11090044 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10166 ENGLISH OAK WAY CONTRACTOR:DRAEGER PERMIT NO: 11090044
CONSTRUCTION INC
OWNER'S NAME: MCINTIRE LORRAINE E TRUSTEE 605 COMMERCIAL ST DATE ISSUED:09/13/2011
VNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420
❑ LICCE�NSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB
License Class C� Lic.# � �, "` "`
/� MECH RESIDENTIAL COMMERCIAL
Contractor �fff?E/� J tV rU J{ Date
I hereby affirm that I am licensed under the provisions of 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
PRESIDENTIAL TL ASPHALT SHINGLES. INSTALL SHINGLE
Code and that my license is in full force and effect.
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:34232140.00 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 CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�? Issued by: / / "Y Date:
Signatur Date1.41
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
1,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,
Business&Professions Code) Sign�r!f Applican Date:
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: HAZARDOUS MATERIALS DISCLOSURE
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 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 by the Bay Area Air 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 must Ownf r or autl zed a C
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"ark'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
-inify 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
gi i..;,ing 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 . . . . . . . . : 34232140. 00
DATE ISSUED. . . . . . . : 09/13/2011
RECEIPT #. . . . . . . . . : BS000014752
REFERENCE ID # . . . : 11090044
SITE ADDRESS . . . . . : 10166 ENGLISH OAK WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MCINTIRE LORRAINE E TRUSTEE
ADDRESS . . . . . . . . . . : 10166 ENGLISH OAK WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
WWI REROOF PERMIT APPLICATION _—
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333 • buildingcuper ino.org \
CUPERTINO (a \
PROJECT ADDRESS , APN# 3
OWNER NAMET PF[ONERl6 E-MAIL
mC i".TIt2 L 1 ry L T�Ll1
STREET ADDRESS CITY, STATE, FAX
it Lr1 ZIP Cc ev ti n o Cit q5oY4
APPLICANT NAMEw Je� PHONE E MpII e�
STREET ADDRESS 25 r'va C17Y,STATE,ZIP�Al n F ``Mt
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINFMR ❑ DEVELOPER ❑TENANT
CONTRACTOR NLICENSE NUMBER ' LICENSE TlP BUS.LIC.#Z
COMPANY NAME C/ " E-MAIL FAX
STREET ADDRESS I�+ CITY,STAT1 V'`5c q5I/Z PHO 4o - ,-O
+4l!
ARCHITECT/ENGINEER.ENAIYF- LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUA'T'ION: `
r
STRUCTURE: ❑ Commercial 'b v 61 C,C,
. L
I yn:NG ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SINGLES AVOOD SHAKES ❑WOOD SHINGr ❑OTHER(SPECIFY)
REMOVE/REPLACEAYES IF NO, PLYWOOD h" 11 TYPE:
11 OSB PITCI� ROOF
❑NO #LAYERS: THICKNESS: E35/8" TYPE: CDX i 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF AASPHA.LT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK (/
✓—D ic-E � X
-par
r r` Ps at TL6sp/VAin C<, IV
L h
By my signature below,I certify to each of the following: I am 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 verity it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to building construction. I authgrize
r ntatives of Cupertino tc enter the above-identified for inspection purposes.
Signature of Applicant/Agent Date: I
SUPPLEMENTAL INFORMATION REQUIRED - - - _
_Ifbuilding is associated with a Home Owner's Association,provide letter
of approval from HOA.
Provide Planning approval to verifY If there any restrictions. =EE ZF' ,r.- �—
Provide copy of Manufacturer's Installation Specifications.
'S<I•`�1r��DS,�..:%�_ �—,�_ =— `,�_�Lam__
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_201 Ldoc revised 03/02111