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11050270 CITY OF CUPERTINO BUILDING PERMIT SING ADDRESS: 10020 MOSSY OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050270 CONSTRUCTION INC OWNER'S NAME: TING EDWARD C AND ALICE C 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 � BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# /0 MECH RESIDENTIAL COMMERCIAL Contracto Date Z,..f JOB DESCRIPTION: RE-ROOF 9.5 SQ- I/2"PLYWOOD,TPO OVERLAY WITf1 2 hereby affirm that 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 nry license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: ! have and will maintain a certificate of consent to sell'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 for which this APN Number:34232103.00 Occupancy Type: permit is issued. Y� 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. indemnify and keep harmless the City of Cupertino against liabilities,judgments, tl costs,and expenses which may accrue against said City in consequence of the ryn 2 -ranting of this permit. Additionally,the applicant understands and will comply Issued by: V1 '!zL Date: with all non-point source regulati per the Cupertino Municipal Code,Section y 18. : /_, G RE-R Signature_ % G Date o �� All roofs shall be inspected prior to an ofing material being installed. If a roof is installed without first obtaining anpection,I agree to remove all new materials for inspection. ElOWNER-BUILDERDECLARATION Signature of Appli �� —Date: Z �� I 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 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) 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 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 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 for which this permit is issued. will maintain compliance with the Cupertino Municipal de,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' ns 25505,25533�jand 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager : �lG� 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If after making this certificate of exemption, I 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 forth\�ith 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 1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature -- Date_ — CITY OF CUPERTINO 3 ITEMS OF 19 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 34232103 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014512 REFERENCE ID # . . . : 11050270 SITE ADDRESS . . . . . : 10020 MOSSY OAK CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : TING EDWARD C AND ALICE C ADDRESS . . . . . . . . . . : 10020 MOSSY OAK CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5615 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 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 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 \ (408)777-3228• FAX(408)777-3333•buildlnaCCDCUDeriino.om CUPERTINO �/ pa nrsr-r�nr�v.ec J S5 1 G Cf . _ _ .j' v OWNER NAME, /T �/�I , j� I PHnw�c c.,kkm - `^-l/l PSTATc�P FAX SIRESI ADDRFcc. n 1 - ' EMAIL C�MDRM 1?� -f yt ( ZIP / FAX ❑DWNER ❑ OWNER-BUILDER ❑ OWNFAAGE,7 CONTRACTOR ❑CDNTRACTORAGENT ❑ Apo-rrmCT ❑ENGwEER ❑ nrrELoPr'R ❑TENANT C CTQR NAMELI S NIIMH LIfy1 T'$�TYPE BUS.LIC. to c` `� E-MAIL FAX CITY,STA sTRET8r 1.V4&Voe ARCHrIBCT/ENGINFERNAMb. LICENSE BUS.LIC. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE;.ZIP PHONE SFDorDuplex ❑ Multi-Family RDOF """'°TT^"' 2{p2�- 1h USE of Commercial ld��'/�(/- .� �. �� u 1,; STRUCTURE: ❑ "► EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHADS ❑WOOD SHINCH ❑OTHER(SPECIFY) REMOVE/REPLACE ❑ El IF NO. PLYWOOD g%7 ❑ PLYWD ❑ OSB PITCH: ROOF O n LAYERS: MCKNESS: 13 5/8" TYPE: 5a CDx ��( ��'12 CLASS: A` PROPOSED ROOF TYPE: ElBUILT-UPROOF ❑ASPHALT SIBNGLES WOOD SHAKES ID �'F WOOD SHINGLES OTHER ICC-ES REPORT f DESCRIPTION OF WORK I o �V ! r 2 -g/— t=yJ lG By my signature below,I certify to each of the followi I the property owner thdrized agent to act on the property owner's behalf. I have read this application and the information I have provided is c c have read thc"Des ' tion o Work and verify it is accurate. I e to c y with all applicable local ordinances and state laws relating to building c n. I a orize re entatives f Cupertino tc enter the above-i tified pro rt for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLE ME AL ORMATION REQ ...max --�rfi--R�M1•�`-�.�M� r.�"�.��. �+.r-�:-��'�—, �r ._.-.�- y-. 7_ If building is associated with a Home Owner's Association,provide letter RE of approval from HOA. E��o«R.TaE-nbo 4 `BusznalG K RES+ w - _Provide Planning approval to verify if there any restrictions. _ 7 kis _ 0 PL7+N2�TII]cYLANRES"IEW Prov' e copy of Manufacturer's Installation Specifications. r� , _Provide signed copy of Cupertino's Tear-Off Policy. J - ReroofApp 2011.doc revised 03/02111