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11050262CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10113 AMADOR OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050262 CONSTRUCTION INC OWNER'S NAME: MIN LEE CHIEH & WEN YANG I 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 O"'NF,R'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C Lic. # 6&7 (&0 BUILDING PERMIT INFO: BLDG ELECT PLUMB r j`-` 1' Contractor Z +� MECH RESIDENTIAL COMMERCIAL Y Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REROOF, 9.8 SQUARES, SINGLE PLY TPO OVERLAY WITH (commencing with Section 7000) of Division 3 of the Business & Professions 2 LAYER FR -10 BARRIER Code and that my license is in full force and effect. 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 Sq. Ft Floor Area: Valuation: $375 performance of the work for which this permit is issued. 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 permit is issued. T)6:� APN Number: 34232024.00 Occupancy Type: APPLICAN"1'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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY F M LAST CALLED INSPE TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additio ie applicant understands and will comply Issued by: Date: With all non -point source re atic)ris per the Cu ertino Municipal Code, Section Signator° Z RE -ROOFS: Date All roofs shall be inspected prior to any r ng material being installed. If a roof is - installed without first obtaining an ins coon, 1 agre o remove all new materials for inspection. 7 ❑ OWNER -BUILDER DECLARATION Signature of Applic / Date: 41, 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROO -COVERINGS TO BE CLASS "A" OR BETTER 1_ as owner of the property, or my employees with wages as their sole compensation, v+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). 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(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 Coinpcnsation, 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 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 "ill maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, S tions 25,505, 25533, and 25 . 53 performance Owner or authorized ager 7`//� S� i Date: z permit is issued. I certify that in the performance of the work for which this permit is issued, 1 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 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 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 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 ofthis city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. eranung 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 3 ITEMS OF 21 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232024.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014515 REFERENCE ID # ...: 11050262 SITE ADDRESS .....: 10113 AMADOR OAK CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 OWNER ............: MIN LEE CHIEH & WEN YANG I ADDRESS ..........: 10113 AMADOR OAK CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 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 10.00 140.00 0.00 140.00 0.00 TOTAL PERMIT ---------- 141.50 ---------- 0.00 ---------- 141.50 ---------- 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cD.cuDeriino.org P1)A=r-r .nnvnce I mgq QV 00 K" l: - - = � N / 0 APN# 2,H:4 /�G, 04 7Vt-S r3' __ lGIt3 -rel u STREET ADDRESS A STAy" • � Fogy" AP C � PHONE Z E-MAIL fA � r � � T STREEDRF,$ P� S f STATE ZIP �� FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CCLICVf NUMB LI�EN$� TYPE BUS. LIC. # V� G� ` 5 COMP00A1vIE '/ �G �Q / E-MAII FAX [i STREET, lylp�� CN QV T CITY. STATE CLI _ ! � l vl cA 5; ARCHITECT/ENGWEERNANTE LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF t,9fDE or Duplex ❑ Multi -Family ROOF VALUATI, N: G� �` , STRUCTURE: ❑ Commercial �'� n U �✓ "� EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES FU7NO. PLYWOOD W. ❑ PLYWD ❑ OSBROOFO RS: THICKNESS: ❑ 5/8" TYPE: 21 CDX — ' 12 CLASS: 1, PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ,,// ❑ WOOD SHAKES ❑ WOOD SHINGLES 9 OTrIER ICC -ES REPORT # DESCRIPTION OF WORK: l o r Ol t/ , l By my signature below, I certify to each of the fill ng: I the property owner ed agent to act on the property owner' behalf. I ha ad this application and the information I have provided ' corre have read the Desc ' on of Wo I: and verify it is accurate. I agree comply with applicable local ordinances and state laws relating to buildin nstru 'on. I authorize rep nta 'ves of Cu ertino tc enter the above-' pyOpert for ' pection purposes. Signature of Applicant/Agent: Date: C `/ SUPPLEMENTAL'TlqfORMATION REQUIRED If building is associated with a Home Owner's Association, provide letter Ov�ER.T� mg:gp 6-Ri i� BUIL7)7NGPYANRE�*IEW £ of approval from HOA.- _ Provide Planning approval to verify if there any restrictions. _�'. n 770?RESS 0 PLAPINII4G PLANTtEVI£R' _ Provide copy of Manufacturer's Installation Specifications. L] 0 �IxzDz Pz — rovide signed copy of Cupertino's Tear -Off Policy.61 - ' ' -- +�' �� `'_t' -.mac -`-.i• ReroofApp_2011.d6c revised 03/02/11 V5