07020003 CITY OF CUPERTINO
BUILDING DIVISION PERMIT $] I'X�AG7tIKZTIf�I'
.
BUIL 1��G4 �KESS: PERMIT NO.
MARY AV DRAEGER CONSTRUCTION INC 07020003
PERMIT ISSUE DATE
OWNER'S NAME:
M & C ASSOCIATION MANAGEMENT 605 COMMERCIAL ST 02/01/2007
SANITARY NO. CONTROL NO.
.ONE:
(408) 5'�6-0420
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
Ui• I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Section 7000)of Division 3 of the Business and Professions Cade,and my license is R EROO F--T/0 E:i I S T I NG AND INSTALL NEW CLASS A BUILT
I a°. in full force and a{fe
i=z License 1 s - Lic.# UP ROO OVER EXISTING GARAGES.
F w Date Contractor
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)W U
U.F- Licensed Professional
o a OWNER-BUILDER DECLARATION
a I hereby affirm that 1 am exempt from the Contractor's License Law for the
a o following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct.alter,improve,demolish,or repair any structure
Z} prior to its issuance.also requires the applicant for such permit to file a signed statement Valuation
- a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $2500
_ (commencing with Section 7000)of Division 3 of the Business and Professions Calc)or
i 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 )WdqNumber Occupancy Type
not more than five hundred dollars(5500). 326520:33 .
❑f,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.).
❑I,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.
❑I 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:
❑I have and will maintain a Cer ifcate of Conscnt 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 Compensation Insurance carrier and Policynumber ares'_
Cartier ,. ;0 bi N Policy No.:-�q2
CERTIFICATE OF EXEMFrION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner 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 CONSTRUCTION LENDING AGENCY
(�- 1 hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
Lenders Name
a4 z Lender's Address
U Q 1 certify that I have read this application and state that the above information is
LL o correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
o.F-t rA liabilities,judgments,costs and expenses which may in any way accrue against said City
U ,Z in consequence of the granting of this permit Date ,� Q j
h� APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued l:y:
SOUR
�p A0 a
11/1 Re-roof;
hgna ire of Appli Contractor Date T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municip adc,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roots shall be inspected prior to any roofing material being installed.
[3 Yes o
If a root'is installed without first obtaining an inspection,I agree to remove
Will the applicant or future buildin upant use equipment or devices which
-
- emit hazardous air contaminants as do by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building
docsnot urrently have tenant th my respons t)notify the occup t of e
mqu' nus c be met or to i uance a C care of Occu Sign u-e of Applicant Date
All roof coverings to be Class "B"or better
Owner or authorized agent are
Community Development
10300 Torre Avenue
Cupertino CA 95014
s. s` Telephone(408)777-3228
Fax(408)777-3333
CITY OF
rUPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
Cc
OWNER'S NAME: VV1}C . SNI vac PHONE # qOX-5-'3<o,-O 49G
FAX #
GENERAL CONTRACTOR: I
2
*��
I am not using any subcontractors: ate
Signature
Please check applicable subcontractors and com [ete the folio* BUSINESS LICENSE #
SUBCONTRACTOR BUSINESS NAM
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
FiLathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF --UPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652083 . 00
DATE ISSUED. . . . . . . : 02/01/2007
RECEIPT #. . . . . . • • • : BS000000369
REFERENCE ID # . . . : 07C20003
SITE ADDRESS . . . . . : 10481 MARY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M F: C ASSOCIATION MANAGEMENT
ADDRESS : 104:81 MARY AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : DRI�EGER, JOHN EDWARD LIC # 21895
COMPANY . . . . . . . . . . : DRAEGER CONSTRUCTION INC
ADDRESS : 605 COMMERCIAL ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (4 )8) 536-0420
FEE ID UNIT QUANTITY .%MOUNT PD-TO-DT THIS REC NEW BAL
---------- - --------- ----------
BPERMFEE VALUATION 2, 500 .00 83 .16 0 .00 83 .16 0.00
BSEISMICRE VALUATION 2, 500 .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 127956
---------------
TOTAL RECEIPT 83 .66
CITY OF CUPERTINO
RLROOF
CUPEkTINO PERMIT APP=LICATION FORM
APN
_ Date:
Building Address: � rO n
Owner's Name: P ne#:
G Gcs,ck �r, D
Contractor: License#:! ^
CLQ C_c S b l!�
Contac • Cupertino Business License
j #:
o,( �CLa �
Type of Roof v
i
Existing: Proposed:
,0" Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
`\ ❑ Wood Shingles 1 ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Sp cs.
I Have--Rcad,.Understand and Will Comply With Cupertino ear Off Policy:
Job Description: War
��0 -axis- inn QW_j�
Residential Comm rcial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Ty(
of Cons zction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING