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11090039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10116 ENGLISH OAK WAY CONTRACTOR:DRAEGER PERMIT NO: 11090039 CONSTRUCTION INC OWNER'S NAME: FAJARDO LUIS F AND LORELA TRUSTEE 605 COMMERCIAL ST DATE ISSUED:09/13/2011 iER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION / 1 ^ BUILDING PERMIT INFO: BLDG� ELECT PLUMB� License Class C Lic.# W( � C k Contractor MECH RESIDENTIAL r COMMERCIAL fe1 t�e I CV fJ S Date I hereby affirm that I am licensed under the provisions o Chapter 9 JOB DESCRIPTION:SFDWL REROOF,11.6 SQ,TEAR OFF SHAKE ROOK, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL 1/2"CDX RADIANT BARRIER,INSTALL Code and that my license is in full force and effect. PRESIDENTIAL TL ASPHALT SHINGLES. INSTALL SHINGLE I 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. 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 this Sq.Ft Floor Area: Valuation:$9000 permit is issued. APPLICANT CERTIFICATION APN Number:34232145.00 Occupancy Type: 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 of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DA S FROM L T CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. g Issued by: �'"� /V/ -"�� Date: Signature Date � OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection, will do the work,and the structure is not intended or offered for sale(Sec.7044, j C Business&Professions Code) Signature o A plicant: ate: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined b the Ba Area Air y y Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 mustau torized r . / Z forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save -nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address .and expenses which may accrue against said City in consequence of the g,;ding of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 54 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34232145 . 00 DATE ISSUED. . . . . . . : 09/13/2011 RECEIPT #. . . . . . . . . : BS000014752 REFERENCE ID # . . . : 11090039 SITE ADDRESS . . . . . : 10116 ENGLISH OAK WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FAJARDO LUIS F AND LORELA TRUS ADDRESS 4190 CHERRY OAKS PL CITY/STATE/ZIP . . . : PALO ALTO, CA 94306-3841 RECEIVED FROM . . . . : DRAEGER CONSTRUCTIO 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 9, 000 . 00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0. 00 0. 90 0. 00 1REROOFRES SQ FEET 12 . 00 168. 00 0 . 00 168 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 169. 90 0. 00 169.90 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 _ 1 10300 TORRE AVENUE •CUPERTINO, CA 950143255 CUPERTINA (408)777-3228• FAX(408)777-3333 • buildingacupertino.org \ 10 cm-era PROJECT ADDRESS / t� APN A 344 D 3L`� /4-S ROWNEL_L)1 r4 `-C~ CLA TL l.F-'�, ONER!6- E-MAIL STREET ADDRESS ,^� ( � 1A I "" � �/ f�O A� 0> FAX APPLICANT NAMEZ g w M ,/ PHONE 5 �'� EMAIL �/ strUe (��,v. STREET ADD:!;?,o c�TMIr�/�r/^`a � CITY,STATE,ZIP �� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TE24ANT CONTRACTOR N LICENSE NUMBER L,f� j® LICENSE TYP)�� BUS.LIC.# COMPANY NAME �/ NCY E-MAIL • FAX STREET ADDRESS 60s - CITY,STA A US g51I Z PHO A ARCHITECT/ENGAIEER NAME LICENSE NUMBER BUS.LIC.-9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE Of SFD or Duplex ❑ Multi-Family ROOF AREA: ^ VALUATION: /!,(") STRUCTURE: ❑ Commercial `` i (�/. CC EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AVOOD SHADS ❑WOOD SHINGL S ❑OTHER(SPECIFY) REMOVE/REPLACE/KYES IF NO, PLYWOOD h" ❑ PLYWD ❑ OSB PTI CfL 4 ROOF ❑NO w LAYERS: THICKNESS: ❑ 5/8" TYPE: CDX —J— 12 CLASS: PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT'# DESCRIPTION OF WORK �/ ✓-D )CE -parr r 12, J e_ h0QS-�- . ve V41 o� By my signature below,I certify to each of the following: I aro the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I a rite natives of Cupertino tc enter the above-identifiedproperiy for inspection purposes. Signature of Applicant/Agent Date: qlzll SUPPLEMENTAL INFORMATION REQUIRED ' - _ _If building is associated with a Home Owner's Association,provide letter = _ of approval from HOA. - ,— ,,-:T. 50 zip. --• -_��P _Provide Planning approval to verify if there any restrictions, —Provide copy of Manufacturer's Installation S ecifications. _�•� • y E_' -�_- ==`=j P ��a.''�In��a��•mss � _-_-- `~+yam Provide signed copy of Cupertino's Tear-Off Policy. ---�-.ter=3��,,,- =�R- :off• �� ';`=�--�=, ReroofApp_2011.doc revised 03/02,/11