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11050257 CITY OF CUPERTINO BUILDING PERMIT BUI_DING.1DDRESS: 10052 MOSSY OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050257 CONSTRUCTION INC ONNNER'S NAME: ASHUTOSH SUKANYA THAKUR 605 COMMERCIAL ST DATE ISSUED:08/22/2011 OWNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTORM:47 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 7 WO �/y�� MECH RESIDENTIAL COMMERCIAL Contractor l J/ �` ��5 JOB DESCRIPTION: RE-ROOF 10.8 SQ-LIT PLYWOOD,TPO OVERLAY WITH 2 1 herebv 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. 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 vvhich 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 which this APN Number:34232109.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION STARTED 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STA cancel. 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 INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs.and expenses which may accrue against said City in consequence of the Issued by: l� Date: granting of this permit. Additi y,the applicant understands and will comply with all non-point source r 1 tionsit Cupertino Municipal Code,Section 9.18- RE- 'S: Signature h' Date All roofs shall be inspected prior to an oofing material being installed. If a roof is installed without first obtaining an spectipn,1 agree to remove all new materials for inspection. �' ❑ OWNER-BUILDER DECLARATION �� Date: Signature of Applican 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) HAZARDOUS MATERIALS DISCLOSURE I.as owner of the property_am exclusively contracting with licensed contractors to construct the project(Sec 7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 695 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 1 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 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 Ilealth&Safety Code,Sections 25505,25533,and 25534 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent�l/%Gl/ �� Date: 4/ a,5�r permit is issued. I certify that in the performance of the work for which this permit is issued,1 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 t'xthwith comply with such provisions or this permit shall be deemwork's for which this permit is issued(Sec.3097,Civ C.)ed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is cored. 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 with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 19 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 34232109 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . • • • : BS000014512 REFERENCE ID # . . . : 11050257 SITE ADDRESS . . . . . : 10052 MOSSY OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ASHUTOSH SUKANYA THAKUR ADDRESS . . . . . . . . . . : 10052 MOSSY OAK CT 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 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 GUPERTlNO (408)777-3228• FAX(408)777-3333 • buildinga-cupertino.org ioo5if o5O 25 PD nTC!`T ATTD TCC 55 d ` • APN# o��RR _ i 1'i LA 4-os j(,t KL+'.ht� Pxo� �'�� E-MAIL STREET ADDRESS O / CITY,STA ^y ( FAX �G 1' l�(� C V� i Ap I ( l , PHONE E-MAIL S DRESS e ` - S'f ,STATE, ZIP 7' FAX uat ❑OWNER (❑OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C0bfrRACTQRNAME LI NUMB LI aq TYPE BUS.LIC.# — 5 E-MAIL FAX Q� Ll C ,STATEct4 2.0 12— —/- / ARCHITECT/ENGINEER NAME LICENSE BUS.LIC.# COMPANY NANM E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF QrSFD or Duplex ❑ Multi-Family RO F_4REA� AT I I A T n.i. SAP -9 11/� STRUCTURE: ❑ Commercial j / (�(/t T " V 1�/ I ` ` EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YF-STgLAYERS: NO, PLYWOOD W. ❑ PLYWD ❑ OSB PITCH: ROOF IfNO T IICKNESS: ❑ 5/8" TYPE: CDX —'12 CLASS A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ;gOTrIER ICC-ES REPORT# DESCRIPTION OF WORK: moi` l a OIC/ l 4�!,(W P� 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 ft Des ' tion o Work and verify it is accurate. I ee to c y With all applicable local ordinances and state laws relating to building c n. I a orize re entatives f Cupertino tc enter the above-i tified pro t for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEORMATION REQ ._. .. _ c _ s AL _If building is associated With a Home Owner's Association,provide letter of approval from HOA. m - VER-MV'D�IIly R BUII:DING PLAN-REVIEW z.. PP v� � _Provide Planning approval to verify if there any restrictions. 5 © pt p, G PLai`rTEs Iz w s� _Prov' e copy of Manufacturer's Installation Specifications. > nr f r _Provide sided copy of Cupertino's Tear-Off Policy. -} - Y _~ ❑ OTR s N� ReroofApp_2011.doc revised 03/0M I