy,
nuumb'er am:' r p
Cartier: Policy No.: � 0 L�-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need riot be completed if the permit is far one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manmr 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'"d CONSTRUCTION LENDING AGENCY
ErCA).h I hereby affirm that there is a construction lending agency for the performance of
fY,h> the work for which this permit is issued(Sec.3097,Civ.C.)
QLendces Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
(y 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
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
CM liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in co Date
uence of the granting of this permit. d
APP U RSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: —� l(-
S A NS. n 1 - 6'
Re-roofs
Sioatf1f,ofApplicant/Contracuy Dare T of R:)of
MATERIALS DISCLOSURE Type
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)? All roofs,;hall be inspected prior to any roofing material being installed.
❑Yes C)to
Will the applicant or future building occupant use equipment or devices which If a roof i.;installed without first obtaining an inspection,I agree to remove
L hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
.strict?
❑Yes ?No
1 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
d not curtently have a tenant,that it is my responsibility to notify the occupant offt
U
is w" ust be met prig issn of a rtificatc of OCCUPY(k)
ccup . /r Signature of Applicant Date
V All roof coverings to be Class',tr"or better
ner o thorized agent Dare
CITY OF CUPERTINO
CUPETINO GENERAL BUILDING
PERMIT APPLICATION FORM
J APN# 1p q c Date: /
Building Address: l
Mailing Address (if dif rent from building address):
Owner's Name: _ /.�� Phone��
U l /�— r&,4vA CNS 11 .-
HOA: (Exterior work only) Yes F1 No El7
If yes, provide letter,from HOA
Contractor: Phone: A/A
N-at w. (/LL Fax: CS� _ 3� — U Ll �S
ContractOof r License#: '� U
Cupertino Business License#:
Contact: � -��. U e\ Phone: I.;/
Fax:
Residential [� Commercial ❑
Job Description: Sb -ct O P eAa-A-Ar
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/IIIN-A ❑ 11/III B, IV-HT, V-B
Valuation: 1 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 02/0 /09
CITY OF C'UPERTINO
CUP^E F GENERAL BUILDING APPLICATION
FEE SC -IEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
3g ( 1STUCOAP Stucco Ap)lications (up to 400 sf) B
additional Stucco application
I WINREP ReplacemE nt windows/sliding glass B
door ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/mason includes plan ck fee
IEPERMITFEE Electrical 'ermit Fee E
1MPERMITFEE Mechanic<<l Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alo ie Electric Pln Ck(hourly) E
1MECPLNCK Stand Alo le Mechanical Pln Ck(hrly) M
IPLMBLNCK Stand Alo ie Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard flan Check(when no E/M/P) B
when not over counter hourl -stand alone
1BCBSC Cal Bldg ;standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
IBUSLIC Business Jicense B
i of 5
www Vigo:
Cupertino .Village
Parish Place 10202
_.. - "1020`1
-.__
10194
T\) N N o o 0193 _.... . __. ..
0192
10191
10121 F 10123
L
�Of£31 CD 10182
t 101
11 � 1U133a o 10173
-10174
10103 1014-! �_�° 10172
10101 10143 _ 10.171 T-
C)
,_�
Parish PIace F10164
i
i
I
f
i
i
i
May 15,2009
i
i
City of Cupertino Building Department
10300 Torre Avenue
Cupertino,CA 95014-3202
I
Re: Building Permits for the Cupertino V!llage Homeowners Association
10101 — 10251 Parish Place, Cupertino, CA
Authorization for Draeger Construction, Inc. to obtain Permits on our behalf
i
To Whom It May Concern:
The Board of Directors of the Cupertino Village Homeowners Association hereby authorizes
Draeger Construction, Inc., 605 Commercial St-eet, San Jose, Ca 95112,to obtain permits for
miscellaneous remedial repairs to be performed in the common areas of our complex as
referenced above. !
i
Should you have any questions,please do not he sitate to contact me.
I
Ve truly yours,
Diana Johnson `
Association Manager
Cupertino Village HOA
i