11070134 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22734 MAJESTIC OAK WAY CONTRACTOR:DRAEGER PERMIT NO: 11070134
CONSTRUCTION INC
OWNER'S NAME: MAVIS MARTIN SMITH REVOCABLE T 605 COMMERCIAL ST DATE ISSUED:07/20/2011
'NER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION
' � /�' (/
/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# U
MECH r RESIDENTIAL COMMERCIAL
Contractor u Date
I hereby affirm that am licensed under the provisions f Chapter 9 JOB DESCRIPTION:REROOF,13.5 SQ,REMOVE WOOD SHAKE,INSTALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions SHEETING AND ASPHALT SHINGLES
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.
I 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 Sq.Ft Floor Area: Valuation:$12882
permit is issued.
APPLICANT CERTIFICATION APN Number:34232122.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue amst said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additions ,t e applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regul ons er the Cu rt' Municipal Code,Section
9.18. ,
c/ Issued by: Date:
Signature Dale
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspec' I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 2550.5,25533,and 25534.
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 OlFkr or aktJlgrized agept: 2(�
forthwith comply with such provisions or this permit shall be deemed revoked. rCe/ f`5'r 0 elk Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
it' -unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
g,uuting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature_ Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 37 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34232122. 00
DATE ISSUED. . . . . . . : 07/20/2011
RECEIPT #. . . . . . . . . : BS000014110
REFERENCE ID # . . . : 11070134
SITE ADDRESS . . . . . : 22734 MAJESTIC OAK WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MAVIS MARTIN SMITH REVOCABLE T
ADDRESS . . . . . . . . . . : 22734 MAJESTIC OAK WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5614
RECEIVED FROM . . . . : DRAEGER CONSTRUCTIO
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 12, 882 . 00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 12, 882 . 00 1.29 0 . 00 1 .29 0. 00
1REROOFRES SQ FEET 13 .50 189. 00 0 . 00 189 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 191.29 0. 00 191.29 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION --------
DATE: REVIEWED BY:
ADDRESS: -2-2 73-c i P1,-1,*
APN: /3- 4- 1 BP#: 0�70 i3 *VALUATION: $1C2,8-82
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK
ISCOPE
FEE ID ROOF AREA
(s.f.)
1REROOFFRES 1,350
F-1 Lj I
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l in o.
FEE ITEMS (Fee Resoh1tion 11-053!ff 7,%1:-1 1) FEE QTY/FEE MISC ITEMS
'40 o0o0o,
Permit Fee: $1 .0 0
Work Without Permit? 0 Yes No $0.00
Strong
Motion Fee: IBSEISMICR $1.29 Select an Administrative Item
BldStds Commission Fee: IBCBSC $1.00 t0000,
,18f
SUBTOTALS: 1 $198.291 $0.00TOTAL FEE: $ 291
Revised: 07/04/2011
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ZZ-7g4-4_ 2_Z7Z2_
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 2.27$2-2Z7Si/
CUPERTINO
(408)777-3228• FAX(408)777-3333•building
(dcupertino.org
PROJECT ADDRESS Ro 1 I + APN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS CRY, STATE,ZIP n FAX
CONTRACTOR NAME��� n � vG� LIC ENS MBER LICENSE TYPE BUS.LIC.#
COMPANY NA E ' C E- AI FAX
�� r
STREET ADDRESS CITY,STATE ZIP PHONE
Co rz Sf 7z---
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPolicv_1011.doc revised 02/16111
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 `
(408)777-3228• FAX(408)777-3333 •buildingacupertino.org
CUPERTINO
PROJECT ADDRESS2 7._:3
4 / � (� APN#
OWNER NAME ', / /_r! / PHONE �--- E-
STREETADD MAus �-V%��a fq L I , STA ZIP FAX
APPLICANT 1� PHONE 771IL
T �
STREET AD RESS C STATE, ZIP FAX
d� ��; �— d
❑OWNER ❑ OWNER-BUILDER . OWNER AGENT ❑ CONTRACTOR LL! NTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRA R NAME LICENSE NUMBER LICe !E TYPE BUS.LIC.#
COMPANY NAME `G E- FAXpe
STREET ADD CITY,STATE,ZIP PHONE
-5t_ CC�ge Oe, zz�-,53 6, 0"�l
If-
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ulti-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE IF NO, PLYWOOD &_'A" ❑ L ❑ OSBPITCH: ROOF
13 NO #LAYERS: THICKNESS: 115/8" TYPE: ElCDX '12 CLASS: A
PROPOSED ROOF TYPE: 1:1 BUILT-UP ROOF ❑ASPHALT SHINGLES ElWOOD SHAKES 11WOOD SHINGLES ElOTHER ICC-ES REPORT#
DESCRIPTION OF WORKAle
e //
X1,
By my signature below,I certify to each of the following: lam r erty owner ora on ed agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I e d the Descripti of Wor and verify it is accurate. I are o comply 'th all applicable local
ordinances and state laws relating to building cons- ctio orize.represent 'ves of Cup rtino tc enter the above-identifie�opertb -or inspection purposes.
Signature of Applicant/Agent: Date: C
SUPPLEMENTAL INFO N REQUIRED _ ` otrc v5E orrl x "� = €
_If building is associated with a Home Owner's Association,provide letter PLATT rCHEcx TrrE 'rRouTiN sL� ter"
of approval from HOA. L7 p ER THE cOIINT1 R� ❑ BUiID7IIGPtAIV REVIEW` - {
_Provide Planning approval to verify if there any restrictions. �;k�r�xEss ❑ `PLANNING PLATItEviEw
T -
_Provide copy of Manufacturer's Installation Specifications. `sAND,►xD _ ❑ FIRE DEPT
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ orH>rIt
ReroofApp_2011.doc revised 03/02/11