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11050254 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 10022 MOSSY OAK CT CONTRACTOR: DRAEGER PERMIT NO: 11050254 CONSTRUCTION INC OWNER'S NAME: VENKATA JANASWAMY& P. DURGA 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_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Classl is b r— (� �� r/ MECH RESIDENTIAL COMMERCIAL Contractor � � Vd'� Date 1 hereby affirm that am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 10.8 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 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 wD4 this permit is issued. APN Number:34232106.00 Occupancy Type: 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 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 INSPECTI N. indemnify and keep harmlesslhe Citv of Cupertino against liabilities,judgments, costs.and expenses whirl ay accrue against said City in consequence of the eranting of this permit Additionally,the applicant understands and will comply Issued by: Date: `J with all non-point s uce regulations the Cupertino Municipal Code,Section 9.18 �- 2l� RE- 00 S. Signaturer Date All roofs shall be inspected prior to any ro n material being installed. If a roof is installed without first obtainingZinspon("1agre remove all new materials for inspection.OWNER-BUILDER DECLARATIONSignature of Applicanti7 Date: 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) I 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 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 Cooe,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ions 25505,25533,and 255 1 r lSection 3700 ofthe Labor Code.for the performance of the work for which this Owner or authorized agen �:�/"� 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 W'orker's Compensation laws of California. It.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 forlhWllh 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 1 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 indemnity 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 with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18 Signature__ _ Date_ CITY OF CUPERTINO 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232106 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014510 REFERENCE ID # . . . : 11050254 SITE ADDRESS . . . . . : 10022 MOSSY OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VENKATA JANASWAMY & P. DURGA ADDRESS . . . . . . . . . . : 1022 MOSSY OAK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5615 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 11 . 00 154 . 00 0 . 00 154 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 155 . 50 0 . 00 155 . 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 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildina aacupertino.ora 1-6&= ___116502_5-q pnn ATnv QQ�Z2MX553 d C1—. APN# z �� 10 LP PHO E-MAIL f� Ou S REET ADDRESS O ` CITY,STA ^ ` FAX A 117, Ap C t y PHONE E-MAIL .STATE, ZIP � FAx . ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT �CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C0brrILACTQRNME!t�� LI NUMB LIEN$ TYPE BUS.LIC.# (� ` 5 1116PAtl A`G �O E-MAIL FAX eq e STREET`S VA pV ,II�V /7 C STA � 12 - / ARCHITECT/ENGINEER NAME LICENSE BUS.LIC.A COMPANY NAME E-MAIL FAX STREET ADDRESSCITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AT rrerrnM. STRUCTURE: ❑ Commercial / 11ki ( S EXISTING ROOF TYPE: JILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD 'w. ❑ PLYWD ❑ OSB PITCH: ROOF 0 #LAYERS: THICKNESS: ❑ 5/8" TYPE: ia CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLESOTFIER ICC-ES REPORT# DESCRIPTION OF WORK / aw By my signature below,I certify to each of the followi I the property owner thorized agent to act on the property owner's behalf. I have read this application and the information I have provided is c ec have read the Des tion o Work and verify it is accurate. I ee to c ly with all 4pplicable local ordinances and state laws relating to building c n. I a or=re entatives f Cupertino tc enter the above-i tified pro/rty or inspection purposes. Signature of Applicant/Agent: Date: Z G SUPPLE ME AL ORMATION REQ `. � �. w' 20 _If building is associated with a Home Owner's Association,provide letter of approval from HOA. _ PP OVER_�'-r'hIIh�ER BIIII�ING ELAN-REV>�W _ Provide Plannin approval to verify If there any restrictions. ss PLAtlNnvc PI A2IREVIEW _Provj. ' e copy of Manufacturer's Installation Specifications. Z - _Provide signed copy of Cupertino's Tear-Off Policy. -y ❑ rosi�.x f -~ _ ReroofApp_2011.doc revised 03/02111