11050231 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22702 LIBERTY OAK LN CONTRACTOR: DRAEGER PERMIT NO: 11050231
CONSTRUCTION INC
OWNER'S:SAME: HONG PIAN 605 COMMERCIAL ST DATE ISSUED:08/22/2011
OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATIONr—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.# 0 (_
MECfI RESIDENTIAL COMMERCIAL
Contractor vZ Date S
hereby affirm th t 1 am licensed under the provisions of Chapter I JOB DESCRIPTION: RE-ROOF 10.4 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2
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.
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. 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:34232039.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify 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 18 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 DAYS M LAST CALLED INSPE TI
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs.and expenses which may accrue a st said City in consequence of the G
A9 3111
-ranting of this permit. Additional) e plicant understands and will comply Issued by: Date:
with all non-point source regula ns the Cupertino Municipal Code,Section
y.18.
RE-ROOFS:
Sianatur Date C� 2 All roofs shall be inspected prior to any roofs g material being installed. If a roof is
installed without first obtaining an inspe o 1 agree -move all new materials for
inspection.
❑ ONVNER-BUILDER DECLARATION
Signature of Applicant:
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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 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 the Health&Safety Code,Sec •ons 25505,25533,and 25"4.
Section 3700 ofthe Labor Code,for the performance of the work for which this Owner or authorized agent• L � 4* 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 sub.lect 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
lorthwtth 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,
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
NN ith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18,
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 21 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 34232039 .00
DATE ISSUED. . . . . . . : 08/22/2011
RECEIPT # . . . . . . . . . : BS000014525
REFERENCE ID # . . . : 11050231
SITE ADDRESS . . . . . : 22702 LIBERTY OAK LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . HONG PIAN
ADDRESS . . . . . . . . . . : 22702 LIBERTY OAK LN
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 AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 990 .50 0753
---------------
TOTAL RECEIPT 990 .50
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
CUPERTINO (408)777-3228• FAX(408)777-3333•building a�cuperiino.org
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❑OWNER (❑OWNER-BUILDER ❑ OWNERAGENT �ONTRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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ARCHITECT/ENGWEER NAME LICENSE BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex D Multi-Family /ROOF AREEA:: �p,� VALUAATTION �/2Ip
2tP 1
STRUCTURE: E3 Commercial (Q' f "- f_o e
EXISTING ROOF TYPE: KUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD g w, ❑ PLYWD ❑ OSB PITCH: x ROOF
O #LAYERS: THICKNESS: ❑ 518" TYPE: 5a CDX -_►_L'1 Z CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ;90THER ICC-ES REPORT#
DESCRIPTION OF WORK r
By my signature below,I certify to each of the follo ' g: the property er o authorized agent to act on the property owner's beh . I have read this
application and the information I have provided is TTec. I have read the escriptio of Work and verify it is accurate. I agree to'0.,
om with all applica;�le local
ordinances and state laws relating to buildi cc on. I authbrize presentati s of Cupertino tc enter the above-ide 'feed pro rt :`or inspection purposes.
Signature of Applicant/Agent: Date: 6
SUPPLEME ORMATION REQUIRED : t . �,
_If building is associated with a Home Owner's Association,provide letter
of approval from HOA.
OYER-.TIE cDZllv�i
.i�.-�� -�.�,.,��x
_Provide Planning approval to verify if there any restrictions.
F.ATI2ESS .� � PS-r"�ZV�TIIdGPL'ANREVI£R' _-
Provide copy of Manufacturer's Installation Specifications.
rovide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/02111
REROOF TEAR-OFF POLICY
is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
GUPERTINO
(408)777-3228• FAX(408)777-3333•building(Dcugertino.org
PROJECT ADDRESS -77 o-2-
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OWNER NAMEPHONE E-MAIL
STREET ADDRESS 7 �r� CITY`;STATE,ZIP ,� / FAX
V /rt�0 G�ff� ( ��
CONTRACTOR NAME
je �%/J C LICENSU NUMBER G LIC E TYPE BUS.LIC.#
COMPANYNAME v( � 7 E-MAIL F 7
STREET ADDRESS (� ` 1 CR,STA ,ZIP' p
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of'/" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to com with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors ar wired to 71led in accordance with Sections R314 an R315 of
the 2010 California Residential Code. -'� _
Signature of Applicant/Agent: Date:
Reroofpolicv 2011.doc revised 02/16/11