11050273CITY OF CUPERTINO BUILDING PERMIT
Bf ILDING ADDRESS: 10050 MOSSY OAK CT
CONTRACTOR: DRAEGER
PERMIT NO: 11050273
CONSTRUCTION INC
OWNER'S NAME: ANANTHAN & HEMALATH VENKATESAN
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
I- � F_
License ClassLic. # _
MF,CH RESIDENTIAL COMMERCIAL
ContractorD�a— C 141 '�'h Date If
.JOB DESCRIPTION: RE -ROOF 9.5 SQ- 1/2"PLYWOOD, TPO OVERLAY WITH
1 hereby al7irm that I am licensed under the provisions of Chapter 9
LAYER PR -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
APN Number: 34232100.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for w/ h this
permit is issued. 1
APPLICANT CERTIFICATION r F
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
180 DAYS FROM LAST CALLED INSPECTI N.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the Cit .-fCupertino against liabilities, judgments,
the
`�
costs. and expenses which may rue against said City in consequence of
Issued by: /� G Date: v
4
,,ranting of this permit. Ad tonally; the applicant understands and will comply
with all non -point sourc egulations per t 6upertino Municipal Code, Section
9 I8
y
Date ✓ �/
RE -ROOFS:
be inspected to any roo material being installed. If a roof is
Signature
All roofs shall prior
for
installed without first obtaining an insp ipti, I agree to remove all new materials
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: %' Date:
1 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
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).
I have read the hazardous materials requirements under Chapter 6.95 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
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 Nlanagement District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety Code, S ions 2.5505, 2553nd 2 , 34.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance ofthe work for which this
Owner or authorized age f ! Date: 2
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
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
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.
-ranting of this permit. Additionally, the applicant understands and will comply
a ith all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
919
Signature-- Date
CITY OF CUPERTINO
3 ITEMS OF 19 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 34232100.00
DATE ISSUED.......: 08/22/2011
RECEIPT #.........: BS000014512
REFERENCE ID # ...: 11050273
SITE ADDRESS .....: 10050 MOSSY OAK CT
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: SylviaM
COPY # : 1
OWNER ANANTHAN & HEMALATH VENKATESAN
ADDRESS 10050 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
9.00
126.00
0.00
126.00
0.00
----------
TOTAL PERMIT
----------
127.50
----------
0.00
----------
127.50
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinoacuoedno.org \�
ReroofApp 2011.doc revised 03/02111
APNs
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OWNER NAME, L u'1t✓l l V ` 1 rInArF
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C4_1 VV C•r C
S-I'REET ADDRFc.c �1 � , STA 7rJP
FAX
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PHONEE-MAIL
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FAX •
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENm;E—=R ❑ DFmoFER ❑ TENANT
CO CT(1R NAME
�`
LI NUMB
-7—
L TYPE
BUS. LIC. #
Vl I u
l
E-MAIL
FAX
CITY, STA
ARCHrTYCTIENGIIQFSR NAME .
LICENSE
BUS. LIC. i
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE of QrSFD or Duplex ❑ Multi -Family RooF"""'°TT^"2�-
111-X
El Commercial (/l/j
'r' �. �� V I�/
STRUCTURE:
EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REN,OvE /REPLACE ❑ YEs
IF NO.
PLYWOOD g K- ❑
PLYWD ❑ OSB
PITCH
12
ROOF
A
O
i LAYERS:
THICKNESS: E35/S"
TYPE: EZ CDX
'
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES 11WOOD SHAKES
❑ WOOD SHINGLES 9,,(( OTr7ER
ICC -ES REPORT i
DESCRIPTION OF WORK: r
all
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 e have read thc� Des tion o Work and verify it is accurate. I e to c y with all applicable local
ordinances and state laws relating to building c on. I a orize re eatatives f Cupertino tc enter the above -i tiled pro for inspection purposes.
/rty
Signature of ApplicanUAgenr
Date: G
SUPPLE AL ORMATION RE Q
`' '4 Caf - y`
If building is associated with a Home Owner's Association, provide letter
i==-
�' y
E o�TaDm._ R>s'v,>w -
_
of approval from HOA.
PP
Provide Planning approval to verify if there any restrictions.
vBUSnic
a?RESS ^ rte` y� Q
'RE
-
PI71 N� IN G PLAN -71 -EW
_ Prov' e copy of Manufacturer's Installation Specifications.
t
Provide Cupertino's Tear Policy.
_ sighed copy of -Off
_ -
ReroofApp 2011.doc revised 03/02111