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11050268CITY OF CUPERTINO BUILDING PERMIT BI ILDING ADDRESS: 10143 AMADOR OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050268 CONSTRUCTION INC OWNER'S NAME: SHIRISH KARMARKAR & SHARAYU 605 COMMERCIAL ST DATE ISSUED: 08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION f F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # V17 V V r— r— F � ` MECH RESIDENTIAL COMMERCIAL Contractor iz'P i.. Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE -ROOF 10 SQ- 1/2"PLYWOOD, TPO OVERLAY WITH 2 (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. 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 Sq. Ft Floor Area: Valuation: $375 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the labor Code. for the performance of the workfo hich is APN Number: 34232021.00 Occupancy Type: permit is issued. APPLICANT' CERTIFICA"['ION I ccrttfy that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. l agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY F OM LAST CALLED INSPE TI indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs. and expenses which may accrue Inst said City in consequence of the /jam /� aruning of this permit. Additio y, th applicant understands and will comply Issued by: Date: UUU 11�� "ith all non -point source re ations r the Cupertino Municipal Code, Section 9 18 RE -ROOFS: Signatur Date` ZS All roofs shall be inspected prior to any ro pig material being installed. If a roof is installed without first obtaining an ins ct n, I agree to remove all new materials for inspection. 171OWNER-BUILDERDECLARATION� Signature of Applican Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ' the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) 1. as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534 . performance Owner or authorized agent: S� - Date: ? / 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 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 c.urcct. I agree to comply with all city and county ordinances and state laws relating W 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 I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Si nahtrc Date CUPERTINO 1611V3 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a( ..cuoertino.org i i 11()502cv � Pvn=f r Ann=e 14 OV 0C? � -, -� -� / I APN # �-I2 32- O z I gWNERNAWS � Kar rnar <�r h U r_ 1s-- E-MAIL =r -r ADDRESS STATE TrIP lam- FAX 2 0 � -e v' � U•o r APELICANT NAhffi PHONE Z E-MAIL S F D _54, Viii PK a STATE, ZIP / 7/ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTQR NANO LICUst NUMB BUS. LIC. # u - 105 COMP• AjrIE � 'n,G LO /fl'7 E-MAIL FAX STREET, lyT�� pv C , STATE N `T/t � fj- j`,�lV l V V ✓c / ARCHITECr/ENGINEERNAME LICENSE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF bSfD or Duplex ❑ Multi -Family ROOF LUATP N: of I VATd �` STRUCTURE: ED Commercial (/ �(' tJ /✓ ` V c EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES , ❑ OTHER (SPECIFY) REMOVE /REPLACE ❑ YES IF NO, PLYWOOD ;W w, ElPLYWD 11 OSB PITCH: ROOF O # LAYERS: THICKNESS ❑ 5/8" TYPE: 5a CDX ' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHADS ❑ WOOD SHINGLES 9�07ER ICC -ES REPORT # DESCRIPTION OF WORK By my signature below, I certify to each of the foll 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 ' correc have read the DeSC on of Wok and verify it is accurate. I agree comply with applicable local ordinances and state laws relating to buildi nstru on. I authorize reps ntatives of Cu ertino tc enter the above-' p�Oper :`or pection purposes. Signature of Applicant/Agent: Date: S C SUPPLEMENTAL ORMATION REQUIRED t_`�t ' "ir: A4 _ If building is associated with a Home Owner's Association, provide letter pis-� nIIlv�Eit 1] BUII DIIVGiPLAN REVIEW` of approval from HOA. — Provide Planning approval to verify if there any restrictions.211 LZ EXPItFSS �� _ PLANiIING p� Provide copy of Manufacturer's Installation Specifications. II FIR�vt Px rovide signed copy of Cupertino's Tear -Off Policy. _ - ReroofApp_2011.doc revised 03/02/11 V5 3 ITEMS OF 21 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232021.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014515 REFERENCE ID # ...: 11050268 OPERATOR: SylviaM COPY # : 1 SITE ADDRESS .....: 10143 AMADOR OAK CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: SHIRISH KARMARKAR & SHARAYU ADDRESS ..........: 10143 AMADOR OAK CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 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 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 990.50 --------------- 990.50 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- 0753 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 605 FINAL REROOF