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11050288 CITY OF CUPERTINO BUILDING PERMIT Bt ILDING ADDRESS: 22643 QUEENS OAK CT CONTRACTOR:DRAEGER PERMITNO: 11050288 CONSTRUCTION INC ONVNER'S NAME: RAJEER KAK& SHAH VINITA 605 COMMERCIAL ST DATE ISSUED:08/22/2011 OWNER'S PHONE: SAN JOSE, CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION I� I F— /} BUILDING PERMIT[NFO: BLDG ELECT PLUMB License Class "' Lie.# V (— I— I� MECH RESIDENTIAL COMMERCIAL Contractor 1 hereby affirm that 1 m licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 9.3 SQ-1/2"PLYWOOD,TPO OVERLAY WITH 2 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. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to sell'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*iCjhis APN Number:34232060.00 Occupancy Type: permit is issued. krl(F APPLICANT CERTIFICATION 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 upon the above mentioned property for inspection purposes. (We)agree to save 180 D7i; M LAST CALLED IN7rVb N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue inst said City in consequence of the granting of this permit. Addition th applicant understands and will comply Issued by: Date: with all non-point source reg ions r the Cupertino Municipal Code,Section 9.18, RE-ROOFS: Sign Date L� G All roofs shall be inspected prior to any rooQfing material being installed. If a roof is installed without first obtaining an ins von,1 agree em ve all new materials for inspection. n ❑ OWNER-BUILDER DECLARATION Signature ofApplica Date: , 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 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(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 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 1 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 Health&Safety Code,Sections 25505,25533,andel 34. Section 3700 of the Labor Code,for the performance of the work for which this t S `"' p L permit is issued. Owner or authorized agep Dater 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 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 18 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232060 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #• . . • • • • • • : BS000014521 REFERENCE ID # . . . : 11050288 SITE ADDRESS . . . . . : 22643 QUEENS OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAJEER KAK & SHAH VINITA ADDRESS . . . . . . . . . . : 22643 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 9 . 00 126 .00 0 . 00 126 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127 .50 0 . 00 127 .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 GUPERTINO (408)777-3228• FAX(408)777-3333• buildinaacupertino.org 2g&-13 _ 09— 2 PD 11TL'l`T ATTR.CC aU'e"a N'S �A-K � G'f'–. ' APN# (' �/3� 32. O(PO OWI C n _ r' �1 ► 1 V I n I Z/1 p4s&, ��^J InI E-MAIL STREET_ADDRESS O �1 ru STATE ^ ` FAX !UANT i '4 PHONE/y �— T E-MAIL STREE�DRF�$S � P � S� .STATE.ZIP � 7/ FAX . ❑OWNER (❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C CT(�R N LI NUMB LI $�TYPE BUS.LIC.# SIL( G� — 1 o5 COMP��A�fE � ,A/G LO E-MAIL FAX STREETV 1 V V✓�pI� .I'I�V /f�� C ,STATFZIP JoN _ 12-- se ARCHIIEECCT/ENGINEERNAME LICENSE V� BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family ROOF VALUATION: STRUCTURE: ❑ Commercial /%y 41 a f T I ` ( EXISTING ROOF TYPE: Un.T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD f." ❑ PLYWD ❑ OSB PITCH: ROOF 5KNO *LAYERS: THICKNESS: ❑ 5/8" TYPE: COX T) :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTTER ICC-ES REPORT# DESCRIPTION OF WORK-- By ORKBy my signature below,I certify to each of the follo �' a the property owne r au rized agent to act on the property owner's be I have read this application and the information I have provided is re real•]the Desc' 'on of ork and verify it is accurate. I ee to co y with all applicable local ordinances and state laws relating to building c trurize pres mt. _s o Cupertino tc-enter thea tified p efi• for inspection purposes. Signature of Applicant/Agent: Date: c' �� SUPPLEMENTAL ORMATION REQUIRED ' —If buildingassociated with a Home Owner's Association, �is n,Provide letter of approval from HOA. ' "oyt$-rarFrn •�-� ilmortvG�'�At�it>rv>Ew x L -'c.-�.,._ ."iii��'�,�_,',�'. ,t- s-'n+cT�g.......y.�.r�v r. �r„Y.•_, s _Provide Planning approval to verify if there any restrictions. Kks y SG a> 0 'PI�iFNGI'LANRESyIER�' Provide copy of Manufacturer's Installation Specifications. C, ovide signed copy of Cupertino's Tear-Off Policy. Thi { r ReroofApp 201 Ldoc revised 03/02111