06120148 CITY OF CUPERTINO a "K-••r ' "• ` "
BUILDING DIVISION PERMIT tCQNTR"CT9'RJYVk0 AITION<,
BUILDING ADDRESS: - PERMIT NO.
OWNER'S NAME: A
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
nr rT rL,c. SANITARY NO. CONTROL NO,
(408) 536-0420
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION Job Description FF I heseby affirm than 1 am licenced under pmvis leis of Chapter 9(mmmncing e
'.zu� with Seniors 7000)of Division 3 of the Bmirmev ppmr. Cma,rr8yliccnuu REROOF MFDWL GARAGES— TEAR OFF EXISTINGr INSTALL
-u Li full tout and i C�
,qz Liccnac — Lk.p NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
F E Dam Commuter T1 n�
CHITELTS DECLARA' � & GRAVEL BUR.,
I�i 1 once mad my plana shall M1c used as public rccnrds
IyU
�ap'9 Licenced Professional
)C�5 OWNER-BUILDER DECLARATION0.Connma
I 1 hmaso .(fla,reSett the,1a.1. encmpt from the ContractCo Limine Law for tic
m following reason.Permit
in 7 on1.5,Business and w,man di Code:Any city or county
which mquis u n permit ac cnvtmcL alcor,improv,demolishi at e-sig any structure
ter' prior m i6 issuance,also acquires;tee applicanl for such permit to tilt a signed sutemem
's�s< OatheisBmnsedpuraceratotheprevisionsofdueConnecmrsLimmmlaw(Chami9Sq.F FFloorArea Valuation
t F e (commencing with Section 7000)of Division 3 of the Business and Professions Com)or 2 3 81
dial he is eompl therefrom and dm herds for the alleged compliant.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant an a civil penalty atNumber Occupancy Type
not mare than five handled dollars($500} 3 2 6 5 2 0 2 9 !�(
❑1,is owner of the property,or my mnpiayms with wages as their sole compensation,
will clothe work,and the structure is not intended or offered fm aale(Sec.Tried,Businaa
and Professions Cade:The Comncter's Licemue Law docs not apply m an owner of Required Inspections
property who builds or i mprova thereon.and who does such work himsel f or dueugh his
own empleyca,provided Nat such impmwmats arc not intended oscillated fmssle,If,
hawse,the building or improvement is sold within one year of completion,the owner.
builder
will have the burden of proving Nat he did not build m improve for purpose of
sale.).
❑1,m owner car the Property am reclusively canuuting with licensed monew"to
construes the project(Sec.7044.Business and Profasiom Code:)The Centmemrs Li.
come law does not apply an an owner of property who builds or improves Hereon.and,
who contracts for such projects with a comVacsor(s)licensed pursuant in He Contractor's
License law.
❑I am commit under See ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
Its y aBimm under penalty of perjury,am of the(allowing declaratiana:
w end will mainuin a Certificate o(Consent soself-inaum for Worker's Compen-
as ton.as provided for by Section 3700 of the Labor Code,for the par(mmence of the
work for 'ch this pants is issued.
ave and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for He performance of the work for which this permit is issued.
My Worker's C—ompmeation;pPe nee carrier and Policy number ale: 1j 0/
Cartier. 7,�S 6F Polity iG W ERS57 'e+l�
ERTIFlC O OF COMPENSATION
I N FROM WORKERS'
COMPENSATION INSURANCE
(Thu section head notbccompleted ifthe permit Is forces hundred dollars(5100)
or lass.)
I comfy that in the performance of the work for which this Permit is based,I shall not
employ any person in any manner so as m become subject to the Workeri Compensation
Lawn o(Califomia Date
Applicant
NOTICE TO APPLICANT:If,after making Out Certificate of Eomption,you should
become subject in the Worker's Compensation provisions of the labor Cmc,you most
.J O forthwith comply with such provuiav or Out permit shall be deemed revoked.
,z.,VI CONSTRUCTION LENDING AGENCY
.fir 1 herchy affirm that Here is a construction lending agency far He performance of
He work fat which this permit Is issued(Sec.3097,Civ.C.)
Q lender's Name ,
] z Leaders Address
U Q 1 certify that I have rad His application and ante Hat the show information is
iL Fconed.I agree to comply with all city and county ordinances and sem laws misting to
V building conswction,and hereby authorne representatives of this city to cnmr upon the
r C ahow-menuorod pwperty for inepccuon purposes.
(We)agme to saw,indemnify and keep harmless Oc City o(Cupenin0 against
up1 liabilities,judgments,coats and expenses which may in any way scam against said Cily
V Z to consequence of the granting of this Permit.
^� APPLICANT ERSTANDS AND_W41.COMPLY WITH ALL NON-POINT
Issued by: Date 2
SOU
Re-roofs
Signature of AppficandContraeter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantsmre arhandle hanardous material
as defined by the Cupertino Municipal C Chapter 9.13,and He Health end Safety
Coda.Section 35533(,)? All roofs shall be inspected prior to any roofing material being installed.
40 ❑Yes
Will the applicant or future building occupant use equipment m de ices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hovarma air contaminants as dcfncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Y�
1haw mail He woundous.Sections W05lsrcqui andmnts 5under Chapter6.95or ifthe Califm-
nia Health urSafety hawaSauna tat iti Sin ane25534J 1.mulyd lhmi(up.,or On
Jas not currently haw a tenant,Hat it is my sa 'hility m notify the attupant of the
ratio els is us es psi u c Cerdfcateo(Ocmpamy. Signatur O pplieant Date
All roof coverings to be Class "B" or better
Owner or autho'.d'xi Data
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT,RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652029 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT # . . . . . . . . . : BS000000082
REFERENCE ID # . . . : 06120148 ,
SITE ADDRESS . . . . . : 10373 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . -. . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1342
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 183 :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
CITY OF CUPERTINO
(IT
CUPER.11NO PERMIT APPLICATION FORM
15:2� 02R Date:
Building AId 1QSS Owncl' a Nang: >
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Conuactor: LicL 'se fl:
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Propo�STI:
I I Hi It-I j 1) Knu1 @ BUI I i-IJ 1)runt
J Asphalt Shingles 0 Asphalt Shingles
-1 Wood Shakes 0 Wood Shakes
A Wood Shil)LICS 0 Wood shingles
(sIp"d\)
0 Odlcl (SIpcciIy)
L1l11 )LI Q'NIS1111" cmm]"s Ci I'lovicic I.C.B.O. Report U
I o he CJ Provide Ndjgl. Installation Specs.
—Read—Ulldcl Stand and W i I I Comply With CLIJM-tillo'S 'rear o rr iv icy:
Job Description:
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—cs ic-1c 1-11,i i I I Commercial ❑
c Ycs ❑ No ❑ Confirmed With Plalmillf, Dept. if
there are any restrictions: El
717)s lod, -1-11--C)j cc t: "I YI)C Of C0IISI[RIC6011: Occupancy -I-011p:
Lplienblc ["cc 11) Fee Description Fee G1-01.11)
--3PERN,1F1.-.1 17- --�Jdg 1;m-lia Pecs BUILDING
13 EN E R G Y Energy BUILDING
13SEISiMICRE Seismic Fee Res —BUILDING
BSE[SiMICCIVI Seismic commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING