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11050212CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10112 AMADOR OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050212 CONSTRUCTION INC OWNER'S NAME: GOPALCHETI MANOJ AND SARALA 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION IW r r— (� r� �V BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class —� Lic. 4Wz T r— j' Contractor e� Date MECH RESIDENTIAL COMMERCIAL �� I hereby affirm that 1 am licensed under the provisions of Chapter(9 JOB DESCRIPTION: REROOF, 9.5 SQUARES, SINGLE PLY TPO OVERLAY WITH (commencing with Section 7000) of Division 3 of the Business & Professions I 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 for which this APN Number: 34232017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS M LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the,� granting of this permit. Addition ,, the applicant understands and will compl17 y Issued by: Date: with all non -point source re" tions per the Cupertino Municipal Code Section 9.18 f l RE -ROOFS: Signature Date e All roofs shall be inspected prior to any roo g material being installed. If a roof is installed without first obtaining an insp ion, 1 agree to remove all new materials for inspection. F ❑ OWNER -BUILDER DECLARATION Signature of Applican 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 BETTER 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 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(x) 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 1 performance of the work fix which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se ns 25505, 25533, and 55 Section 3700 of the Labor Code, for the performance of the work for which this 17 Dat . Owner or authorized agent r /� e"' 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply 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 ARCHITECT'S DECLARATION indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1 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. S i a natu re Date CITY OF CUPERTINO 3 ITEMS OF 22 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN . 34232017.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014513 REFERENCE ID # ...: 11050212 SITE ADDRESS .....: 10112 AMADOR OAK CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER ............: GOPALCHETI MANOJ AND SARALA ADDRESS ..........: 10112 AMADOR OAK CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 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 ----------------------- 12CBSC VALUATION ---------- 375.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 375.00 0.50 0.00 0.50 0.00 1REROOFRES SQ FEET 9.00 126.00 0.00 126.00 0.00 ---------- TOTAL PERMIT ---------- 127.50 ---------- 0.00 ---------- 127.50 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 • buildingacuperiino.orn PDnMo AnnDLCC �'` Or O149L4 0 ' APN# 3� �I % GU7Z- /GV 2- �CCfJZ-/a !/L� /D to ,/ 3z Io Z J�"� ^' OWNJ{ME ,d CJ��g2x -S-3 ' SZ7E-MAIL PHONE n I "1 f STREET,ADDRESSO STA . `1Y, C AP CANTItj PHONE E-MAIL d- 7- rr 3 STREET140DRF,$ f .STATE, ZIP � FAX • � P � S (❑OWNER � ❑ OWNER -BUILDER ❑ OWNER AGENT ,CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ EN0NM ❑ DEVELOPER ❑ TENANT C CTQR NAMELI NUMB LI T$ E BUS. LIC. # Ill u l 5 COMP��AjvIE � I V G �O /�� E-MAIL FAX sTREE V EL 9T STATE 1 L Jy W . !`I �V . ARCHITECT/ENGINEERNRME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP NE USE OF ErSFD or Duplex ❑ Multi -Family ROOF A15? VALUATION: r ❑ Commercial �{� Y- �( STRUCTURE: (� / EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO.PLYWOOD I W. ❑ PLYWD 11OSB PITCH: ROOF 5KNO # LAYERS: THICKNESS: ❑ 5/8" TYPE: Ea CDX 12 CLASS: `4 PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES 99OTHER ICC -ES REPORT # DESCRIPTION OF WORK: Ely By my signature below, I certify to each of the Poll ng- I am the property owner or authorized agent to act on the property o eros behalf./have have read this f.ply application and the information I have provide tr Wit. I have Fead the Des ' tion of Work and verify it is accurate. I agr to comth all applicable local ordinances and state laws relating to 1pildi co s on. I riz enta 'ves of Cupertino tc enter the inspection purposes. abo7�t� Signature ofApplicant/Agent: SUPPLEMEORMATION REQUIRED _ If building is associated with a Home Owner's Association, provide letter -x:'�-i-"-:�� c •3r-;: {r�.�,..�,. _. -yam .. �. � f 4} ,� ...A : ,� -_ ...� .. 1to11NcL>P . " 1?�AN•REVIEW of approval from HOA.P — Provide Planning approval to verify if there any restrictions. ^�. �Z�r-Fi'ad�, ,�t'..•,ya T�ItES$ :: xg.� 4..:wy �4r y .,R..... '.�',. - -r � P�A2�INIIQG Prov: copy of Manufacturer's Installation Specifications. r PL7s1V"RENEW _ Provide signed copy of Cupertino's Tear -Off Policy. (] + ReroofApp_2011.doc revised 03/02/11 YS