06120149 (2) CITY OF CUPERTINO ,�«� �' �
BUILDINCD]VISION PERMIT CflNT.RAGTOR`INFUT:?L �'1'�I(pN ,`
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
M & C ASSOCIATION MGMT 605 COMMERCIAL ST 12/21/2006
IYEFns stone SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIEC PLUMB MECH
Iiop LICENSED CONTRACTOR'S DECLARATION - IOb DBSCrIpnOn
C 1 hereby affirm that l am licensed toner proWsions of Chapter 9(commencing
m withsemum7").fDivision3afWeBusi.andPrefortionsCode,anTdmylimoseis REROOF MFDWL GARAGES— TEAR OFF EXISTING, INSTALL
n in full farts and ffe V
Iq: License a �3 Lk sl NEW 3/8" CDX OVER EXISTING 3/8" CDX NEW 5 PLY TAR
r Dam Conlmctcr
A MICT'SDECLARATI Sc GRAVEL BUR.
i 4 1 understand my pla nt.hall Wawa as public menthe
IyU
°ay
Licensed Pmfcsxionei
i y g OWNER-BUILDER DECLARATION
hcm .....
- '
p I ,,by,IErm that
I..am.mmpt from tiro CssionstCo License Law for thy
i o o following mama. emit 1 7031.5.Business and Professions Cole:Any city as county
m�+ which requites Insurance.emso a uormWe alter.improve,demolish Permit i an repair any suadum
?iy
prior wim ensedponat 10 We
applicant it,such Permit in OlcasigneJ summcm
• < IhmhcislieenuJpursuamtothcpmvisionsoftheConuachn'sLimrueLaw(Chapter9 Sq.Ft.Floor Area $2381 Valuation
ih g (commencing with Section 7000)of Division J of the Business and Professions Code)or
5 that he is exempt therefrom and We basis for the alleged exempdon.Any viola0m of
Section 7031,5 by any appliant far a permit subjects the applicant m a civil penalty ofNumber Occupancy Type
.1 aam than five hundred dollars($500). 3 2 6 5 2 0 2 7
❑1,al owner of the property.army employees with wages as theirsolecompensation,
will"the work,and the structure u Fool intended oraQared forsate(Sec.7044,BusinessRe aired Inspections
and Ii fessians Cade:The Contractor's License Law does nm apply m im owner of q p
property,who build,m improves thereon,and whodoessuch wakhurati f or through his
own emplayees,provided Not such improvement are not intended proffered for uk.If.
however,the Wilding or improvement is said within am year of completion,the owner.
budder will have the burden of proving Nat M did nm Wild or improve for purpose of
salts.
Q 1,as owner of the property,am eaelusimly connecting with licensed mntnmom to
crumpret Ne project(Sea 7(44,Business and Professions Cade:)To,Contractor',Li.
come law docs not apply as an owner of property who Wilds or improves Wastes,and
who contracts for such projects with a contracmr(a)licensed pursnsm in We,Contractor's
License law.
❑1 am exempt undm Sec. ,B&P C for ass meson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 y ai m,under penalty of perjury one of the following dacleations:
I
and will maintain a Cenifieateaf Consent o self-insure for Workers Camper-
We labor Code,for the penianuance of the
rkf eh Nis permit is issued.
I have and will maintain Workch Compensation Insurance,as required by Section
3700 of the labor Cade,far the performance of the work for which this permit is Issued.
My WorkQefs�Compounds.lWri me carrier and Policy murder,are:
Carrier:So s✓/�/V�Policy No.:L�w� a0
C Fl TE OF E Pf1ON FROM WORKERS'
COMPENSATION INSURANCE
(Thuuctinn need mtbccomplcmd if the permit Is far one hundred dollars(SIM)
carless.)
I minify that in the performance of We work for which this permit u issued.I shell not
employ any paten in any manner so as ke become subject to the Workers Compensation
Lawes of California.Dam
APPlicant
NOTICE TO APPLICANT:IL after making this Ccnificatc of Exemption,you should
become subject to We Workar's Compensation provisions of the Labor Coal you must
sJ O forthwith comply with ouch Provisions or this permit shall Ise domed revoked.
Zy CONSTRUCTION LENDING AGENCY
[-r IbemhyNGmWWft.is a construction lending agency for the poformenm of '
v� the work fur which War permit is issued(Sea 3097,Civ.C.)
W Q Lender's Name
Lender's Address
U C) I certify thaw I haat road this application and sum that the above information is
(y correct.I agree to comply with all city and county ordinances and state laws moving to
U Wilding conaWction,and hereby audorie representatives of this city to enter upon the
W aha.e.mcroomed preprny far inspection pummels,
(We)agree to save,indemnify and keep harmless the City of Cupertino against
it, liabilities,Judgments,costs and expense.which may in any way acemc againat said City
V Z in cmump rtm or the granting of this permit.
^' APPLICANT U STANDS WI MPLY WITH ALL NON-POINT Issued by: Date 2/Z
SOURC E S.
_ _ Re-roofs
ignanuro of App t HAZARDOUS MATERIALS DISCLOSURE tar
Oeste Type of Roof .
Will the applicant or future building occup nastum or handle hmardous material
as defined by the Cupertino Municipal Code.Chapter 9.13.and We,Health and Safety
Cade,suction 255320)7 �M All roofs shall be inspected prior to any roofing material being installed.
❑Yes
bell the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mail harardnus air caosainanu as Jefincd the Bay Area Air Quality Management all new materials for inspection.
District]
Yrs
Ihave&Safet theheasdoons 2555,2553and nm4.I undhapmrd.95 ifthe Cali fon � ,at ���
nice Health av SreadW to Sccuatm2550als requirements
eq land cats n.1 rChapandaurorae building tom/..(_
does not curers ha tenant.that it u my res lily or notify the occupant of We
requireis t etprior u a enileateafOccupancy ignatureofApplicant Date
Owns.or...Wf.cl agcm Date All roof coverings to be Class "Bin or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652027 . 00
DATE ISSUED. . ... . . . : 12/22/2006
RECEIPT #. . . .: . . . . : BS000000083
REFERENCE ID # . . . : 06120149
SITE ADDRESS . . . . . : 10369 MARY AV -
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M & C ASSOCIATION MGMT SERVICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1341
RECEIVED FROM . . . . : RECEIPTINTERFACE
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' CU]"ERTINO 0(012-010
c U 4'.kT IN 0 PERMIT APPLICATION FORM
Date:
[-utTl i-c-li I I-,�-Address:
Phonc 4:
?-n 1Y 3c)
License il:
Cupcilino BUSilICSS License
0 C -
Type of Roof c-'Overin"..
Esistinp: 111-opooTs ]:
J 1111ilt-Up 11 Built-Up 10o('
CJ Asphalt U Asphalt Shingles
J WoodSlInkcs 0 Wood Shakes
;,j Wood shm,Ies ❑ Wood Shingles
L) OtIm (Sjpecify)
Provide I.C.R.O. Report 8
'fa he Removed 0 Provide Mfgi. Installation Specs.--LJI'C'C)-Sta11CI 1111CI Will C:C)illl)IY With CUIM-6110'S TeM 0A,Policy:
lob Description:
Residential �'' Commercial ❑
-F—irc Tn-11-ep-—Yes —❑ -No ❑ Confirmed with Planning Dept. if
'
cl-�,- there are any restrictions: El
c st of Pt 0 1 ccl: Type of Construction: Occupancy "I'OL11):
Applic:IhIc Fee 11) Pec Description Fee Group
13 p F R N/I F F,L 1314o Pe[.1114 Fees BUILDING
IF- R-E N E'R G Y Energy BUILDING
B s 17-1 s\/I I-C R E Seismic Fee Res BUILDING
BS E I S\/I I C 0 M Seismic C0 ,11,11circi,-d -BUILDING
------- DPLANCHK Plan check Fcc BUILDING
BUSLIC, IhShICSs UCCIISC BUILDING