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11050208CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10072 AMADOR OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050208 CONSTRUCTION INC ONS NLR'S NAME: MILLER RUTH E ET AL 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION ( (� F License CLie. N �7 BUILDING PERMIT INFO: BLDG ELECT PLUMB F_ i �� MECII RESIDENTIAL COMMERCIAL Contractor 01�ff �� Date � �� I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REROOI', 9.5 SQUARES, SINGLE PLY TPO OVERLAY WITI-I (commencing with Section 7000) of Division 3 of the Business & Professions LAYER FR-10 BARRIER 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 Sq. Ft Floor Area: Valuation: $375 performance of the work for which this permit is issued. 1 have and will maintain 'Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work to which this permit is issued. APN Number: 34232014.00 Occupancy Type: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I asrce to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to hUdding construction. and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS R M LAST CALLED INSPECTIO indemnih and keep harmless the City of Cupertino against liabilities, judgments. cost,. and expenses which may accrue against said City in consequence of the granting of this permit. Additior3il<the applicant understands and will comply Issued by: Date: with all non-point source reg ions per the Cupertino Municipal Code, Secti 9 18. RE-ROOFS: Signature _ _ [ Date �� / All roofs shall be inspected prior to any ing material being installed. If a roof is installed without first obtaining an in, n lection, I agree to remove all new materials for inspection. �. �e, ❑ OWNER-BUILDER DECLARATION Signature of Applica Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BET I'ER 1. 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 & Professions Code) 1, as owner of the property. am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation. as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Cod Chapter 9.12 and I have and will maintain Workers Compensation Insurance, as provided for by Section 3700 the Labor Code, for the the for the Health & Safety Code, S tions 25505, 25533, and 255 of performance of work which this Owner or authorized age# Date:44/ permit is issued- 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith compiv with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's .Address 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save aider unly and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARA'T'ION costs. and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. sianature Date 4 ITEMS OF 22 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232014.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014513 REFERENCE ID # ...: 11050208 SITE ADDRESS .....: 10072 AMADOR OAK CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER MILLER RUTH E ET AL ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5606 RECEIVED FROM ....: DRAEGER CONST. 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 ---------- 375.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 375.00 0.50 0.00 0.50 0.00 1BUSLIC FLAT RATE 1.00 115.00 0.00 115.00 0.00 1REROOFRES SQ FEET 9.00 126.00 0.00 126.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 242.50 ---------- 0.00 242.50 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build inga agupertino. org 11 C� 10 Pnn=rr nnvrcc APN# ? SLA 6QLI �W OWJC�f1z- NERV . Jai PHONE 61 zS 31 S� E-MAIL SiREE DRESS O ` �1TY STATE ^ ! FAX AP CANT Aj PHONE E-MAIL STREE�D C STATE, ZIP Z FAX S-� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTQR N LICvfNUMB r, 0 LI — E BUS. LIC. # u COMP6PXe' / E-MAIL FAX STR,ETV8 pV (av1 J • C STATE 2012, ARCHITECT/ENGINEER NAME LICENSE E BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex E3 Multi -Family ROOFA A� yy '; ' ♦ VALUATION: G7 ❑ Commercial �i� �° fl �� v -Z 1�/ STRUCTURE: EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) __ REMOVE /REPLACE 13 YES IF NO, PLYWOOD g'/" ❑ PLYWD 13OSB PITCH 12 ROOF A 54NO # LAYERS: THICKNESS: 115/S" TYPE: CDX ' CLASS PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES 'go' R IMES REPORT # DESCRIPTION OF WORK: -,� By my signature below, I certify to each of the foll ng- I am the property owner or authorized agent to act on the property o er's behalf. have read this application and the information I have provide ' orr . I have Fead the Des ' tion of Work and verify it is accurate. I agr to comply th all applicable local ordinances and state laws relating to 4ulldi co s on. I riz enta 'ves of Cupertino tc enter the abo e�prope or inpurposes. G Signature of Applicant/Agent: Date: SUPPLEME FORMATION REQUIRED .�. � .. _ ,,MORaO If building is associated with a Home Owner's Association, provide letter SEP k p $M. S ING p z _ of approval from HOA. Provide Plasmin approval to verify If there an restrictions. Provide Planning aPP fY � Y -SK 5 n eE3CP.TtESS h �� ` � Pd.Ai4�*IIdG TtE�R' — —Prov' copy of Manufacturer's Installation Specifications. � ❑� PLe1N Provide signed copy of Cupertino's Tear -Off Policy. _ ❑I7x. _xr y . ReroofApp_2011.doc revised 03/02/11 VS