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11050277 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10038 DOVE OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050277 CONSTRUCTION INC OWNER'S NAME: PRADIP JHA 605 COMMERCIAL ST DATE ISSUED:08/22/2011 ONNAER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420 ❑ ,ICENSED CONTRACTOR'S DECLARATION I� f— f— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Cl as Lie.# � — ����� MECH RESIDENTIAL COMMERCIAL Contractor f'i Date Z S �� JOB DESCRIPTION: RE-ROOF 9.5 SQ- 1/2"PLYWOOD,TPO OVERLAY WITH 2 1 hereby affirm that I am licensed under the provisions of Chapter 9 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. 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. Sq.Ft Floor Area: Valuation:$375 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 forP", i fys APN Number:34232089.00 Occupancy Type: permit;s issued (��/� APPLICANT CER'T'IFICATION 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 DTOM LAST CALLED INSPECTION. mdenurily and keep harmless the �'�t 'of Cupertino against liabilities,judgments, costs.and expenses which ni, accrue against said City in consequence of the -ranting of this permit. itionaliy,the, licant understands and will comply Issued by: Date: with all non-point sou regu ions per e <upertino Municipal Code,Se [ion 9.18. 1 RE-R 1"'S: Signature Date All roofs shall be inspected prior to an offing material being installed. If a roof is installed without first obtaining an i pect "n,I a e o remove all new materials or inspection. .J ❑ OWNER-BUILDER DECLARATION Signature of Applicant Date: I 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 1.as owner of the property,or my employees with wages as their sole compensation, s\ill 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. I 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(a)should 1 store or handle hazardous I have and%N ill maintain a Certificate ofConsent to self-insure for Worker's material. Additionally,should 1 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 performance of the work for 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 ff alth&Safety Code,Se i ns 25505,25533,and 25534 ' Section 3700 of the Labor Code,for the performance of the work for which this �/ �� � �'/Date: Owner or authorized agen 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 CONSTRUC'T'ION 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 fiorth%vith 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 ccrtily 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 L;1)011 the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,;osts and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. "ranting of this permit.Additionally.the applicant understands and will comply nh 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 . . . . . . . . : 34232089 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT # . . . . . . . . . : BS000014508 REFERENCE ID # . . . : 11050277 SITE ADDRESS . . . . . : 10038 DOVE OAK CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . PRADIP JHA ADDRESS . . . . . . . . . . : 10038 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 CUPERTINO (408)777-3228• FAX(408)777-3333 • building(mcupertino.org 14,1) 624,k_ 01- 05 0 2�-�- pnnrcrr nnnntcc APN# p -rte nL5y'Z OV,rntcn,.., P J/ � E-MAIL STREET ADDRESS STATE ZIP FAX 2,Z(1-70 AP CANT N PHONE E-MAIL J'yr 3 S ;ABDR1;�S I/ISL P �f ST jc�Y!S� ATE ZIP FAX ❑OWNER (❑OWNER-BUILDER ❑ OWNER AGENT 5;CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT COCT(�RNAME LI NUMB LI ENTYPE BUS.LIC.# 6 lo COMP5n Y 'A/G LO E-MAIL FAX S � CIQY t- ,�� C ,STATE CiA ARCHTTECT/ENGINEER NAME LICENSE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family ROOF AREA VALUATION- •� STRUCTURE: ❑ Commercial -1 (�� �7/ (� o) ld EXISTING ROOF TYPE: UI,T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD fiz/S- ❑ PLYWD EDOSB PITCH: ROOF O #LAYE THICKNESS: 135/8" TYPE: 21 CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ;9OTHER ICC-ES REPORT# DESCRIPTION OF WORK: � O(�2!/�. l 2q,Z By my signature below,I certify to each of the following: I e property owner or au zed ent to act on the property owner's behal I have read this application and the informaton I have provided is corre ave read the Descripti f Work d verify it is accurate. I a ee to co with all applicable local ordinances and state laws relating to building cons c' I authorize repre ves of Cu 'no tc enter the abo 'fled prop for inspection purposes. Signature of Applicant/Agent: Date: 44 SUPPLEMENT ION REQUIRED " �VMS `i+�ace1 * _If building is associated with a Home Owner's Association,provide letter of approval from HOA. ou�R_r»sn at $uIIaoING! RE EW`' Provide PIanning approval to verify if there any restrictions. 'EXP,RESS � ❑ P,LA°NfIING PLATTREVIER'- Provide copy of Manufacturer's Installation Specifications. r C7 raNnnsD D nR r'DM, rovide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11