06120135 (2) CITY OF CUPERTINO w °' ' - -
^6UHAI"iUDIVISIOtN PERMIT 1C 01WT"GYORXVo'.'dRM�'��ON
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
NEpoa rr r+ac SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION - 70b D0SCllptlOn
w 1 hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing
with Se<tion]O(10)of Division3 of NC Buunen aM Professium Codc,entl myliccnse is REROOF MFDWL GARAGES- TEAR OFF EXISTING, INSTALL
a in full fade and u l6
;°y i License I '� Lick NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
I„ Dam Conuaztar
QQARCHITECTS DECLARA & GRAVEL BUR,
i 2 t 1 understand my plans shall W used as public records
(iU
Q to Licensed Pndcssional
)003 Oat lam eUILDER ongfrm Ce Contractor's
I hereby.('firm e.11. exempt from the Conuacror's License Law for the
m following reason.(Srcut I 703 LS Business end Pm@e o li Cole:Any city or county
which requires a permit le quires Me acme improve,demolish,comfort any ratemore
s—'^ prions its�ensed a rmanilso I.Ban pga applicant cd for such Convertor's
censele a La.(Cha mem
that W commcing it pussuam mlhc provisions of lW Me Business
Law(C Code)Or 'Sq.Ft.Floor Area 23$1 Valuation
t� ong he acingwithmsefrm and ofDivision tr the
the Busmen andon.Any
Nn io u eu.5 b saurefrom and the aper far the alleged exemption.Any violation of
Section 7031.3 airy applicant for a permit ubjecu the applicant to a civil penalty of Number Occupancy Type
nos more Nan five
hundred dollars(M). 32652013 :Cl7'
1,ns owner of she property.u my employcu with wages v Neirsolc compensation,
will da Ncwork.and Nestmcsure rnotimmndtitnuffted forsalt(Ste]044,Buirtw ns Required Inspections
and Professions Cade:The Contractors Liamse Law does Ml apply to an owner of q p
property who boddsmrimproves thereon,and whodeessuch work himself or Waugh his
own employrrs,provided Nat such improvements an,not intended uraffercd for axle.If.
however,dee building or improvement is sold within one you of completion.the owner-
, builder will have the aurtlen of proving Nal be did not build or improve for purpose of
nn.).
❑1,as owner of to property.am exclusively contracting with Banned centracmrs or
construct the project(Sec.7144,Business and profenions Code)The Conuacmrs Li.
cense law docs not apply he an owner of property who Wilds or improves themon.and
who canner for such projects with a contractor(s)licensed pursuant to the Comminorr
Lkenae law.
❑I am exempt under Sec. ,B A,P C for this mason
Owner Dale
WORKERS COMPENSATION DECLARATION
1 he atnon under smutty of perjury oar of Ne following deeati
luans:
am and will maintain a Cerdfiam of Consent to s df4resum for Workers Compere -
anion,m pmv' cd for by Secuan 3900of Ne labor Cade,far dm performmce of the
workfor els Nisperm(lisiuued.
ave end will maintain Workers Compensation Insurance,as required by Section
3700 of the labor Code,for the performance of Ne work for which this permit is issued.
My Caner: fCompenn�uanylnsu/r�p�e amu.,and Polin.;77W�r�.(
Carrier.a`2 '/ CA OF
iN FROM
jS.�
CERTIFICATE OF EXEMPTIONPROM WORKERS'
COMPENSATION INSURANCE
(Thr section need not W completed if the permit is fmone hundred dollars($100)
or less.)
I orally Nat in the performance,of the work for which this permit is issued.l shall not
employ any person in any manner m an in become subject o the Worlaus'Compcuaflon
Laws or California.Dam
Applicant
NOTICE TO APPLICANT:If,alta making this CeaiEeam of Exemption,you should
become subject to the Worker's Compensation previsions of Ne Labor Code,you muss
.,Q forthwith comply with such provisions or Nis permit shall W decmcd temkcd.
,z•,ti CONSTRUCTION LENDING AGENCY
(-•� I Weby alOrm that Nem is a construction lending agency for the performance of
> the work(or which this paced(is Issued(Sec.3M,Civ.L'.)
W�Q Lender's Name ,
D z Lenders Address
U C) 1 ennify that t have read this application and state Ng the be.information is
ry r correct,l agree to comply with all city and county on intmens and sok laws relating m
OU building construction,and hereby autharre ropmaenutives of this city to enter upnn the
r 4 ahovc-mentioned property for mspcedon purposes.
(We)agree m save,indemnify and keep harmless Ne City of Cupertino ageing
rfA liabilities,judgments,tests and expenses which may in my way accrue agtlnst midCity n
U in consequence of the granting of this permit.
APPLIC -P
DERSTAOMPLY WITH ALL N OI Issued by: Date
SOU NS.NOS
_ Re-roofs ��--
igneurcafApli HAZARDOUS MATERIALS DISCLOSURE Dem Type of Roof
Will the splicer or forum Watling e.Chapter
9,1 or handle Harbor anmaterial
as defined io the 32(x)?no Municipal Cada Chapter 9.12,and Jan Hce1N mJ Safety
Cale Ballon 25532(.)? Q�7 / All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or rutum Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit loominns air comeminanu u Jcfincd Me Bay Ana Air Quality Management all new materials for inspection.
District?
❑Yes
1 have real the harardous materials requirements under Chapter 6.95 of the Califon
noes nt d:SefctyCade.Sudons 25505.25577 and 25574.1 undcntsnd Nazif the huiWing
dans not cure tl hau a tenant Nal is r my m 'lily m notify the occupant of the
reyui n hmus(Wmelp' n ora ertr6ateeroccupm gnatureofApplicant Dat
o neroraeNnri,edagml Dam All roof coverings to be Class "B" or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652013 . 00
DATE ISSUED. . . . . . . : 12/22/2006
RECEIPT #. . . . . . . . . : BS000000069
REFERENCE 'ID # . . . : 06120135
SITE ADDRESS . . . . . : 103'39 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1339
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
•
CITY Of CUPERTINO
CI--IFFRj-lN0 PERMIT APPLICATION FORM
I'iv r —
— -- 32(p-52- p 13 D te:J2 I��l a7�
Bu,ldin^ Address L —
-� ;_ / D3 11 �
�_� -rrr
� Owucr-s Name: _) Phone #:
Ccoo
Cunu'nctor: -
/ License #:
Contact: Cupertino Business License P:
Type of Roof Covering:
Existing: ]'roposc I:
U IIniIL-Up Itool ®Milt-Up roof
..7 Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shales
❑ W,"d Shimles ❑ Wood Shingles
❑ Uthur(SpecilA )-- _--- ❑ Othur(Specily)
lulnhur of cxisiing coacrings_--- ❑ Provide LC.13.0. KcporL 11 --_
iU Tu he Removed ❑ Provide Nlfgr. Installation Specs. _
ave RcacL Understand and Will Comply With Cupertino's 'hcar 01'1'Policy: ❑,�_
.lob Description: — -
Lai
I:esidentiA Commercial ❑
hire Zone: Yes ❑ No ❑ Confirmed With Planning Dept. if
there are any restrictions: ❑
Cost ohProlett: Type of Construction: Occupancy group:
Qlv. if
:Applicublc Fee ID ('ce Description Fee Group
BPGRYIPI�6 Blcl,, Permit Fees BUILDING
BENERGY EncrgY BUILDING
BSEISNIICRE Seismic Fee Res BUILDING
_ BSEISMICOM Seismic Commercial BUILDING
BPLANCI II< Plan Check Fee BUILDING
�_ _ BUSLIC Business License BUILDING