11050274 CITY OF CUPERTINO BUILDING PERMIT
B('ILDING ADDRESS: 10008 DOVE OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050274
CONSTRUCTION INC
OWNER'S NAME: ACHIM PANTFOERDER 605 COMMERCIAL ST DATE ISSUED:08/22/2011
OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATIONF- i
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.#
U r r F-
44 _ METH RESIDENTIAL COMMERCIAL
Contractor -e v 4 Date !� Z S //
JOB DESCRIPTION: RE-ROOF 9.5 SQ- 1/2"PLYWOOD,TPO OVERLAY WITH 2
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 LAYER FR-10 BARRIER
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
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. Sq.Ft Floor Area: Valuation:$375
1 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 APN Number:34232092.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in ormation is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I 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 DAYF OM LAST CALLED INSPECTION.
indemnifi'and keep harmless the City of Cupertino against liabilities,judgments,
costs.and expenses which may ac e against said City in consequence of the
--ranting of this permit. Addi rally,the applicant understands and will comply Issued by: Date:
(Y/2'7/
with all non-point source ulations per the Cupertino Municipal Co e,Section
9.18. `
R OFS:
Signature / Date l� All roofs shall be inspected prior toe roofing material being installed. If a roof is
installed without first obtaining inspection;I a to remove all new materials f
inspection. ��
❑ OWNER-BUILDER DECLARATION Z�
Signature of Applican Date:
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. I 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
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 the Health&Safety Code,Sect' ns 25505,25533,a d 2553
Section 3700 of the Labor Code,for the performance of the work for which this j/-�It'
permit is issued. Owner or authorized agent: �1 ` Date: �! 60 �/
1 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 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 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITEC'T'S DECLARATION
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
'l is,
Signature______- Date- —
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34232092 . 00
DATE ISSUED. . . . . . . : 08/22/2011
RECEIPT # . . . . . . . . . : BS000014508
REFERENCE ID # . . . : 11050274
SITE ADDRESS . . . . . : 10008 DOVE OAK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ACHIM PANTFOERDER
ADDRESS . . . . . . . . . . : 10008 DOVE OAK CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DRAEGER CONT
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 VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
L M
, t
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(a�cuper(ino.org
CUPERTINO 1105
v r�5!^Z�, I
ponrcrr 1006? �ft=lr APN# , l�
I YYI.
STPEEJ
ADDRESSO / �'IY, STATE ^ ( FAX
AP CANT IJ P `,(f PHONE C z�- E-MAIL
ffl)STREE�DM P � S ! .STATE,
❑OWNER ❑ OWNER-BUILDER ❑ OWNER-AGENT R�C/ONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
C CTQR N LI NS NUMB r E BUS.LIC.#
u
COMAp ` '/ E-MAIL
M� FAX
f(�lG� Y C STATE �y
STREET�Iy1�I� Cb QY �� C�/ CiA -2012—
ARCHITECT/ENGINEER NAME 7 LICENSE BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP
USE OF FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION-
El cf I f
STRUCTURE: Commercial
-S v�R� r1. '� �ff� S
EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD w. ❑ PLYWD ❑ OSB PITCH ROOF
R�NO I #LAYERS: THICKNESS: ❑ 5/8" TYPE: Ea CDX ,� '12 CLASS: A
PROPOSED ROOF TYPE:
El ROOF ❑ASPHALT SHINGLES E)WOOD SHAKES ID WOOD SHINGLES 'goTHER ICC-ES REPORT#
DESCRIPTION OF WORK: t
i
By my signature below,I certify to each of the following: I e property owner.or au zed ent to act on the property owner's behal I have read this
application and the information I have provided is correc ave read the Descripti f Work d verify it is accurate. I a ee to comp] with all applicable local
ordinances and state laws relating to building cons c' I authorize repre es of Cu no to enter the ab fled prop /:`or inspection purposes.
Signature of Applicant/Agent: Date: G
SUPPLEMENT ION REQUIRED u �_ ;
_Ifbuilding is associated with a Home Owner's Association,provide letter
of approval from HOA. at ING rltnx t v_v
t5 r
Provide Planning approval to verify if there any restrictions. p ss pLa�ivl ratrc PLANWVIER
_Provide copy of Manufacturer's Installation Specifications. n - [j'FIREDEPT
Y,.; 4 �."*'.'•f� hap "1 ..
rovide signed copy of Cupertino's Tear-Off Policy. _ ❑ tx• r
ReroofApp_2011.doc revised 03/02111