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09110046 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:DRAEGER PERMIT NO:09110046 BUILDING ADDRESS: 22415 RANCHO DEEP CLI DR CONSTRUCTION INC OWNER'S NAME: SHIRLEY POITRAS 605 COMMERCIAL ST DATE ISSUED: 11/09/2009 t SAN JOSE,CA 95112 PHONE NO:(408)536-0420 AER'S PHONE: 4082555398 LICENSED CONTRACTOR'S DECLA(RATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clas — Li..ft (o ((.,o-7 Vo— v it QMECH RESIDENTIAL r COMMERCIAL r Contractor 4-��T�'��- �rDate ` ^—t 0 "1 JOB DESCRIPTION:RE-ROOF TEAR OFF&INSTALL 50MIL I hereby affirm that I am licensed under the provisions of Chapter 9 DURLOAST SINGLE (commencing with Section 7000)of Division 3 of the Business&Professions PLY CLASS A 30SQ 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 Sq,Ft Floor Area: Valuation:$13984 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35602035.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all no - oint source regulations per the Cope . o Municipal Code,Section __-�L�-� Date: 918 Issued C Si"nature �,e �❑ RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, f Applica ate: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature o Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Ith&Safety Code,Sections 25505,25533,and 25534. 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 wn o thorized ge t: to �_ 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. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lender's Address mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35602035 .00 DATE ISSUED. . . . . . . : 11/09/2009 RECEIPT #. . . . . . . . . BS000009149 REFERENCE ID # 09110046 SITE ADDRESS 22415 RANCHO DEEP CLI DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER SHIRLEY POITRAS ADDRESS 22415 RANCHO DEEP CLIFF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 ------000 ---------- ---------- TOTAL PERMIT 392 .40 0 . 00 392 .40 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF A -,, CITY OF CUPERTINO REROOF CUPEkTiNO PERMIT APPLICATION APN # Date: (✓ y Building Addre . Z E� _r —` Owner's Name: �' .�� Phone #:Lfo cs_2 ,rj � 3� o If es rovide letter from HOA HOA: Yes N ❑ Contractor: Phone #: C, 9-2V-313 Fax #: Cupertino Business License #: Con actor Ligen #: Type of Roof Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) 0�w 4/1 �l Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: � 1,(-_ /),e 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: n I e Read, Understa d and Will Compl with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO a(;(tl REROOF CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 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. P>5 Homeowner's Name: C 2 Z l 5 Job Site Address: T�-C 1 Roofing Company N '`�- L/r_ Applicant's Signature: ate: / C PP � Greg Casteel Building Official Revised 07/30/08 Community Development sam 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY 0 XPEkTINO Buildin De artment JOB ADDRESS: PERMIT # 22 f C" OWNER'S NAME: 1� Q �` PHONE # Q GENERAL CONTRACTOR: # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: 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 oofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature