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11050261CITY OF CUPERTINO BUILDING PERMIT I Bt H.DING ADDRESS: 10073 AMADOR OAK CT OWNER'S NAME: CHIANG YAO-KO OWNER'S PHONE: ❑ LICENSED CONTRACT'OR'S DECLARATION License Class Lie. # Contractor GLS Date J -A77 1 hereby affirm th t 1 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 provide, rovide for by Section 3700 of the Labor Code, for the performance of the work for wf1i t permit is issued. i 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 huilding construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs_ and expenses which may accrue against said City in consequence of the ,,ranting of this permit. Additionall , the applicant understands and will comply with all non -point source regul• i n per the Cupertino Municipal Code, Section I 9.18. /"" r' Signature Date ❑ OWNER -BUILDER DECLARATION I 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 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). 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 pertbrmance of the work for which this permit is issued. I have and wiil maintain Workers 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 ofthe Labor Code, I must lbrthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certity 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 indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs. and expenses which may accrue against said City in consequence of the ,ranting of this permit. Additionally, the applicant understands and will comply .� ith all non -point source regulations per the Cupertino Municipal Code. Section 9 I8 Signature Date CONTRACTOR: DRAEGER PERMIT NO: 11050260 CONSTRUCTION INC 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 SAN JOSE, CA 95112 PHONE NO: (408)536-0420 F– F– 1— BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL. JOB DESCRIPTION: REROOF, 9.8 SQUARES, SINGLE PLY TPO OVERLAY W1141 2 LAYER FR -10 BARRIER Sq. Ft Floor Area: I Valuation: $375 APN Number: 34232027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY M,LAST CALLED INSPE I N. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any ro ng material being installed. If a roof is installed without firs[ obtaining an insc� tion, I a o remove all new m serials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS 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 1 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 1 will maintain compliance with the Cupertino :Municipal Code, Chapter 9.12 and the Health & Safety Code,31"14 ions 25505, 25`53333,, a/2�4. Owner or authorized age J r Date:�� 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 Profession CITY OF CUPERTINO 3 ITEMS OF 21 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232027.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014515 REFERENCE ID # ...: 11050260 SITE ADDRESS .....: 10073 AMADOR OAK CT SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: CHIANG YAO-KO ADDRESS ..........: 10073 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 ------------------------ --BCBSC VALUATION ---------- 375.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 :-BSEISMICR VALUATION 375.00 0.50 0.00 0.50 0.00 :-REROOFRES 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 I� REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcuoer'tino.org PDATC!`T ATTID CCC u00.-73_ Amadlor`(��K' APN# 3tJz . 2 . 0 E-MAIL OW.NT • O �'' Is Q- .- Cn --- 3 1 J- STRIE�ADDRESS FAX 0 ` AP ICAIAl T 1 _GIPHONE E-MAIL D- �. -z 3 STREDRF�S STATE, ZIP 2 FAX P S (El ❑ OWNER OWNER -BUILDER ❑ OWNER AGENTCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CT()RNAME LI NUMB LIr- TYPE BUS. LIC. # f'n u 5 E-MAIL FAX STRFEi, /y�8((/�ll j Q,in r� CrI Y, STATE N_ _ ��l l � �y l -U J� 22 / ARCHT/ENGAIEERNAME ITEECC LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF D or Duplex ❑ Multi -Family ROOF VALUATt, N: c� I STRUCTURE: ❑ Commercial�(/ �'� /� x. J� -(, U� �. EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHADS ❑ WOOD SHINGLES , ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO, PLYWOOD W. ❑ PLYWD ❑ OSB PITCH: 12 ROOF O #LAYERS TrIICK7VESS: ❑ 5/8" TYPE: RI CDX CLASS:(A� PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ,,// ❑ WOOD SHINGLES O7 OTHER ICC -ES REPORT # DESCRIPTION OF WORK Ely By my signature below, I certify to each of the foil ng: I the property owner, ed agent to act on the property owner' behalf. I ha ad this application and the information I have provided coat have read the DI ' on of Wok and verify it is accurate. I agree comply with applicable local ordinances and state laws relating to buildin nstru on. I authorize rep ntatives of Cu rtino tc enter the pefi for ' pection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL ORMATION REQUIRED If building is associated with a Home Owner's Association, provide letter o�s�aCDI�IC� "�` w 'CI a �a1c gLAat REv>�w } z of approval from HOA. pp — Provide Planning approval to verify if there any restrictions. U0 Q S _ '�1LikNG Provide copy of Manufacturer's Installation Specifications. R 3 STA: -E3 Y PLANREYIE9� 0 �txEDz Cupertino's Tear Policy. (] rovide signed copy of -Off .Og, T- ReroofApp_2011.doc revised 03/02/11 yS