11070123 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22754 MAJESTIC OAK WAY CONTRACTOR:DRAEGER PERMIT NO: 11070123
CONSTRUCTION INC
OWNER'S NAME: SOULES BERNARD E AND KAREN E 605 COMMERCIAL ST DATE ISSUED:07/20/2011
(
:,:R'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
/ W
License Class "" Lic.# � � 0
MECH r RESIDENTIAL COMMERCIAL
Contractor Date � y
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF,13.33 SQ,REMOVE WOOD SHAKE,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEW
SHEETING AND ASPHALT SHINGLES
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,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 provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12882
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34232119.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may acc a against said City in consequence of the
granting of this permit. Additio ,thf applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source re a'ons per ertino Municipal Code, ection 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date y Issued by: Date:
L OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofs ,material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspect* ,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant Date:
construct the project(Sec.7044,Business&Professions Code). W
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
[have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must O �
forthwith comply with such provisions or this permit shall be deemed revoked. m
��er or a�uored e��ent
Date• �/
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
it' nify and keep harmless the City of Cupertino against liabilities,judgments,
c. :md expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
4 ITEMS OF 37 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34232119. 00
DATE ISSUED. . . . . . . : 07/20/2011
RECEIPT #. . . . . . . . . BS000014110
REFERENCE ID # . . . : 11070123
SITE ADDRESS . . . . . : 22754 MAJESTIC OAK WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SOULES BERNARD E AND KAREN E
ADDRESS . . . . . . . . . . : 11902 S HITCHING POST TRAIL
CITY/STATE/ZIP . . . : PARKER, CO 80134
RECEIVED FROM . . . . : DRAEGER CONSTRUCTIO
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 882 .00 1. 00 0. 00 1 . 00 0 . 00
1BSEISMICR VALUATION 12, 882 .00 1.29 0 . 00 1 .29 0. 00
1BUSLIC FLAT RATE 1.00 115 . 00 0 . 00 115 .00 0. 00
1REROOFRES SQ FEET 13 . 00 182 . 00 0. 00 182 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 299.29 0. 00 299 .29 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 2Z— qL4_'ZZ^7Z2.
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•building
(cDcupertino.org
PROJECT ADDRESS f +J 7`PN#
OWNER NAMEPHONE1 -7 E-MAIL
STREET ADDRESS C STATE,ZIP /J FAX
CONTRACTOR NAME LIC ENS SF-,NUMBER LIC SE TYPE BUS.LIC.#
vGPip Z Z_
COMPANY NA E 1� E- AI FAX
4L
STREET ADDRESS CITY,STATE Z�� PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm(Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPolicy_2011.doc revised 02/16/11
Z
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinga-cupertino.org \v
PROTECT ADDRESS 22-754I�J r APN# ��3 i_ft '
OWNER NAME
STREET ADDRESS CITY, STATE,ZIP FAX
APPLICANT NAME j,j /r PHO E-MAIL
STREET ADDRESS/v g-r-� ov0'^A �,t CITY,STATE, ZIP 1� n Il Z F z O�
❑OWNER ❑ OWNER-BUILDER 1 OWNER AGENT �NTRACTOR ❑CONTRACTOR AGENT(�j❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRAC%i N / >t-xIxtobt 1 76 E.� -T.6% LICE SE NUMBER LISTYPE BUS.LIC.#
COMPANY / EMAIL,
STRPET ADDRESS CITY,STATE,Z
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUA ION:
STRUCTURE: ❑ Commercial , ` t3ejj(W�5" 12- 1 z:5 . CFO
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 5i�YOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE P ...TIFINO. PLYWOOD 19 w, ❑ ❑ OSB PITCH: ROOFNOAYERS: 11 THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF �45PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: � � ` � � tn
aa
By my signature below,l certify to each of the following: I am ZPe
owner or thorize agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I eescripti of Work d verify it is accurate. I agree to co ply with all applicable local
ordinances and state laws relating to building construction aus es of Cupe no tc enter the above-iden ed pro em;for inspection purposes.
Signature of ApplicanVAgent: Date:
SUPPLEMENTAL INFORMATION REQUIRED ' s x x�>rFIC310
_If building is associated with a Home Owner's Association,provide letter
ALAN CHECK TYPE R ROUTING SLIP
of approval from HOA. �iv�x7 cDa�t x - ❑i c PLAN REVIEW-
z,
r1 r
_Provide Planning approval to verify if there any restrictions. ExPlss ❑'>PLANNING PLANREVIEw
M:x
_Provide copy of Manufacturer's Installation Specifications. j] s� � _ ❑'
w
Provide signed copy of Cupertino's Tear-Off Policy. ❑-ol>�x':
ReroofApp_2011.doc revised 03/02/11