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11090032CITY OF CUPERTINO BUILDING PERMIT BL ILDING ADDRESS: 10026 SPANISH OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11090032 CONSTRUCTION INC C !ER'S NAME: CHANG GABRIEL KAI LANG TRUSTEE 1605 COMMERCIAL ST ER'S PHONE: ❑ LICENSED CONTRACTOR'S DECLARATION License Class _ ''nnLi.c. # rte ' ?Jb' C% Contractor &JqL( 1+��I��J�wADate % I hereby affirm that I am licensed under the provisions o Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. SAN JOSE, CA 95112 DATE ISSUED: 09/13/2011 PHONE NO: (408)536-0420 BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r— MECH F RESIDENTIAL f— COMMERCIAL JOB DESCRIPTION: SFDWL REROOF, 8.5 SQ, TEAR OFF SHAKE ROOK, INSTALL 1/2" CDX RADIANT BARRIER, INSTALL PRESIDENTIAL TL ASPHALT SHINGLES. INSTALL SHINGLE VENT (RIDGE 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 permit is issued. I Sq. Ft Floor Area: APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date LI OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. 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. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 .mnify and keep harmless the City of Cupertino against liabilities, judgments, ts, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date APN Number: 34232076.00 Valuation: $6700 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA FROM LA AL�L�fE�DPINSPECTION. Issued by: i �/�3 •l l RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 6��_ Q5 Signatur o pplicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. O,w=r or horize a Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional REROOF PERMIT APPLICATION =— COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cuperiino.og CUPERTIN0 Rerooflpp_MI.doc revised 03102111 �1 PROTECT ADDRESS OWNER NAME PHONE E-MAIL C OA m L .Z t. -Z. LAO L4 rg v, r ! STREET ADDRESS zyk�,v CITY, STATE, ZIP FAX r ,� Lvl ev u� mo CAID/ /' Q E M� APPLICANT NAME ` A PHONE q 2111 J C' T CITY, STATE ZIP/�� j STREET ADDRESS J rGQ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N L.I 0 /( LICENSE TYIEHUS. LIC. #COMPANY 4LICENSEUMBER NAME sr�STREET AJL FAX ADDRESS Y, STATE � 4V S q51 JZ () l YHO ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC.' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family ROOF AREA: _ VALUATION:[ STRUCTURE: ❑ Commercial ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) EXISTING ROOF TYPE: /)400D REMOVE /REPLACE. YES IF NO, _71 PLYWOOD 'hn ❑ PLYWD ❑ OSBPTTCIfi L� ROOF A El NO # LAYERS: THICKNESS: El 5/9- TYPE: CDX —7-- .12 CLASS: PROPOSED ROOF TYPE: 11BUILT--UPROOF ASPHALT SHINGLES 11WOOD SHAM ElWOOD SHINGLES ElOTHER ICC -ES REPORT # DESCRIPTION OF WORK r r -o ' x -- hates �c o�� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owners 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 au rize r ntatives of Cupertino tc enter the above-identifiedproperty for inspection purposes. signature. of Applicant/Agent Dom' SUPPLEMENTAL INFORMATION REQUIRED - _ _ If building is associated with a Home Owner's Association, provide letterer _ of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. - ; = T.. _ 2 Provide signed copy of Cupertino's Tear -Off Policy. _ = -� �3 v3' Rerooflpp_MI.doc revised 03102111 �1