06120152 CITY OF CUPERTINO r '' '
'BUILDIIIF. T
DIVISION PERMI .1NTTtAG7 r''RJNFQRMATJQ' ,-"
cf. n'r:<,_�_. .. .YI'•.� •• � „ ' PERMIT NO.
BUILDING ADDRESS;
ATE
AIT nPAPr-pp
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
(g�4nvTlsna SANITARY NO. CONTROL NO.
(408) 536-0420
BUILDING PERMMNFO
ARCHITECT/ENGINEER:
BO EO PLO MEOCH
Sa z LICENSED CONTRACTOR'S DECLARATION Job Description
UC 1 hereby affirm Nel l am luxmnd umkr provision of Cheplar Y(commencing
iO iNSttuan'!0(N))ofDiviaion3afd,aBusincstandPrafcssiunsCodc.andmyliccnscis REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
=uodi in full farce and fm
Z License Cl}, Lle.g sem( V NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR '
Dam — Conuacmr�)
AR LTSDECLARA ON & GRAVEL BUR.
I W j 1 understand my plans shall Be used u public records
Id
eta Cleansed Pmfcssiannl
5 OWNER-BUILDER DECLARATION
q I hemhy billion that I am exempt from the Contractors License Law for the
iC o fallowing moon.(Section 70315,Business and Profession Code:Any city.11...ty
'm e which requires a permit to ennswa.alcor,improve,demolish,or repair any snactum
Za prior m its issuance,also mquncs the applicant far such permit to file asigned statement
< that he is licensed pursuant m the previsions of the C...Wr's License Law(Chape,9 Sq.Ft.Floor Area $2381 Valuation
(commencing with Section 7000)of Division 3 of lie Business and Profusions Code)or
But he is exempt themfsam and the basis for dm alleged exemption.Any violation of e,p�,i
Secdon 7031.5 by any applicant for a permit subjects the applicant.a civil penally of 32652021 :li l•J' Number Occupancy Type
not mom Nan five hundred dollars($500).
0 I,as owner of the pmpmy,or my employee with wags n theusole cmmpensadon,
will do thework.and Be soccure isnotinunded araRcred fanale(Se..7044.Business ns Required Inspections
.it Profession u
Cade:The Canumrn s License law donot apply m caner
an of q p
property who bui lda or im prove thereon,and who does suc h work himself or Nmugh his
own emplay es,provided that such Improvements am not intended oroRered forsale.IL
however,the Wilding orimprovement Is sold within one year o(completion.the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively convening with licensed conuacmm to -
construct the project(See.7044.Business and Prornsians Code:)The Contractors Li-
cense Law don misapply m an mann of property he builds or improvn,Bemon.and.
whomouacts for such projects with acmdreat r(s)licensed pursuant in the Conuacmr's
Lice.law.
D l am exempt under See. ,B&PC(.this moan
Owner Data
WORKER'S COMPENSATION DECLARATION
1 affirm under penally of perjury arm of Om following dttlue0an:
are and will maintain a Certificate of Consent in self-insure for Workers Co rism-
mtion.n prov' cd far by Section 3700 of the lab.Code.for the performance of tBe
work far c Nis pennis is issued.
ave end will maintain WarkerS Compensation Inunnce,as required by&coca
3=,r Ne Labor On.far Ne peRonnance of the work far which Nia permit is issued.
My Warkcr en n and Policy number so. ^
Cartier Policy No.: '12—O�i
CERTIFICA OF EfPfION FROM WORKERS'
COMPENSATION INSURANCE
mbsewstio t need nothe complemd if the permit is formic hundred dollam($1001
or less.)
1 certify that in the Performance of IBe work for which Nis permit is issued.l shall not
employ any person in any memories as lo become subject o IBe Workers'Compensation '
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL alter making this Cerifica a of Exemption,you should
Become subject in the Workers Compensation provisions of Ne Lahr Cade,you or
,J Q foMwith comply with such provisions or this permit shall Be deemed m rked.
ZgA CONSTRUCTION LENDING AGENCY
(~ I hemM1y affirm that there is a comnretion lending agency for the performaue of
FL the
.,it for which this permit is issued(Sec.3097,Civ.C.)
W� 0 Leaders Name
2 Lenders Address
U Q I certify that I have reed this application and sum that the above information Is
LL F correct.l agree to comply with all city and county onlimmers and state laws minting m
O U building consvuction,and hereby authonre representatives or l,is city to enter upon the
r W
above-mentioned Nndespeepo,prOwhich s.
F g14 (We)agree to save,indemnify and keep hamdcas the City of Cupertino against
fA in consequence
of he gran i and expensesthipe mit. may in any way accmc againslavd City
U z AcPLICANTc of the granting of this permit Date
APPLICANT U ER ANDS AN ILL C MPLY WITH ALL NON-POINT Issued by:
SOURC E AT S. -
Re-roofs
Signature of Appli mnueemr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Nam building occupamstou or handle herudous material
u deOned by the Cupertino Municipal Code, hapmr 9.12.end ft Health and Safety
Code,section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0 Yn
Will the applicant ar future building ecu t tau equipmcnl Or devices which If a roof is installed without First obtaining an inspection,I agree to remove
emit hazardous all containing as define Bay Arca Air Quality Management all new materials for inspection.
District?
O Yes
Ihavcmad NeharaNdmc25 ialsrcquircmc5534.1rChepmrd.95arNe Califon- �—'t— / ^ �✓ ��
nim Health&Salary Cade,Secvons23505,25533 and 75534.11.nowndth scup building /
dos oat currcn0y m a nant,mat it i my rospmnsihility mnotify ilm eccupanwf dm
regm,m own m met Pd iss acenlfcamorOcmpn Sign lure of Applicant Date
��6Akgy All roof coverings to be Class"B"or better
Owner ser authorize agent Dam'
- LA
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652021. 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000086
REFERENCE ID # . . . : 06120152
SITE ADDRESS . . . . . : 10357 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . ... . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1340
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
•
i ,
�f CITE' O[i CUPERTINO QW2. 0
16 ,�
Cl�mm l "4.it?R(,J) lT 1<
CUPERTINO PERMIT APPLICATION FORM
A N, Date:
�� Huildim, ALIC]Iess:
owner :; Nam,e:
Phone #:
�1 t /1�5CC icY�i`m '1'��c�iv,rd �,(>.i ����P.S � 1, ��5� � coD
Cotlructot:
License 11
Contot.t Cupertino [3usuiess License q:
Type of Roof Covering:
Lcisting: Propos cl:
�.] Iluilt-I Ip Raub ®�Built-IJP roof
t] Asphall shinglcs ❑ Asphalt Shingles
:J WnodShnkcs ❑ Wood .Shakes
U Wood .Shingles ❑ Wood Shincics
U Utherl,Spcci(vI--- --- ❑ 0ther(Spccily)_.__ _
:vWPIhcr oI CNIStIll g cav 2 i itgS ❑ PIOViLIC I.C.13.0. Report II
07 "ro he Removed ❑ Provide Migr. Installation Specs._ ---
• %
I I lave R.cad. Understand and Will Comply With Cupertino's "Ibar Off Policy:
lob Description: `
Residenli,tl 0� Commercial ❑
Fire /_one: Yes ❑ No ❑ Contu•med With Planning Dept. if
here are any restrictions: ❑
Cost of Project: Type of Construction: Occupancy group:
Qtv. if
Applicable Fee ID Fee DcscriplionFee Group
13PFRNIFF,E Bldg Permit Fees BUILDING
_ T3 E—NEAGY Energy BU1LDING
BSElSNIICR17 Seismic Fee Res BUILDING
BSEISIMICONI Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
�_ _ BUSLIC Business License BUILDING