The URL can be used to link to this page

11050272 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10040 MOSSY OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050272 CONSTRUCTION INC ON NER'S NAME: AMIT MAI"TRA 605 COMMERCIAL ST DATE ISSUED:08/22/2011 ONVNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION I� F_ tr— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class i/3 Lia# U /�. MECH RESIDENTIAL COMMERCIAL Contract Date y Z`5� �J JOB DESCRIPTION: RE-ROOF 9.5 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2 hereby affirm t at I 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. 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:34232101.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above inP ation 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 M LAST CALLED INSPECTION. ndemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue,against said City in consequence of the ll ,ranting of this permit. Additiot y,the applicant understands and will comply Issued by: Date: with all non-point source re ations per t 'upertino Municipal Code,Section 14 9.18. "�) V RE-RO Signature Date All roofs shall be inspectedprior to any to material being installed. If a roof is installed without first obtaining an in ecc io ,I agre remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: cF- ' :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 L 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) L 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 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 3, I have and wthe Health&Safety 25 4. ill maintain Worker's Compensation Insurance,as provided for by Code,Sections 25505,2553nd Section 3700 of the Labor Code,for the performance of the work for which this ` Date: permit is issued. ZS� Owner or authorized agent: G/ / 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 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 indemnify and keep harmless the City ol'Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs.and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,ranting ofthis 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 O� (408)777-3228" FAX(408)777-3333•buildinD d)cuDertino.cm �\ CUPERTINO APNs L2:f � OWNER NAME. Q 1 Y l (` r Prinwt� MLyheAj q00 0-71 r*4gjL l/,7Q L pi STREET ADDRF_e.c _ �TIY,STATF T7P /� FAX EMA 3 IL FAX ❑ OWNER ❑ OWNER-BUrLDER ❑ OWNER AGENT 54CIONTRACTOR ❑CONTRACTDRAGENr ❑ ARCH7r= ❑ENmgEzR • ❑ DEvEELoPER ❑T iANT C CTQR NAME LI NUMB EA TYPE BUS.LIC.@ �- E-MAIL FAX CITY,STA STREET$ Cd wrP� ,r� �� C A M/2— ff-i ARCHIIECTZENGINF.ER NAME . LICEI.TSE BUS.LIC.-9 COMPANY NAMb E-MAIL FAX STRE—t r ADDRESS CITY,STATE,ZIP PHONE USE OFSFD or Duplex El Multi-Family ROOF ^*"•TT^* 2�- 1 TdSTRUCTURE: ❑ Commercial A 11ki1,a�y S EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD h" ❑ PLYWD ❑ DEB PITCH: ROOF O R LAYERS: THICKNESS ❑ 5/8" TYPE: CDX '1 Z CLAss: A PROPOSED ROOF TYPE: ❑B=-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 0OTrm ICC-ES REPORT-0 DESCRIPTION OF WORK 51 n e. l -C�ff�/••' C/V��Y 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 thL"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 or=re entatives f Cupertino tc enter the above-i tified pro rt for inspection purposes. Signature of Applicant/Agent Date: Z G —'+ fit'.. • :.�Yt••='p`—' t SUPPLE AL ORMATION REQ 4 .. a ` r4 � Kis--.�„i x•`?��F-�"��1.��-�.�``�'C"��'� � s- - _If building is associated with a Home Owner's Association,provide letter i�_=�^� • P 'F - F Ro N �� {"` of approval from HOA. 41_O�T1±,R TH,F�.'DI71C.']iER-i}a w-TBIJIL��G'Y�.A_N.REV,IER''' .,Y g PP fY Y #3 EXPREss _ PLax`�.nrcPLeiivlEw Provide Planning approval to veri If there an restrictions. xy _Prov' e copy of Manufacturer's Installation Specifications.C�o _Provide sip ed copy of Cupertino's Tear-Off Policy. t f Q oTaER f' — v� ReroofApp 2011.doc revised 03/02111