05080231 (2) COPY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORAN5.FORMATION
BUILDINGADDRESS: DRAEGER CONSTRUCTION INC PERMIT NOO5080231
0892 CANYON TA DR
OWNER'S NAME: PERMIT ISSUE DATE
COMPASS MANAGEMENT 605 COMMERCIAL ST 08/25/2005
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
uoo .LICENSED CONTRACTOR'S DECLARATION
n I M1eroby affirm that 1 am licensed under provision of Chapter 9(commenting Job Description
iou with Section 7")of Division 3 ofthe Business and Professions Code,atld my license is _
« imm�force and cit O REROOF—OVER LAY. W/DURO-LASTe`ON A BUILT-UP ROOF
j = License Cl l��i S Lic.1
zoo Da¢ N—SO-07 Con
ussmr
ARCHITECTS DECLARATION
3LLFF—t I understand my plans shall W used as public meet& /' p
Licensed Profenim.lut
ut OWNER-BUILDER DECLARATION
I
1 hereby affirm Nal l am exempt room the Contractors License Law for the 1 \ qt y/���
Ka C (ollowin,mann.(Secdon 703 1.5,Business and Profession Cale:Any cityor county '�i1 5 V.1111 a�T $7254
m which requires a snit to ennswct.alcor,improve,demolish,or repair an structure r
prior b)its issuance,also requires the applicant for such permit to Ne a signed statement wont lac/ I u V �e1T
Nat W is licensed pursuant the provision of the C.ntncnra License Li.(Chapter 9 Sq. Ft. Floor Area Valuation
,el-$ (commencing with Section 7(X00)of Division 3 or the B usiness and Profession Chile)or
to
`s— Net h<is exempt therefrom and the basis fer the alleged exemption.Any violation or
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penity of
not mart Nan five hundred dollars(5500), f Occupancy Type
El
I,as owner of the propmty,m my employees with wages u Noir sole compcnmion,
Mil do the.,it.and Ne swaum isnot intended.,offered for sale(Sec.7044,Businns
and Professions Code:The Contractor's License Law does not apply to an co m,or Required Inspections
property who builda orimproves thereon,and who does such work himself.r through his
own employee,provided Nat such improvements arc not intended or offered formic.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of moving that he did not build or improve for puryosc of
ale.).
❑1,as owner of the property,am exclusively contracting with licensed wnuacams in
connnsct the projea(Sec.70a4.Business and Professions Code:)The Contractors Li.
nue Law docs not apply to an owner of property who Wilds or improves Merton,and.
who contracts for such projects with a contractor(s)licensed pursuant on Ute Contractors
License law.
❑I am exempt under Sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I haw and will maintain a Certificate of Consent to mlf.imum for Worker's Compete
1M37y
on,as provided for by Section 3700 of theN
Later Code.for e performance of the
rk for which Nis permit is issued.
1 haw and will maintain Worker's Compensation Insurance,a requited by Section
W.f the labor CadeNnc
,for e perfmmaanr the work for which Nitis permis issued.
Workers C9tnrcnatian homm nce artier and Policy numberarc:
rrie.a U'cOel (`a(Y�Cy No.: IQ N R 43>{l7—
OF
EMPTI FROM WORKERS
COMPENSATION INSURANCE
(This section need not becompleted irthe Permit is for one hundred dollars($100)
or Icsn)
1 coni ry that in the Performance of the work for which this permit is issued,I shall not
employ any person in any manners,as n become subject o the WorkersCompensation
Laws or California.Da¢
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Wcome subject n the Worker's Compcassti.n provisions.r the Labor Cole.you m u
.J z forthwith comply with such provision or this permit shall W doomed cooked.
'Z'" CONSTRUCTION LENDING AGENCY
I Wrcby affirm that there is...Curb lendingagcmy,for the patfirmance of
[� the work for which this permit is issued(Sec.3097,Civ.C.)
LQ Q Lenders Name
= ,z Lender's Add.
U Q 1 certify Nu I have rad this application and ser¢tha the show information is
W CorecL I agree to comply with all city and county ordinances and state laws relating to
CU building consu.ction.and hereby auth.riw nqueacntatiws of this city to enter upon ft
ly above-mentioned pnperty for inspection purposes.
(~ IY (We)agree to saw,indemnify and keep harmless the City.(Cupertino agaimt
vy
SO R liabilidCajudgmenu,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
R GULAT S.
Re-roofs 'q'
Signature of Applicant/Conuncnr Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle haarmus material
as defined by the Cupenin,Municipal Code.Chapter 9.13,and the Health and Safety
Code.section 25532(1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or Jcvice ONO
a roof is installed without first obtaining an inspection,I agree to remove
it hanrdous air contaminants as defined by the Bay Area Air Quality Managcmcm all new materials for inspection.
ct7 J
❑Yes /fTNN\u
1 haveread the harardousmatcri.b.,Fd. ms umk,Chapter6.95.fthe Calif.,
nia Health&Safety Cock,Semon 25505.25533 amI25 l onWrstand thm if 11rc Wilding
don not cmmmly haw a¢nano Nat it is my mspomihility n notify tW scup.,or the
mgaim hien Wme issaaneOf.CertifiateorGcapar¢y. Signa[ureofApplicant Date
11 x n w � —` y_ZS o All roof coverings to be Class'B"or better
00.ocr or authodmd agent part
M Community Development
10300 Torre Avenue
j F Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
O.7D 8:e�z3/
OWNER'S N a� PHONE # slag, a
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
✓ Roofing elk{. -7 (. 1 D
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
aamu
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY-OF Telephone: (408) 777-3228
U P E t�T I I�Ip'® Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
dnd-manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
�® 5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 1[�sc42 l 1 S!2 a 'V
Roofing Company Name: \?ro_e c e� N
Applicant's Signature: Date: -2s-oS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF �s�'�° 23
OW-CUPEI�TINO PERMIT APPLICATION FORM
APN # � (� 0 Z Date:
Building Address:
v, s
Owner's Name: Phone #:
c q
Contractor: Phone#: License #:
1 .7
Contact^ Phone#: Cupertino Business License 9.-
Type
:Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) -H' Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residerit all Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
3AS,�i Re
Qty. if
Applicable Fee ID Fee Description Fee Gro up
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
3 �f2-1