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11050281 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 22663 QUEENS OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050281 CONSTRUCTION INC ON1"NER'S NAME: HYUN HEO DONG & KIM HYE KYUNG 605 COMMERCIAL ST DATE ISSUED:08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATIONF_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class -- Lie. F_ _ MECH RESIDENTIAL COMMERCIAL Contractor i '�a�. Date5 l I herebyaffirm tha am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 10.4 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2 ' p p 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 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 w wch this APN Number.34232064.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I ccrtifN 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 xvith 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 M LAST CALLED INSPE indemnifv and keep harmless the City of Cupertino against liabilities,judgments, costs.and expenses which may accrue a said Cit in consequence of the granting of this permit. Additionall , ie pli and rstands and will comply Issued by: A16 Date: with all non-point source regu ons r(h uperti Municipal Code,Section 9.18. R E- Signature _Date 5f 1, All roofs shall be inspected prior to an ooti72aterial being installed. If a roof is installed without first obtaining an i pecti I agree o remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: ate: 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(x)should I store or handle hazardous I hart 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 I perforniance 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 Health&Safety Code,Sections 25505,25533,and 2534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agentDate�� / permit is issued. • 7�?i 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,atter 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 indenuiifj and keep harmless the City of 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. 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 15 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232064 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014524 REFERENCE ID # . . . : 11050281 SITE ADDRESS . . . . . : 22663 QUEENS OAK CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HYUN HEO DONG & KIM HYE KYUNG ADDRESS . . . . . . . . . . : 22663 QUEENS 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 10 . 00 140 . 00 0 . 00 140 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 141 .50 0 . 00 141 .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 950143255 (408)777-3228• FAX(408)777-3333 • building aacupertino.org CUpERTtNO . APN# 3q'2_ 32- O LP q OWNFD'T•,•� c P E-MAII, � GDnS Ko 1i 14-- n Ss2• STREET ADDRESS � lI v, STATE?� ^ ( FAX 2 0 (� � C,yNrr N 4k2i a�( U— ?J� .STATE. ZIP � ?' FAX . ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CCT(IRNAME LI NUMB BUS.LIC.# bl( u ` 5 COMPA6�AIv1E '/ Cb rVG GO me E M - FAX STREP re8CD LAA QY ,LA /7 C ,STA E CLI 12 ARCHITECT/ENGINEER NAME LICENSE `. BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2<SFD or Duplex ❑ Multi-Family Ro A: VALUATInN- „i1n.r1 I STRUCTURE: ❑ Commercial (� /� , 6` (� S EXISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YP,S I"r NO, PLYWOOD g w, ❑ PLYWD El PITCR. ROOF O #LAYERS THICKNESS: 135/8" TYPE: 5a CDX '11 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES JE�OTHFR ICC-ES REPORT# DESCRIPTION OF WORK 17 /+ 2 _eg By my signature below,I certify to each of the foil g: I am the prop r or authorized agent to act on the property owner/bef. I have read this application and the infonnation I have provided' rrect. I have re a Descrip'on:af Work and verify it is accurate. I gree to cwithall applicable local ordinances and state laws relating to build' tructi . I auth a represen 'ves of Cupertino tc enter thea ove-' ?M pror inspection purposes. Signature of Applicant/Agent: Date:X 44 G SUPPLEME ORMATION REQ D _If building is associated with a Home Owner's Association,provide letter P �= oN�sL� rad" of approval from HOA. ` 4 -4 t PP Provide Planning approval to verify if there any restrictions. — ,Pza-nl�Ic rLiisl xEz�IEw _Prow' copy of Manufacturer's Installation Specifications. j] C3 ni L Provide signed copy of Cupertino's Tear-Off Policy. �- ;y ❑ So�Tgr ;` ReroofApp_2011.doc revised 03/02/11