11050275 CITY OF CUPERTINO BUILDING PERMIT
Bt 11,DING ADDRESS: 10018 DOVE OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050275
CONSTRUCTION INC
OWNER'S NAME: VINAY& SEEMA HAMMADY 605 COMMERCIAL ST DATE ISSUED:08/22/2011
OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Cla 1 Lic.#i r— F
�G MECH RESIDENTIAL COMMERCIAL
Contractor a05 Date l.� Z_0
hereb affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 9.5 SQ- I/2"PLYWOOD,TPO OVERLAY WITH
> p p 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.
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 w h this APN Number:34232091.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I ccrtity that I have read this application and state that the above information 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 DAY FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs.and expenses which may ace against said City in consequence of the 'Q
granting of this permit. Additi ally,the applicant understands and will comply Issued by:
with all non-point source r ulations per tl upertino Municipal Code,Section
9 18
---- — / // RE-ROO
Signature _Date f All roofs shall be inspected prior to any ro ng�.ma[erial being installed. If a roof is
installed without first obtaining an ins Imp<I agr�°remove all new materials for
inspection. /
❑ OWNER-BUILDER DECLARATION
Signature of Applican - ate:
1 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
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). I 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 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
nerlormance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and�\ill maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seqtins 25505,25533,and p55 4
Section 3700 of the labor Code,for the performance of the work for which this Owner or authorized agent: bate: � �I
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
CONSTRUCTION LENDING AGENCY
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 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,
;osis,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
,ranun u of this permit.Additionally,the applicant understands and will comply
uh all non-point Source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18
Signature___ _ Date _
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Elk: Lot :
APN . . . . . . . . : 34232091 . 00
DATE ISSUED. . . . . . . : 08/22/2011
RECEIPT #. . . . . . . . . : BS000014508
REFERENCE ID # . . . : 11050275
SITE ADDRESS . . . . . : 10018 DOVE OAK CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : VINAY & SEEMA HAMMADY
ADDRESS . . . . . . . . . . : 10018 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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTtN4 (408)777-3228• FAX(408)777-3333 • building aocupertino.org
1061 Y 00 VC 04< c [ 10 5 U 2,74'j
PDnMv Ann=e¢ APN#
31-12 32
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STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 21fFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION- •�1
sTRvcrvRE: ❑ Commercial (M( (' 3/ T `
EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES FI,
NO. PLYWOOD g w, ❑ PLYWD ❑ OSB PrrCH: ROOF
0 AYERS THICKNESS: ❑ 5/s" TYPE: CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 9 OTHER ICC-ES REPORT#
DESCRIPTION OF WORK
By my signature below,I certify to each of the following: I e property oprner,or au zed ent to act on the property owner's behal I have read this
application and the formation I have provided is correc ave read the Descripti f Work,4M verify it is accurate. I a ee to cOmpl with all applicable local
ordinances and state laws relating to building cons c' I authorize repre es of Cu no tc enter the abo 'fled prop for inspection purposes.
Signature of Applicant/Agent: Date:
44
SUPPLEMENT TION REQUIREDa :ta
-3`,i� -5:�.h?3""+Tr"�?`,G vyy z-yS _ Ct'p :. f• � �' +.
_If building is associated with a Home Owner's Association,provide letter
of approval from HOA. 4
OVER. �S'DIINTAHt 34_UILtIAGPLANREVIEW
_Provide Planning approval to verify if there any restrictions. 5 TE_ANc P -
T ... ,_.
—Provide copy of Manufacturer's Installation Specifications. FiRRn
rovide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/02/11