11090036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10046 SPANISH OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11090036
CONSTRUCTION INC
OWNER'S NAME: YEUNG CHICK M&TANG GRACE KA SHUN 605 COMMERCIAL ST DATE ISSUED:09/13/2011
ER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f- ELECT PLUMB
License Class Lie.#
MECH RESIDENTIAL COMMERCIAL�
Contractor COP �- Date 1
I hereby affirm tha I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SFDWL REROOF,8.5 SQ,TEAR OFF SHAKE ROOK,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL
Code and that m license is in full force and effect. 1/2"CDX RADIANT BARRIER,INSTALL PRESIDENTIAL TL
Y 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
Sq.Ft Floor Area Valuation:$6700
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34232078.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAY FROM LAS CALLED INSPECTION.
9.18.
Signature / Date Issued by: ate:
LJ OWNER-BUILDER DECLARATION /�•/�
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree AP remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. A
Business&Professions Code) — ✓
Sn
1,as owner of the property,am exclusively contracting with licensed contractors to ig <re f pplicant Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
or o 'zed nt•
forthwith comply with such provisions or this permit shall be deemed revoked. > Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of%ork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
inify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
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 34232078. 00
DATE ISSUED. . . . . . . : 09/13/2011
RECEIPT #. . . . . . . . . : BS000014752
REFERENCE ID # . . . : 11090036
SITE ADDRESS 10046 SPANISH OAK CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YEUNG CHICK M & TANG GRACE KA
ADDRESS . . . . . . . . . . : 10046 SPANISH OAK CT
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 6, 700 .00 1. 00 0 . 00 1 .00 0. 00
1BSEISMICR VALUATION 6, 700 .00 0.67 0. 00 0 .67 0 . 00
1REROOFRES SQ FEET 9.00 126. 00 0. 00 126 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127.67 0. 00 127.67 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 _ `0
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333 -buildingcupertino.org
CUPERT{N4 (a \
PROJECT ADDRESS 1 SPC)j to APN# 3L-1 AMS� 6019 et I
OWNERNA M (�� AIL
PHONE E-Mo
U N c H�u �,� -4- -rA-\jt c" was ,, 416- 1
STREET ADDRESS ,TV r CITY. STATE ZIP 1411 / +n Q n� 0, FAX
APPLICANT NAME w� � PHONE
STREET ADDRESS 05 4LOtt r f`� CITY,STATE
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR
CONTRACTOR N LICENSE NUMBERL/ ® LICENSE TYPE�� BUS.LIC#�
COMPANY NAME NST ! E-MAIL FAX
FAX
STREET ADDRESSl_ _ CMY,STATE, J gSI/Z PHO 0
ARC=CT/ENGINEER NAME LICENSE NUMBER 5 BUS.LIC.A
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: t �i
STRUCTURE: ❑ Commercial J�1 JC7 ` G,
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES A'OOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACEKYES IF NO, PLY-WOOD 'h" ❑ PLYWD ❑ OSB PITCFL ROOF
ElNO #LAYERS: THICKNESS: El5/B" TYPE: CD X -.12 CLASS:
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF AASPHALT SINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑0THER ICC-ES REPORT#
DESCRIPTION OF WORK _
✓—O f17 LU 6D&
-rte,
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. Iau rize r ntatives of Cupertino tc enter the above-identifiedpropert;for inspection purposes.
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUIRED = - — --
If building is associated with a Home Owner's Association,provide letter—
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications. :� _
-'_, '.....r.-4• .+ =r;,z:__
_Provide signed copy of Cupertino's Tear-Off Policy. =�_.;�_9�=-�,-.___^;__ .o,,.• �___�%,r_.� �:;—=;
�'�
ReroofApp.2011.doc revised 03/02/11