11050250 CITY OF CUPERTINO BUILDING PERMIT
fit H,DING:kDDRESS: 10053 LONG OAK LN CONTRACTOR: DRAEGER PERMIT NO: 11050250
CONSTRUCTION INC
OWNER'S NAME: SREE KUMAR PARMESWARAN 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 Class Lic.#
cel
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MECH RESIDENTIAL COMMERCIAL
Contractor l Date
JOB DESCRIPTION: RE-ROOF 9.7 SQ-1/2"PLYWOOD,TPO OVERLAY Wfffi 2
1 hereby affirm It am licensed under the provisions o 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
I 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 ich this APN Number:34232051.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I ccrtil\ 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 DAYS ROM LAST CALLED INSPECTION.
indemnity and keep harmless the City of Cupertino against liabilities,judgments,
costs_and expenses which may rue against said City in consequence of the Issued by: Date: `�
,"ranting of this permit Ad onally,the applicant understands and will comply
/;
with all non-point ,our egulations pert pertmo Municipal Cod ,Section
21
9 1
/ RE-RO
Signature � Date Z�J �l All roots shall be inspected prior to any r mg material being installed. If a roof is
installed without first obtaining an in ection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant � Date:� l
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
1.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,
13LISI11CSS& Professions Code)
I.as ovv ner 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 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 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Co e,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by
the health&Safety Code,Se 'ons 25505,25533,a d 255 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agenT 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 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 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
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
indcmnily 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.
,,ranting of this permit-Additionally,the applicant understands and will comply,
vwith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 I2{.
tiienaturc-- _
— Date
CITY OF CUPERTINO
3 ITEMS OF 21 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34232051 . 00
DATE ISSUED. . . . . . . : 08/22/2011
RECEIPT # . . . . . . . . . BS000014506
REFERENCE ID # 11050250
SITE ADDRESS . . . . . : 10053 LONG OAK LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SREE KUMAR PARMESWARAN
ADDRESS 10053 LONG OAK LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DRAEGER CONSTRUCTIO
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
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
INO (408)777-3228• FAX(408)777-3333 •building aacuperiino.org
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USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑
Commercial 7 ?iYV17( � '�t j ��v 't/ (� S
EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD K- ❑ PLYWD ❑ OSB PITCH: ROOF
O k LAYERS: THICKNESS- ❑ 5/8" TYPE: RI CDX '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES oOT. ICC-ES REPORT#
DESCRIPTION OF WORM-- 17 V TMJ/ l
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By my signature below,I certify to each of the foil n • I am the property er or authorized agent to act on the property owner's behalf. I have read this
application and the inforLiation I have provided i co ct. I have read th escriptio of Work and verify it is accurate. I ee to comr
th all applicable local
ordinances and state laws relating to bui ng c n ction. I riz resentativ s of Cupertino tc enter the ab fled propeinspection purposes.
Signature ofApplicant/Agent: Date:
SUPPLEMEINFORMATION REQ "
_If building is associated with a Home Owner's Association,provide letter I -z P � T�E "- k oUtc sL>P=:* r
of approval from HOA. ov>>ixsE epa(al`� 3 Bc�n; iGPicn*r._REr�>Ew~ 7.
�z< a e --�;•�"- �'=
_Provide Planning approval to verify if there any restrictions. 7.7 �xEss ❑ PLaxtrnlc PLA%�IxEVIEw
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Provide copy of Manufacturer's Installation Specifications. , Q kTitEnF r - _
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Provide signed copy of Cupertino's Tear-Off Policy.
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ReroofApp_2011.doc revised 03/02/11