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09110047I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 11023 CANYON VISTA DR I CONSTRUCTION EGER I PERMIT NO: 09110047 I O" NER'S NAME: GINEY PALMER 0.. NER'S PHONE: 4089967332 LICENSED CONTRACTOR'S DECLARATION License Class C—, Lic. #(p2( (67 6 Contractor Date [ _,F ` I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that 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 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 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all n - int source regulations per the Cupertino unicipal Code, Section 9.18. S" -ature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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 (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 the above mentioned property for inspection purposes. (We) agree to save .nnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 605 COMMERCIAL ST SAN JOSE, CA 95112 DATE ISSUED: 11/09/2009 PHONE NO: (408)536-0420 BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB I— MECH F_ RESIDENTIAL f— COMMERCIAL f— JOB DESCRIPTION: RE -ROOF TEAR OFF & INSTALL 50MIL DURLOAST SINGLEPLY CLASS A 30SQ Sq. Ft Floor Area: I Valuation: $13984 APN Number: 35628041.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date. RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without firskoktlaining an inspection, I agree t remove all new materials for inspection. Signature of ApplicanDate l ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu lino Municipal Code, Chapter 9.12 and the Fl-eklth & Safety Stade, Sections 2 50 , 3, and 25534. IN,ri d a ad \ 1 A -1 1'\ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35628041.00 DATE ISSUED.......: 11/09/2009 RECEIPT #.........: BS000009149 REFERENCE ID # .•• 09110047 SITE ADDRESS .....: 11023 CANYON VISTA DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GINEY PALMER ADDRESS 11023 CANYON VISTA DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: DRAEGER CONST INC. 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 ---------- 13,984.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 13,984.00 1.40 0.00 1.40 0.00 1REROOFRES SQ FEET 30.00 390.00 0.00 ---------- 390.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 392.40 0.00 392.40 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 784.80 --------------- 784.80 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #299 VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF L11 I I o t--{ -1 -� CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION APN # _ Date: (� Q Building Address: 2 C:� i� t 0 C�4 Owner's Name:` ��` rn�' Phone #: 11 HOA: Yes No ❑ If yes, provide letter from HOA Contractor: Phone#: (C Sc Fax #: Cupertino Business License #: Co tractor License #: Type of Roof Covering: Existing: Proposed: 9- Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Wood Shingles ❑ Other (Specify)��,r,-�,- t�� CA3r Number of existing coverings ❑ Provide I.C.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 50 7,% r8 C Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have"e, , Understand and Will Comply with Cypertino's Tear -Off Policy: Signature Revised 02/05/09 FA CITY OF CUPERTINO a REROOF CITY OF CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1 REROOFCOM Re -roof Commercial B 1 COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1SFDWLROOF 1RER00FRES Re -roof Residential B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B 1 BUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building Department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agree to comply with 2007 IBC Standards and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre -inspection and/or tear off approval. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. u NEC ✓r t�- Homeowner's Name: Job Site Address: Roofing Company N Applicant's Signatur Greg Casteel Building Official 1A bQ_ CMPr- Je T_ M- UJ Revised 07/30/08 CITY OF .,UPEkTINO Comm uzuty Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: IICz ct>�A bz_ PERMIT # rvdL-) OWNER'S NAME: �� kph} PHONE # �0-= %a ` GENERAL CONTRACTOR. F # I am not using any subcontractors: UQC �1 -6,) Signature Date Please check applicable subcontractors and complete the following information: A k)N K , � '91k.- " ) Owner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing 6e Roofing Septic Tank Sheet Metal Sheet Rock Tile A k)N K , � '91k.- " ) Owner/Contractor Signature Date