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05070136 CITY OF CUPERTINO BUILDING DIVISION PERMIT +�CONTRACTQR IN FORMATION w BUILDING ADDRESS: COSMOS ROOFING PERMIT N0.05070136 20130 AP OWNER'S NAME: PERMIT ISSUE DATE TAM JASON Y AND MARY C 1901 OLD MIDD 11ME: SANITARY NO. CONTROL NO. (415) 493-6373 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uoa LICENSED CONLRACIOR'S DECLARATION U- I hereby affirm Nat I am limwd under provisions of C ap,r 9(commencing Job Description IRw withS don]IXIO)af Division3of NCBusineasand fcssiurts Co ,an licevcis ate„ infanuo¢aneerr/Cl. yY a a TI/0 SHAKES-RESHEET OSB ADD CERTAINTEED j vn 2 Liceax ass I �-- ' Lic s ^t£0 Dam d ARC HITELCon TSDECLARATION 18 U4 )I v`wgap� SIDENTAL SHAKE SOS#R��C,OMfJP ///S��HINGLES W 1 understand my plan:ensu he used as public records •� LL Licensed Proportional `Qy3 OWNER-BUILDER DECLARATION 9 4 I 1 heo:hy affirm that 1 am exempt from the Conuactoes License Law for the O �� Q O following mason,(Section 7031.5,Business and Profession Code:Any city or county K m which mquires a Permit to construct,alter,improve,demolish,or repair any structure (�af' ✓ prior a its issuance,saw requires the applicant for such Permit on file a signed annulment ID�435 < that he is licensed pursuant the provision of the Contrxlah License Law Charter Sq,Ft. Floor Area V11 ,(sj a� Valu l z�° (commencing with section]t]W)of Division 3oftM Business and Profession Code)or ////�[v/// 'y F$ that he u exempt dtcrefrom and the basis for the alleged exemption.Any violadon of Section 7031.5 by any Applicator for a permit subjecu the applicant W a civil penalty of APN Number Occupancy Type not mom than rive hundred dollars(SS(K). 31633079 . 00 ❑Luownrofth6 the ony,mmyotimeoces withwagonfor ale((Sec. 1144,Bsin ss will do Nework ande: swnureuntiesLiWede Gave rdos.1a(Sec.]064,Besi,of and Profession Cade:The Casdescon,Uarho Law docs rat apply iso an ruga(of Required Inspections property who builds or ed thaws thereon,and who does such work himscl medWrough his ' Own employees.the wiping or i provehimprosemcnuarenot intended completion. for owner huilder ,Nebuilding orimprovementis sold within one Wild of Improve Ne owner builder will have d,burden of proving Nat he did not build or improve far puryose of ' axle.). O 1,as he,of tl,property,am exclusively emorraming with licensed ountractors W Construct the pmjen(Sec.7014.Business and Professions Code:)The Contractors Li. rue Law docs not apply to an owner of property who builds or improve Uumon,and who contracts for such projects with a contractor(s)licensed pursuant a the Contactors License Law. ❑I am exempt under Sec. B A P C for this reason Owner Dau WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury CO.of the following declaration: ❑1 have and will maintain a Cerdfcum of Consent to aelf-insure for Workera CompCn. sstion,as provided for by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workcrs Compensation Insurance,m recruited by Section 3700 of the Libor Cade,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Cartier and Policy number am: Carrier. S , 4 4^-Are-- Policy No.:a5 7I -[I5- I 12-5 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars($la) or less.) 1 cenlfy Nat in the performance of the work for which this permit is issued,l shall not ,ploy any person in any mann,An As W become mbjm m to Workers''Compcwdon Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Campeave of Exemption,you should became subject to the Worker's Compcnution provisions of the Labor Code,you must QZ forthwith comply with such provisions or this permit shall ba deemed revoked. Z CONSTRUCTION LENDING AGENCY [-i I hereby affirm Nat Here is a contraction lending agency for the performance of CL she work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name IL Z Lender's Address fJ Q 1 certify that I have mad this application and some that the&hove information is ly F' corms I agree to comply with all city and county ordinances and sok laws telaring to Q(, Wilding convention.and hereby authaodrcpruenotisrs of his city to enter upon the W above-mcnliund pmpeny for inpection prpgses. F0. (Wo)agree to save,indemnify and keep harmless the City of Cupertino against "N liabilities,judgments,costs and expenses which may in any way accme against mid City („)Z in consequence of the granting of this permit. / APPLICANT U RSTAND AN ILL CO LY WITH ALL ON-POINT Issued by: Date L SOURCE RE TION r ,/`I(° 5 Re-roofs Signature of ApplicaHAZARDO Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the a Cuper or)Muni building occupant care or handle Heallous material As defined by the Cupertino Municipal Calc.Chapter 9.13,and the Health and Safety Code.oY zss3z(&3t� , Na All roofs shall be inspected prior to any roofing material being installed. `ut If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building by the Bt esu equipment or devices which g mit hazardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yea �]Nu 1 have real the hazardous materials requirements under Chapter 6.95 of tic Califon M.Hear"SafcryCode,Sections 155)5,25533 and 35534.1 umkrslxnd hat lithe building / does not currently hast a tenant,that it is my rcepnnibility W notify d,occupant of the • g ((( requirements which muss M met prior to issuance Of a Certifier,Of DCCap Cy. Signature of Applicant Date Owr a r o„ All roof coverings to be Class"B"or better INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO i • PERMIT INVOICE OPERATOR: suem Sec: Twp: Rug: Sub: Blk: Lot: APN . . . . . . . . : 31633079.00 INVOICE DATE. . . . . . : 07/21/2005 REFERENCE ID # . . . : 05070136 SITE ADDRESS . . . . . : 20130 APPLE TREE LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TAM JASON Y AND MARY C ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2002 CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844 COMPANY . . . . . . . . . . : COSMOS ROOFING ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WY CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (415) 493-6373 FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE ____________ ___ __________ __________ __________ B PERMIT FEES 4116 P 180.36 0.00 180.36 SEISMIC FEE RES 2013 P 1.10 0.00 1.10 ____________ ____________ 181.46 0.00 181.46 - Jul 21 05 08: 22a Cosmos Roofing (6501969-9905 p. t 07/26/2005 13:48 5105383282 LEGALITIES I^ < PAGE 011 Commuairy Development 10300 Morro Av Cupertino CA.95014 Selep6ox(40b)11'I-322b9 Fes(408)777.3333 LUPI TING Building Department JOB ADDRESS: /3o Q I PERMTI "OSo7o 13 � OWNER'S N ANM: IPHONEN el,5 lke rf GENERAL CONTRACTOR IFAX# Tam not using any subcontractors: ` 7 1,los Signatur Date Please check applicable subcontractors and complete th owing information: 61 1 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical inis - Electiical Excavation _ Felicing Flooring-Carpeting Linoleum% Wood Glass/ Glazing Heating Insulation Landscaping -- Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving _ Plastering Plumbing Roofing - - Septic Tank - - - Sheet Metal - — -- Sheet Rock Tile — "/0 -S _ pruner/Cgntzactor Signa Date Community Development Department Building Division 0 City of Cupertino 10300 Torre Avenue � CITY OF Telephone: (408)777-3228 U P E f�T I N 0 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. 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 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. Homeowner's Name: Job Site Address: ZO/ 30 Roofing Company Name: Applicant's Signature: Date: ,tt o5 OGreg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF CITY OF �CUPEkTINO PERMIT APPLICATION FORM APN# 13// 1�J /I nV Date: 7b //0 S Building Address: ((QQZa 1 3 O / Owner's Name: i Phone #: Contractor: Phone #: License #: 650 9 6/ 9- 76 93 Contact: Phone#: Cupertino Business License#: 65o 410u - 7-q , (4 1:''Cf4( Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )C Asphalt Shingles �I Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles , ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed O Provide Mfgr. Installation Specs. I Have Read, Understand and WillCom ly Wit Cu ertino's Tear Off Polic : Jo Descri tion: To 0 ResidentialCommercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if Ap2licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING