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11070155 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:DRAEGER PERMIT No: 11070155 Bt H.DING ADDRESS: 10060 MOSSY OAK CT CONSTRUCTION INC 605 COMMERCIAL ST DATE ISSUED:08/22/2011 OWNER'S NAME: HOUSTON JAMES E PHONE NO:(408)536-0420 7(commencingwith HONE:Cl SAN JOSE,CA 95112 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB F_ s Lic.# MECH RESIDENTIAL COMMERCIAL a(�F/ N Date © JOB DESCRIPTION: RE-ROOF 9.5 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2 irm that am licensed under the provisions of Chapter 9 LAYER FR-10 BARRIER g with Section 7000)of Division 3 of the Business&Professions hat 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 r'ompensation,as provided for by Section 3700 of the Labor Code,for the Valuation:$375 performance of the work for which this permit is issued. Sq.Ft Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which t� APN Number:34232099.00 permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that 1 have read this application and state that the above in ormation is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating M LAST CALLED INSPECTION. to building construction,and hereby authorize representatives of this city to enter 180 DAY upon the above mentioned property for inspection purposes. (We)agree to save !/ indemnify and keep harmless the City of Cupertino against liabilities,judgments, Date costs.and expenses which may accr against said City in consequence of the Issued by: : granting of this permit Additio ly,the applicant understands and will comply with all non point source re joss per the Cu ertino Municipal Code,Section 9 18 RE-ROOFS: Date �,/ All roofs shall be inspected prior to any roofl>40terial being installed. If a roof is Signature_ — installed without first obtaining an in spec ff,agree to remove all new materials for inspection. Date: [71py'NER-BUILDER DECLARATION Signature of Applican I hereby affirm that I am exempt from the Contractor's License Law for one of ILL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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(SecJ044. 13LIS111CSS&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I as owner of the property,am exclusively contracting with licensed contractors to 1 have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California health&Safety Code,Sections 25505,25533,and Chapter d the I will C I hereby affirm under penalty of perjury one of the following three e Cupertino M ealth maintain&Safety Code,Section 25532(a)should Isunicial otoreor handle hazardou declarations: material. Additionally,s r devices which emit hazardous I have and will maintain a Certificate of Consent of tile for Worker's the air contaminants as defined by the BayuAre eAint rQuality Management District I Compensation,as provided for by Section 37 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this per is issued. the Health&Safety Code,Sec ' ns 25505,25533,and 255 I have and will maintain Worker's Compensation Insurance,as provided for by / l Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent �` permit is issued. I :cltiIN that in the performance of the work for which this permit is issued,1 shall n„t ell,Plov am,person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY ompcnsation laws of California. IL after making this certificate of exemption,I become Subject to the Worker's Compensation provisions of the Labor Code,l must whereby for twhich this rm that hpermit is issued(Sec 3097 Cere is a construction lending rveC)for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. 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 oomph with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION upon the above mentioned property for inspection purposes.(We)agree to save 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. Date__________ Signature_----_------ --- CITY OF CUPERTINO ITEM 19 OF 19 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232099 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014512 REFERENCE ID # . . . : 11070155 SITE ADDRESS . . . . . : 10060 MOSSY OAK CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HOUSTON JAMES E ADDRESS . . . . . . . . . . : 10060 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 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 1BSEISMICR VALUATION 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 1REROOFRES SQ FEET 0 . 00 9 . 00 0 . 00 9 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 9 . 00 0 . 00 9 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 802 . 00 0753 --------------- TOTAL RECEIPT 802 . 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 95D14-3255 11010IS5 (408)777-3228• FAX(40.8)777-3333 • buildinaCcDcuperrino.org CUPERTINO 0(,Uc0 PDATC!`T1_TTD.CC J S5 `- ` �� APN§ OWNER NAME, J ` 1`r 1 V/� PFinw� r u.4AM STREETADDRFc.c ��,STATF 7*IP FAX PHONE y U� �� EMAIL SD C ,�ATE,& ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT �ONrRAC1'OR ❑CONTRACTOR AGENT ❑ ARCHrmcr ❑ENGNEER ❑ DEVELOPER ❑TENANT C04TRACTQRNAME 9� LI NUMB LI TYPE BUS.LIC.# til( u COMPOre E-MA , FAX STRIOWFISS [/✓t PV ,II�V !�� CITY.STATEZIPNT/� M12- /-/- ARCHITEC(ENGINEER NAME LICENSE � BUS.LIC.# COMPANY NAME E-MAM FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex E3 Multi-Family ROOF e)tEa "^T"nTT^*'¢ STRUCTURE: ❑ Commercial APr/ EXISTING ROOF TYPE: Ua.T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD W' 11PLYWD El OSB PITCH: ROOF O I *LAYERS: THICKNESS: ❑ 5/8" TYPE: EZ CDx ,(( :12 CLASS: A PROPOSED ROOF TYPE: 11BUILT-UPROOF 13 ASPHALT SHINGLES 11 WOOD SHAKES E) WOOD SHINGLES 0' 71AER ICC-ES REPORT# 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 ect have read thGrDes tion o Wbr1:and verify it is accurate. I ee to 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/It :`or inspection purposes. Signature of Applicant/Agent Date: Z G ._. SUPPLEME AL ORMATION RE �-� , :PLA2d CHECIC'TYPE. s+`� _If building is associated with a Home Owner's Association,provide letter of approval from HOA. r O«RTHE�CDIIh'�ER� � BUII.�RjGP`GA_NREV,IEW� r" _Provide Planning approval to verify if there any restrictions. CRESS PL�Ni�'II4GPLANREVIEW Prov' e copy of Manufacturer's Installation Specifications. P r w — - ' EiRE'DEET Provide signed copy of Cupertino's Tear-Off Policy. ❑ roT� �� _ Reroof.4pp 2011.doc revised 03/02/11