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11050233CITY OF CUPERTINO BUILDING PERMIT BI ILDING ADDRESS: 22659 WEEPING OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050233 CONSTRUCTION INC OWNER'S NAME: AUDREY WANG 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION I— h f— License CI -s ' Lic. # BUILDING PERMIT INFO: BLDG ELECT PLUMB F" f— (� -/ MECH RESIDENTIAL COMMERCIAL Contractpr /i t y Date 1 hereby affirm t at 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE -ROOF 10 SQ- 1/2"PLYWOOD, TPO OVERLAY WITH 2 (commencing with Section 7000) of Division 3 of the Business & Professions LAYER FR -10 BARRIER 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 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 APN Number: 34232034.00 Occupancy Type: permit is issued. R APPLICANTCERTIFICATION 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 1 0 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 TION. 180 DAY OM LAST CALLED IN7FA indemnitN and keep harmless the City of Cupertino against liabilities, judgments, cost;_ and expenses which may accrue against said City in consequence of the granting ofthis permit. Additionally, a licant understands and will comply Issued by: Date: with all non -point source regulon s per e Cuper unicipal Code, Section If 9 18. RE -ROOFS: �.-- Signature_ Date All roofs shall be inspected prior to any roofin aterial being installed. If a roof is installed without first obtaining an inspec n, agree to remove all new materials for inspection. ❑ OW'NL:R-BUILDER DECLARATION ` Signature of Applica ate: 1 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) 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 1 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 I store or handle hazardous I hay e 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 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 Section 3700 of the Labor Code_ for the performance of the work for which thist the Health & Safety Code, Sections 25505, 25533, and 255 Owner • CE S 70� y Date: permit is issued. or authorized agentl// 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. II; after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions ofthe Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith 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 certifv 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 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. granting 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. Slgnalnre Date /i/ CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232034.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014522 REFERENCE ID # ...: 11050233 SITE ADDRESS .....: 22659 WEEPING OAK CT SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 OWNER ............: AUDREY WANG ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5632 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(ftuper'tino.ora 11 ()156 23 3 0W k-_ —a # PD n Ma" �A n�nD=C //// I AFRI /.ill) I 2 v 3 OWT`n n *•A dr PHONE-e2E-MAIL- STREEADDRESS0 `I l� C-( FAX AP ICANT "A PHONE E-MAIL STRE'R7:,$ ! C , STATE ZIP FAX 1 An 4 _54 (❑ 13 OWNER OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTQRNAME r/l u 90%, LI NUNID lo LIJgEN TYPE BUS. LIC. # COMP.�YPXe, - jj, Y /� E-MAILAX STREET�� fy1JI�(�lE-MAILCy l c STA _ / � cT/� �,. QY LA [ ARCHMECT/ENGINEEER NAME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STRUT ADDRESS CITY, STATE, ZIP PHONE USE OF FD or Duplex ❑ Multi -Family ROOF AREA: v S'l/i'�i 2/V?�(j�. O V.A117A-rrnwr. �i Commercial ! f` %� 2 C! Ko STRUCTURE: ❑ 'Vf P)1,; (i EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO, PLYWOOD w. ❑ PLYWD ❑ OSB PITCH: 12 ROOF O #LAYERS TrIICKNESS: ❑ 5/8" TYPE: CDX ' CLASS: `� PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ;9OT1IER ICC -ES REPORT # DESCRIPTION OF WORK: znlo By my signature below, I certify to each of the followi . I am property owner or autho ' ent to act on the property owner's behalf. I ve read this application and the information I have provided i c ect. i e read the Description O and erify it is accurate. I agree t comply all applicable local ordinances and state laws relating to buildin ction autho ' sentati of Cupertin tc enter the abov-'den ' I property ` inspection purposes. Signature of Applicant/Agent: Date: li C SUPPLEMENTAL TION REQUIRED _ If building is associated with a Home Owner's Association, provide letter 42 _ A oL vis o ,JXR ��c Pr•�Nit�vi ° of approval from HOA. —Provide Planning approval to verify if there any restrictions.ss � ,, K O-�LAIu.*>�tcPL�vIZEVI3:w:. Provide -copy of Manufacturer's Installation Specifications. f s5.. 1 :,-il,`ovide Cupertino's Tear signed copy of -Off Policy. 4 r S"i+�'6..,�d,.`ywypa—.ae. ReroofApp_2011.doc revised 03/02/11 V5