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0703010 7777777 CITY OF CUPERTIN_O BUILDING DIVISION PERMIT �TT �N'I .GTQR I .�RMATION ' PERMIT NO. BU1LDf 6 rT JESS: 1U3�51 MARY AVE DRAEGER CONSTRUCTION INC 07030100 PERMIT ISSUE DATE OWNER'S NAME: M & C ASSOCIATION MGMT 605 CO ERCIAL ST 03/16/2007 SANITARY NO. CONTROL NO. jNE:RRVT('FC BUILDING PERMIT INFO ARCHITECT/ENGINEER: REROOF T/O EXISTING, INSTALL NEW BUR C & ELECT PLUMB MECH D D 0 i p p LICENSED CONTRACTOR'S DECLARATION " ^ ^ ]pj��$�riptl Op^ VI hereby affirm that I am licensed under provisions of Chapter 9'(coflftaheing ^^^^ `^^ ^ Z� with Section 7000)of Division 3 of the Business and Professions Code,and my license is "t 0- in full force aneffect / -7 t y2 License Class r -C Sri « Lic.8 t-p Date —t l_--7 Contractor ARCHITECT`S DEC 7 d< I understand my plans shall he used asp - >aU U.y Licensed Professional O< OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the p Oa following mason.(Section 7031.5,Business and Professions Code:Any city or county {i which requires a permit to construct,alter,improve,demolish,or repair any structure a—N prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)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 ApN Number Occupancy Type not more than five hundred dollars($500). ❑I,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 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- ccnse 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 Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work fo�,�h. :,r this permit is issued. all maintain Workers Compensation Insurance,as required by Section 00 of Code,for the performance of the work for which this permit is issued. My Worker Comq�nation Insurance carrier and Policy number are: y Carrier. G S�r.S Policy No.:�I�C I �' 10600 CERTIFICATE OF EXEMPTION 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY rte- 1 hereby affirm that there is a construction lending agency for the performancc of fY> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lender's Address [certify that i have read this application and state that the above information is rL O correct.1 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 ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against C/) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of ' 1. Date '- APPLICANT UNDER S AND WILL COMPL ITH ALL NON-POINT Issued b'': SOURCE REG 6 3 Re-roofs Sign u ofAp UC r Dare a of Roof GUS ALS DISCLOSURE Type upanL store or handle hazardous material as dcftncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑Yes $K.— Will 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r materials for inspection. Disrict? / - ❑Yes (❑Dkf I have read the hazardous matenal tui der Chapter 6.95 of the Califor- niaHealth&Safety Code,S 5.25533 and 25534.I dcrstand that if the building does not currently h tenant that it is my responsibi' notify the occupant of the requirements st t prior to iss enifxatc of ocai�nerv� S 1 t ;i4, Date ll roof coverings to be Class"B"or better Owncr or rued agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI'C RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bl:c: Lot: APN 32 352009. 00 DATE ISSUED. . . . . . . : 03 /16/2007 RECEIPT #. . . . . . . . . BS)00000709 REFERENCE ID # . . . 07 )30100 SITE ADDRESS . . . . . : 10331 MARY AVE SUBDIVISION . . . . . . . CITY CU?ERT INO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : M �: C ASSOCIATION MGMT SERVICE ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1339 RECEIVED FROM . . . . : RE2EIPT INTERFACE CONTRACTOR . . . . . . . : DRAEGER, JOHN EDWARD LIC # 21895 COMPANY . . . . . . . . . . : DRAEGER CONSTRUCTION INC ADDRESS . . . . . . . . . . : 605 COMMERCIAL ST CITY/STATE/ZIP . . . : SAV JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 536-0420 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 50, 000.00 540.00 0.00 540 . 00 0.00 BSEISMICRE VALUATION 50, 000.00 5. 00 0 .00 5 . 00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 545.00 0.00 545 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 545. 00 101503 --------------- TOTAL RECEIPT 545.00 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 REROOF CUPEKTINO PERMIT APPLICATION FORM APN# Date: 3119/6 Buijp3t6ta10333 0335 (o3g1- 103.13- /03Vf Owner's�N1ame: � Pho�0,: � �, _ g� Contractor: 7� . License#: (0 Contact:d _r � 0 > Cupertino $��ess License #: Type of hoof Covering: Existing: Proposed: Ji Built-Up Roof Built-Up roof COM f n /❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: I"UVL 0,V A rC4 I ' l �l fl.Q,W l Residential Commercia ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: U Cost op O eco Type of onst ction: 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 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Buildi ag Department JOB ADDRESS: PERMIT # 1033/_ 0 3�— 1a 33 — l0 3 7 -io3yi-/n r?O -?WDU OWNER'S NAME: PHONE # c(b? Z)o 1dv� GENERAL CONTRACTOR: FAX # I am not using any subcontractors* gt�e Date Please check applicable subcon and com plete the followin ' rmation: SUBCONTRACTOR B E BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Til e ntrignature Date