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