11050279 CITY OF CUPERTINO BUILDING PERMIT
Bt'IWING ADDRESS: 10058 DOVE OAK CT CONTRACTOR:DRAEGER PERMITNO: 11050279
CONSTRUCTION INC
ON)NER'S NAME: ANA D SOUZ& LYNN ENG WEI 605 COMMERCIAL ST DATE ISSUED:08/22/2011
OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420
❑ ICI;NSED CON'TRACTO 'S DECLARATION I
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clas Lia ( F_
_ MECH RESIDENTIAL COMMERCIAL
Contractor ` ` Date ?S
JOB DESCRIPTION: RE-ROOF 9.5 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2
1 hereby affirm that 1 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.
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 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 f ich this APN Number:34232087.00 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 DAY ROM LAST CALLED INSPECTION.
indenin ly and keep harmless the y of Cupertino against liabilities,judgments,
costs.and expenses which m accrue against said City in consequence of the � 1/
eranting of this permit. A rtionally,the applicant understands and will comply Issued by: 'L Date:
ith all-lion-point so uc regul ions 7ertino Municipal Code,Section
R - OOFS:
Signator Date t� All roofs shall be inspected prior to y roofing material being installed. If a roof is
installed without first obtaining a mspeCtion,la ee remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Z
Signature of Applican Date:
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 mvncr of the property,or my employees with wages as their sole compensation,
ill do the work.and the structure is not intended or offered for sale(Sec.7044,
13ustness& Professions Code)
f L as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
1 construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
j 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(a)should 1 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
i C ompensation,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
pet I romance of the work for which this permit is issued. will maintain compliance wit he 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-25534./
3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen z'/L'( Date:
permit is issued.
1 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,1 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
lorthwith comply vith 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
corre,t. I agree to comply with all city and county ordinances and state laws relating
to buiidtng 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
indunnifi-and keep harmless the City of Cupertino against liabilities,judgments,
casts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
grantiug of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
—
Q 18.
Signature__ _ _ Date
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34232087 . 00
DATE ISSUED. . . . . . . : 08/22/2011
RECEIPT #. . . . . . . . . : BS000014508
REFERENCE ID # . . . : 11050279
SITE ADDRESS . . . . . : 10058 DOVE OAK CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANA D SOUZ & LYNN ENG WEI
ADDRESS . . . . . . . . . . : 10058 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 765 . 00 0753
---------------
TOTAL RECEIPT 765 . 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
CUPERTtNU (408)777-3228• FAX(408)777-3333 •building aacuper'rino.org
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USE OF FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION�', •�(I/x'
STRUCTURE: ❑ Commercial �7 (/�(� h �/ k� /) (V ` c
EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO. PLYWOOD h" ❑ PLYWD ❑ OSB PITCH: ROOF
56NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: 21 CDX '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ,9OTIRER ICC-ES REPORT#
DESCRIPTION OF WORK-
By
ORKBy 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 information I havgprovided is corre ave read the Des
f Work d verify it is accurate. I a ee to comp] with all applicable local
ordinances and state laws relating to building cons c' . I authorize repre ves of Cu 'no tc enter the above-:dafied prop for inspection purposes.
Signature of Applicant/Agent: Da44
te:
SUPPLEMENT ION REQUIRED
_If building is associated with a Home Owner's Association,provide letter P Tom " -"' .. G sL7p r
of approval from HOA. ov�x -+,pzat BUII�1G>�tAN..RErw
Provide Planning approval to verify if there any restrictions.
;: 1rXP,RESS � PLA"NNA'G PLATTREYIEVi
Provide copy of Manufacturer's Installation Specifications.
-STAND)=,
0 FIxEnFPs -
rovide signed copy of Cupertino's Tear-Off Policy.
Rerooftlpp_2011.doc revised 03/02/11