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11050276 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10028 DOVE OAK CT CONTRACTOR: DRAEGER PERMITNO: 11050276 CONSTRUCTION INC OWNER'S NAME: VIVA) RAUT 605 COMMERCIAL ST DATE ISSUED:08/22/2011 ONINER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION �/� BUILDING PERMIT'INFO: BLDG ELECT 'PLUMB License Class Lic.# 017 'L F_ r MECH RESIDENTIAL COMMERCIAL --A Contractor ;��'y V� Date Z, hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 9 5 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2 P P LAYER FR-10 BARRIER (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 ofthe Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$375 1 have and will maintain Worker's Compensation Insurance,as prVided for by Section 3700 ofthe Labor Code,for the performance of the workich[his APN Number:34232090.00 Occupancy Type: permit is issued- APPLICAN"T 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs..and expenses which may ccrue against said City in consequence of the -7� Lranting of this permit. Ad tonally,the a licant understands and will comply Issued by: U�� Date: with all non-point source gulatiglts pe e upertmo Mu;27 .on 9 In. RE-WS: Signature DateAll roofs shall be inspected prior to any of �, ree I being installed. If a roof is installed without first obtaining an i ec on, o remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION — �� Signature of Applica 'Date: 1 hereby affirm that I 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 ov%ner 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 I 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 vices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Ai uality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertin nicip od ,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 533,a 2711)at Section3700 ofthe Labor Code,for the performance of the work for which this Owner or authorized agen l' �/ permit is issued. I certif} that in the performance of the work for which this permit is issued,I shall not emplo} 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,1 CONSTRUCTIOLENDING AGENCY N 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 ccruty 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 huilding consUuction.and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indcnmiify and keep harmless the City ol'Cupertino against liabilities,judgments, posts.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. Signature _Date CITY OF CUPERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232090 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT # . . . . . . . . . : BS000014508 REFERENCE ID # . . . : 11050276 SITE ADDRESS . . . . . : 10028 DOVE OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VIVAJ RAUT ADDRESS . . . . . . . . . . : 10028 DOVE OAK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DRAEGER CONT 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 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 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 PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 1 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTEN4 (408)777-3228• FAX(408)777-3333•buildingacupertino.ora 1602-k 1t05'0�2. �P pnnt=rrennvrcc !tel ry/(��" _ /� — APN# /�r� �'2 D Cl./ Tt1f�.�T[/".Jj� r l STREET ADDRESS STATE 7rIP � FAX AP CANT I� PHONE Z E-MAII. I/ll `�- �y d... .3 T FAX . ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C CTQR NAME LI NUMB LI�gEN$�TYPE BUS.LIC.# Vt G� - 1 5 COMPRa, I V G � E-MAIL FAX S `� Q� (`IAV /O� C STATE (�^ �/ / IQ ARCHITECVENGWEERNAIvS LICENSE �-V` BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE usE of FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION- USE y� w •c11h STRUCTURE: ❑ Commercial .� (/{/j( r {� �� p J) �U I EXISTING ROOF TYPE: KUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD g'h- ❑ PLYWD ❑ OSB PITCH: ROOF 54NO #LAYERS: THICKNESS: ❑ 5!8" TYPE: CDX -:12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER ICC-ES REPORT# DESCRIPTION OF WORK > moi` •e l a O(�!/ti. l 2 -�` �l2 /G By my signature below,I certify to each of the following: I e property owner or au zed ent to act on the properly owner's behal I have read this application and the information I have provided is correc ave read the Descr yeti f Work d verify it is accurate. I a ee to romp with 2. applicable local ordinances and state laws relating to building cons I authorize repre ves of Cu 'no tc enter the abo feed prop for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT ON REQUIRED `tw- -�� -ers..kyr..acc;--•,�-�.��'#-+',�y- �-`t7c ��w k..� -n ��..-��: _If building is associated with a Home Owner's Association,provide letter tP e ?XPE r` ' x LIWI- of approval from HOA. ov�R T -� ht t luzrrG Pnx.REv�w _Provide Planning approval to verify if there any restrictions. ' EXP�LES6 ❑pI;,A'N�G PLATTRE�'IER' - _Provide copy of Manufacturer's Installation Specifications. rovide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02111