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11050234
CITY OF CUPERTINO BUILDING PERMIT Bt H.DING ADDRESS: 22669 WEEPING OAK CT CONTRACTOR:DRAEGER PERMIT NO: 11050234 CONSTRUCTION INC OWNER'S NAME: BOBRINK VIRGINIA D 605 COMMERCIAL ST DATE ISSUED:08/22/2011 OWNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION F� F— F_ PBUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. © I- r— F- . MECH RESIDENTIAL COMMERCIAL Contractor // �' _Date �f_ G'� hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 10 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. 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. 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 fo which this APN Number:34232035.00 Occupancy Type: permit is issued. APPLICAN'I'CER'1'IFICA7'ION 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 DAY ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue agaikist said City in consequence of the / granting of this permit. Additional) e plicant u stands and will comply Issued by: G^ Date: 7 If with all non-point source regi ns r the Cup mo Pvlunicipal Code,Section 9Ix I RE-1109m: Signature _Date All roofs shall be inspected prior to any ro material being installed. If a roof is installed without first obtaining an insp tip agree to, remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION _— Signature of Applicant: J� Date: 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) I.as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I 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 1 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 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,Scons 25505, 5533,and 2 4. Section 3700 of the Labor Code,for the performance of the work for which this g PA" �� /� - permit is issued. Owner or authorized a ent Date: I certify that in the performance of the work for which this permit is issued,1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 kvith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature _Date CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232035 . 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . BS000014522 REFERENCE ID # . . . : 11050234 SITE ADDRESS . . . . . : 22669 WEEPING OAK CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BOBRINK VIRGINIA D ADDRESS . . . . . . . . . . : 22669 WEEPING OAK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5632 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 10 . 00 140 .00 0 . 00 140 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 141 .50 0 . 00 141 .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 CUPERTINO (408)777-3228• FAX(408)777-3333 • building a(�cupertino.orq c50E3q PDt *=r J 0* APN# L32 D PHONE E-MAILOWNF *`""'L • Y l lel l q 5661-1 El ST}2EE�ADDRESS O ` Qi QTY• STA ^ ( FAX AP C I PHONE Z &MAIL FAX . ❑OWNER (❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C CT(2R NAME � LI NUMB BUS. E BUS.LIC.# Vt G� E-MAIL FAX QIr C .STATE CIA /� ARCHTTECT/ENGINEER NAME LICENSE BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or Duplex ❑ Multi-Family /ROOF AREA: Vet tr"TT^* J( 2/(�T�j•CIO STRUCTURE: ❑ Commercial v S n/ 2- F I (` S ExISTING ROOF TYPE: UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO. PLYWOOD W, ❑ PLYWD ❑ OSB PITCH ROOF O #LAYERS TrBCKNESS: ❑ 5/8" TYPE: CDX — — 12 class: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ;90THER ICC-ES REPORT# DESCRIPTION OF WORK: r leg By my signature below,I certify to each of the followi . Jam property owner or autho ' ent to act on the property owner's behalf. I ve read this application and the information I have provided i c ect. I e read the Description ork and erify it is accurate. I agree t comply all appliUble local ordinances and state laws relating to buildin n ction autho ' sentati of Cupertin tc enter the ab ov -'den' I property f inspection purposes. Signature of Applicant/Agent: Date: C SUPPLEMENTAL TION REQUIRED 4 _ _If building is associated with a Home Owner's Association,provide letter Wzg �* of approval from HOA. OVER T1�E CDTTh'�ER BUILDIIVG PLA.*I RE VIEW v Provide Planning approval to verify if there any restrictions. - = II: I ss EJ xlazvxz�Ic PL I vlsw —Provide copy of Manufacturer's Installation Specifications. - r -nix-- t rovide signed copy of Cupertino's Tear-Off Policy. ❑-joTB�R ReroofApp_2011.doc revised 03/02/11