11050232CITY OF CUPERTINO BUILDING PERMIT
Bt ILDING ADDRESS: 22649 WEEPING OAK CT
CONTRACTOR: DRAEGER
PERMITNO: 11050232
CONSTRUCTION INC
OWNER'S NAME: MEI HSHIEN-KWEI
605 COMMERCIAL ST
DATE ISSUED: 08/22/2011
OWNER'S PHONE:
SAN JOSE, CA 95112
PHONE NO: (408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
#_ ��
F_ F
License Class Lic.
J
MECH RESIDENTIAL COMMERCIAL
Lf/ Date
Contract t! �hat
JOB DESCRIPTION: RE -ROOF 10 SQ- 1/2"PLYWOOD, TPO OVERLAY WITH 2
1 hereby affirlicensed under the provisions of Chapter 9
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.
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.
Sq. Ft Floor Area:
Valuation: $375
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34232033.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for ch th's
permit is issued.
APPLICAN 1'CER'I'IFICA"MON
I certifv 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
180 DAYS M LAST CALLED INSPE TI N.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnity and keep harmless the City of Cupertino against liabilities, judgments,
costs- and expenses which may accrue against said City in consequence of the
Issued by: Date: /
eranting of this permit. Additio , the applicant understands and will comply
wth all non -point source re a ns per theCrtino Municipal Code, Section
9 18.
"
SDateCG
RE -ROOFS:
All roofs shall be inspected prior to any roofin-waterial being installed. If a roof is
to.
for
installed without first obtaining an (lagree to remove all new materials
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: ate:
I 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
1, as owner of the property, or my employees with wages as their sole compensation,
%N ill 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).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I 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 1 store or handle hazardous
! ha�c and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety Code, Sect[ ns 25505, 25533,,�and 2
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
N'/,
Owner or authorized agent. S /� Date:
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
CONSTRUCTION LENDING AGENCY
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
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 certih 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18
")ignaturc __ Dale--------_--
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34232033.00
DATE ISSUED.......: 08/22/2011
RECEIPT #......... BS000014522
REFERENCE ID # ... 11050232
SITE ADDRESS .....: 22649 WEEPING OAK CT
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............: MEI HSHIEN-KWEI
ADDRESS ..........: 22649 WEEPING OAK CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: SylviaM
COPY # : 1
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
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aecugerfino.org
11050 23; -
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 5KCONIRACrOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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ARCHrrECT/ENGn11EER NAME
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BUS. LIC. #
COMPANY NAME
E-MAIL,
FAX
STREET ADDRESS
CrrY, STATE, ZIP
PHONE
USE OF FD or Duplex ❑ Multi -Family
ROOF
V.AT ITAT M,r. ZtauP. O
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CAREA:
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STRUCTURE: El/"),q
Commercial
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EXISTING ROOF TYPE: UILT-UP ROOF ❑ ASPHALT SHINGLES
❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE ❑YES
IF NO,PLYWOOD
fia, W, ❑
PLYWD 13OSB
PITCH
�
ROOF
A
0
# LAYERS:
THICKNESS:
135/8"
TYPE: la CDX
,12
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES
❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER
11-1
ICC -ES REPORT #
DESCRIPTION OF WORK:
' ent to act on the property owner's behalf. I ve read this
By my signature below, I certify to each of the followi . lam property owner oRfCoupert�intc
application and the information I have provided i c ect. I e read
the Descriptioork and erify it is accurate. I agree t comply all applicable local
ordinances and state laws relating to buildin ction autho
sentati enter the abov -'den ' Ie p� pe inspection purposes.
li
Signature of Applicant/Agent:
Date: `
SUPPLEMENTAL TION REQUIRED
..
_ If building is associated with a Home Owner's Association, provide letter
of approval from HOA.,T�
_Provide Planning approval to verify i there any restrictions.
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�LAIQivING PL�11H R'E'S� :
_ Provide copy of Manufacturer's Installation Specifications.Zei
� �
rovide signed co ertinos Tear
of C ' Policy.
4-
J� PY u P -Off
ReroofApp_2011.doc revised 03/02/11
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