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11050211CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10092 AMADOR OAK CT CONTRACTOR: DRAEGER PERMIT NO: 1105021 1 CONSTRUCTION INC OWNER'S NAME: XU GANG AND MARY MEI 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 ONVNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG � ELECT F- PLUMB License Class_ Lic. #�� ` (.... �— fl MECH RESIDENTIAL COMMERCIAL Contractor(/ �" G Date JOB DESCRIPTION: RERROF, 9.5 SQUARES, SINGLE PLY TPO OVERLAY WITH 1 hereby affirm th, t I am licensed under the provisions of Chapter 9 (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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $375 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 which this APN Number: 34232016.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I ccrtifv that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED Corea. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to buildina, construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS ROM LAST CALLED INSPEC ION. indemnifv and keep harmless the City of Cupertino against liabilities, judgments, costs. and expenses which may accrue,against said City in consequence of the Issued by: Date: granting of this permit. A on' , the applicant understands and will comply with all nun -point sou reg tons per the Cupertino Municipal Code, Section 9 18 A RE -ROOFS: ,�ignaur _ _ _Datw All roots shall be inspected prior to any ro ing material being installed. If a roof is installed without first obtaining an in coon, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: � I hereby affirm that 1 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, \\ ill do the work, and the structure is not intended m offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE L as owner of the property, am exclusively contracting with licensed contractors to 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. 1 will I 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 have 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 1 will maintain compliance with the Cupertino Municipal Code, -Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect'ons 25505, 25533, and 2553 . Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen Date: permit is issued. 1 certily that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, atter making this certificate of exemption, I become subject to the Worker's Compensation provisions of the 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. ,ranting of this permit. Additionally, the applicant understands and will comply 'A ith all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature_ Date CITY OF CUPERTINO 3 ITEMS OF 22 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232016.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014513 REFERENCE ID # ...: 11050211 SITE ADDRESS .....: 10092 AMADOR OAK CT SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: XU GANG AND MARY MEI ADDRESS ..........: 10092 AMADOR OAK CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: SylviaM COPY # : 1 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 9.00 126.00 0.00 126.00 0.00 TOTAL PERMIT ---------- 127.50 ---------- 0.00 ---------- 127.50 ---------- 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 • buildingacupertino.orG pnnterr wnr�vrec Avt A .op— al7-4 o APN#�� 32- C) I J GlJ1Z— /Gy1r2- /C�fJ2_ /y fill /0 JZ2 �/ 32 /0 Z OWNERjd{M/ E � A PHONE n I -S-315J, E-MAIL STREE? ADDRESS STA FAX 2 O -0, AP CANT N PHONE E-MAIL D— r w :y 3 STREE�DR(F.,$ STATE, ZIP 2' FAX om � _54� ElOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT R�CONrRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CT ()RNAME LI NUMB LIjgENTYPE BUS. LIC. # u 16 L coMPi>�1Y�AjvIE V F�l/G�`O E-MAIL FAX STREET, /yl�� QY CITY, STATE CAM12— � —Z 1 V ��/i ,A / ZQ ARCHITEECCT/ENGINEER NAME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP ONE USE of SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: ` ❑ Commercial STRUCTURE: l EXISTING ROOF TYPE: UILT-UP ROOF 11 ASPHALT SHINGLES 1:1 WOOD SHAKES ❑ WOOD SHNGLES • ❑ OTHER (SPECIFY) REMOVE /REPLACE 13YF.S IF NO, PLYWOOD !� w- 11PLYWD El OSB PITCH: ROOF 5KNO # LA=: THICKNESS: ❑ 5/8" TYPE: id CDX —b—: 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLESpTR ICC -ES REPORT # DESCRIPTION OF WORK: lei By my signature below, I certify to each of the foll ng- I am the property owner or authorized agent to act on the property o er's behalf. have read this application and the information I have provide rr t. I have Fead the Des ' tion of work and verify it is accurate. I agr to comply ,• th all applicable local ordinances and state laws relating to 1pildi co tion. I riz a enta 'ves of Cupertino tc enter the abo properr :or inspection purposes. Signature of Applicant/Agent: Date: 5 G SUPPLEME FORMATION REQUIRED `WNW- _ If building is associated with a Home Owner's Association, provide letter � z I~ _� , RoT=G sITP. r . _ nsQ OAR TFn srl g BUXI)ING"P,�AN,REVSEW_ of approval from HOA. _ Provide Planning approval to verify if there any restrictions. t t e— r�'" D Prov: copy of Manufacturer's Installation Specifications. $7EXZ'�tESS �piA'NNII�G PL7iTI RE. Provide signed copy of Cupertino's Tear -Off Policy. ins, � 4h - g Reroof.4pp_2011.doc revised 03/02/11 YS