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04090064 CITY OF CUPERTINO '� '^` ` BUILDING DIVISION PERMIT kCONTRACTaOR INFO'CtMAT IONS. BUILDING ADDRESS: PERMITNO. COSMOS ROOFING 04090064 M PERMIT ISSUE DATE ONE: SANITARY4-1 OLNO. ARCHITEC 71ENGINEER: BUILDING PERMIT INFO PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION O wF I hereby affirm that I am licenecd under provisions of Chapter 9(commencing Job Descrip nCu i`uj with Section 7W)ofDivision 3 ofmc Busincssand Professions Code.and my license is "y in run tura ands 4 ,qz Loan Us. `3 tie.« La` REROOF W/SHAKES NOV �� 2004 F p Dalc Contractor ? sfs ARCHffELTS DECLARATION �������N �U 1 understanJ my plans Nall be uttd az puMk cards LLo t, Licensed Profession.)S OWNER-BUILDER DECLARATION sF I hereby affirm Nal 1 am aninin rrum the Convact.e.Uantt Law far the 00 following mason.(Secuun 7131.5,Business and Professions Code:Any city or county i31L which requires a Permit m construct,alma improve,demolish,a mpar,any structure Fiy prior in is issuance.also requires;tlm applicant forauch permit in file a signed satimem s o NathcislicensedPurnnntlothcpravisionsof@cConmcmr'sUcensclaw(CTapmr9 Sq. FL Floor Area Valu tion on (commencing with Section 7W0)of Division 3 of the Business and Proreamm,Code)or on y _ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty ofQccll anC-Type am Mme dtam BK hundred dollar(S50n. 3 2WV$111r2t4r0 0 P Y YP ❑I,as owner of the property,u my employees with wages an their sole compensation, will do the work.and the structure is not intended oraVered forsale(Sec.70".Business and Professions Code:The Contractors U.law docs wt apply On an owner or Required Inspections property who buildsarimprowa Merron,and whodaessuchwork himself or Wough his awn employva,provided thmsuch improvements art not intended oroRered foraJe.It. however,the building or improvement is sold within one year of compleuw,the owner builder will have the burden of proving that he did rat build or improw fm puryott of sale.), ❑1,as owner of the pmperty,am exclusively contracting with licensed contractors to construct the project(Sec.711 Business and Professions Code:)The Canuanor's Li. cense Law does not apply in an owner of property who builds or improsm Merron,and, who contracts for such protea with a conuanor(s)licensed pursuant in the Conani License law. ❑ I am excmpl under Sec. B&P C for this moon Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ore of the fallowing declarations: 1 haw and will maintain a CertUicate of Consent m ttlf-insure for wohefs Compton station,u provided for by Section 37M of me Inbar Code,for the perfornence of the work for which mist permit is issued. "how and will maintain worker's CGmpensauon I...,as required by Swim. 700 Grim labor Code.for the Performance of the work for which this permit is issued. My WukeY ore dation Inggurencc orticr end Policy ri:?im: Cerin: - — oC- Polity No.: c/ 7 I `/lis CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE flits section need not no completed if the permit is for one hundred dollars($100) or I.) 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 Worked'Compcnsalion Latest of California Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Eaemption,you should become subject to the Worker's Conformation provisions of the Labor Code,you must 0 z forthwith crmPly with such prmvisirns or this permit snail be desmed rewked. z O CONSTRUCTION LENDING AGENCY E" I hereby affirm that there is a construction lending agency for me Performance of C' the work for which this permit is issued(Sec.3097,Civ.C.) 6w.Q Undcls Name ]z Lender's Address V Q 1 cantly that 1 haw rend this application and slow that me draw information is (y F' correct.1 agree to comply with all city end county ordinances and aur law miming to 0 V building construction.and hereby initiation mpreem:tives of this city to cru upon the W ahawtmeminned dgmnropcst for ndcarecuom which may D. (We)agree to save,indemnify and keep harmless the City of Cupertino against Lo�Z inconseajudgmenue costs and expensexmit. they in any way accrue against said City / U z in cansequcnee of Ne granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON7 Y 01W Issued b : SOURCEREG Date �= �3 6L� Re-roofs Signorina of ApplmanVCom nor Dem HAZA DOUS MATERIALS DISILOSURE Type of Roof Will the applicant or future building occupant stare or handle hoodoos material CU', &lured by dm Cupertino Municipal Code,Chapter 9.12.arW the Health and Safety Code.=1 15532(6)? ❑yea `MIRr— All roofs shall be inspected prior to any roofing material being installed. Will me applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it bmarums,din comzminana as derincd by on Bay Arca Air Quality Management all new materials for inspection. 7nm suict7 1 C]yes Iban rexd mehvardtws 25505.2553als and 255 underChapter dconanb.95 oche Califon Hcalth&Sorry Codc.Sauons 25505.]5533 and 25530.1undcrslond matirmc buildinges not currently how a tenant,that it is my msporuibillty m notify de cupium or the Gimmcna son Monet priarm aema nracwneam ansa Signature of Applicant Dale �3t 9 /ate ownm ar aulnodveda rat am All roof coverings to be Class "B"or better Seo 13 04 08: 05a Cosmos Roofing 16501969-9505 0. 1 Community Development 10300Totte AVMW Cupmtioo CA 05014 Tdephooe(408)777-7228 CUPEkTINO F"(408)7".3333 Building Department JOB ADDRi399: rERbn r#� µ a g a o l0 g i A n v-6 Aum OWNER'S NAME: n E C PRONE# Qf)9 rl 4> g4 4 GYRAL CONTRACTOR FF/AX#i � I atn not using any su /,j 1 / C 6 JlYt6J / 3 b z) Si true Date Please check applicable atbcamtractors and complete the following Worm um. SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE Cabinets k Millwork Cement Finishing Reehieel ExcavationFloortrw Carpeting Fendng -- -- Linoleum/Wood Glass/Gluing Heating -- Insulatim --- LandscaP"`g Ladling — Masonry — Onuunetttal Sheet Metal Painting/ Wallpaper .____ Paving Plastering — Pl ---- RooSrrg ' Tank Sheet Metal — SheetRack - Tile -- Owner ontractor Signature Date Community Development Department Building Division City of Cupertino Ll 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E kT I N O 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 1997 UBC Standards and manufacturers specifications on re-roofing. 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. 1 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. 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. Homeowner's Name: aa Q e !V OYIg Job Site Address: 0 7{e Roofing Company Name: r�� �Gp paiy 6 A plicant's Signature: (/ Date: ? f3 Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF o ° CUPERTINO PERMIT APPLICATION FORM APN# Date: -� � •�V 2/7i �/3 a� Building Address: 104��/ Cin Owner's Nam Contractor Phone Aliceme#: C. 56 -969 - 266-3 _? F 5 44F Contact: Phone#`4 � Cupertino Business License#: /ft8 S/ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles 2S Wood Shakes Di Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Residential 751 Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are an restrictions: LJ Cost of Project: Type of Construction: Occupancy group: /7, *b - o0 Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING / BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING • n "