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11050209CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10083 AMADOR OAK CT OWNER'S NAME: YAO KO-CHIANG ET AL OWNER'S PHONE: ❑ LICENSED CONTRACTOR'S DECLARATION License Class( ---;)2 Lie. %# 7 0 Contractor /t'� G Date hereby affirm that am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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. 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 fo ich this permit is issued - APPLICANT CERTIFICATION I ccrtif) 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 a crue against said City in consequence of the _ranting of this permit. Add on ly, the applicant understands and will comply with all non -point sourc ° egul• ions per the Cupertino Municipal Code, Section 9.18. Si -gnat 1 Date ❑ OWNER -BUILDER DECLARATION hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: I. as owner of the property, or illy 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) 1. 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 lorthwmth comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that 1 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 1,, buildinu construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indenuuly and keep harmless the C ity 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 ith all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Date CONTRACTOR: DRAEGER PERMIT NO: 11050209 CONSTRUCTION INC 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 SAN JOSE, CA 95112 PHONE NO: (408)536-0420 F— F' BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH I RESIDENTIAL COMMERCIAL JOB DESCRIPTION: REROOF, 9.8 SQUARES, SINGLE PLY TPO OVERLAY WITH LAYER FR -10 BARRIER Sq. Ft Floor Area: I Valuation: $375 APN Number: 34232026.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY M LAST CALLED INWX Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any ro f g material being installed. If a roof is installed without first obtaining an ins ti , I agree to remove all new materials for inspection. j Signature of Applicant Date: - l ALL ROOF C VERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 1 use equipment or devices which emit hazardous 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 the Health & Safety Code, Se 'ons 255005, 25533, and 255 g A�`/� �/ � ' " �_17 1 Date: Owner or authorized a en 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 underst«nd my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 21 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232026.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014515 REFERENCE ID # ...: 11050209 SITE ADDRESS .....: 10083 AMADOR OAK CT SUBDIVISION ......: CITY CUPERTINO IMPACT AREA ...... OWNER YAO KO-CHIANG ET AL ADDRESS ..........: 10083 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 10.00 140.00 0.00 140.00 0.00 TOTAL PERMIT ---------- 141.50 ---------- 0.00 ---------- 141.50 ---------- 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 ATTID L'CQ t�i E-F�•G— APN# Cd� 2 q2- D(�TC!`T (Pooh: d'-Qyg -G-�r(3Q23-41 -3 - / J ✓ OWNER AME STATE 7�IP n' STRETI)DRESS C c�� O ` ! _"TFAX AP CANT Aj PHONE EMAIL STATE, ZIP STREEI�BD SJ_ 'Af / �// ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER GENT QKCONTRACTOR 11 CONTRACTOR AGENrr ❑ ARCHITECT El ENGINEER 11 DEVELOPER ❑ TENANT C (?R N LI NUMB LI E BUS. LIC. # coMP Y NAjE-MAIL vIE ✓Cb r (�l� FAX ( C STATE STREET �� l b 2V � —� ARCHITECT/ENGNEER NAME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE,r�,_' ) ONE USE OF tSfD Duplex E] Multi -Family ROOF A: VALUATI N: �I ❑ Commercial ` 1 STRUCTURE: EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO. PLYWOOD "S., ❑ PLYWD ❑ OSB PrTCH: ROOF A I 54NQ # LAYERS' THICKNESS: ❑ 5/8" TYPE: CDX-b--:12 CLASS: PROPOSED ROOF TYPE: 11BUILT-UPROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES �( ❑ WOOD SHINGLES ;g.. ICC -ES REPORT # DESCRIPTION OF WORK:�I 4 -eg By my signature below, I certify to each of the foil ng: I the property owner zed agent to act on thtproperty owner' behalf. I ha ad this application and the information I have provided ' correc have read the Desc ' Ion of Wok and verify it is accI agree comply with applicable local '7// ordinances and state laws relating to buildi ns tru 'on. I authorize rept ntatives of Cu rtine tc enter the abpgOpe for cbon purposes. C Signature of Applicant/Agent: Date: SUPPLEMENTAL ORMATION REQUIRED ;PI:A"TI � � -- �'�'PE�''-�,�, � � `G; 9L1P ='""_ If building is associated with a Home Owner's Association, provide letter _ of approval from HOA. - Cl`BUILDIl�IG PIAN RENEW �i �' Provide Planning approval to verify if there any restrictions. (] egg p pygE�gr Provide copy of Manufacturer's Installation Specifications. a� _ Cupertino's Tear -Off Policy. ..' oxtt rovide signed copy of ReroofApp_2011.doc revised 03/02111 ys