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CITY OF CUPERTINO
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BUILDING DIVISION PERMITCONTRACORINFORMATION
BUILDING ADDRESS:
COSMOS ROOFING
PEND rNO.
10243 BEARDON DR
02120093
OWNER'S NAME:
1901 OLD MIDDLEFIELD WY
APPLICATION SUB DATE
GOODWIN CHIN
12/23/2002
IONS
(415)493-6373
SANITARY NO. CONTROL NO.
ARCUITELTMNGINEERc
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O
OIr�
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Job Description
��F. ®
with Seaion7000)ofDivision Sof Ne ffe Busincxsm4Profcssirns na
lc.nJ mylimnscis
in fall lonctece` %,S Sj
REROOF
— sec a ,/
Datecomms uClL o _
REMOVE/REPLACE BUILT UP ROOF FEB 19 2003
DEC!,
rslanJ my plans shall W used as public records
BUILDING
Lienscd Prelessional
OWNER BUILDER DECLARATION
1 hereby affirm that I am cnem in from the Comractor's License Law for the
following reason. (Section 71131.5. Business and Professions Cock: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any structure
prior in its issuance, also requires the applicant for such permit W file a signed Statem nt
that he is licensed pursuant to the pmvisionsof the Contractor's License Law Choi 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7010) of Division 3 of the Bust rums and Professions Codc) or
Nal he is exempt theodecm and the basis for the alleged exemption. Any violation of
$5925
scetiun 7031.5 by any applicant for ap.I, subjects tW applicant m a civil penalty of
man five hundred dollars
APN Number
Occupancy
Occu pane y Type
not mare (nand.
32632025.00
❑ I. as owner of the property, or my employees with wage as dreir sole compensation,
will du the work, and the structure is not intended or offered for sale (Sec. 7014, Business
and Pmfessiom Codd: TW ConuacmYs License Law does not apply to an aware of
305 — FRAME Required Inspections
property who builds or improves thereon, and who doessuch work himself or through his
ownemployacs, provided that such impruscmems are not intended oroRered for safe. If,
307 — INSULATION
however. Ne building or improvement U sold within one year of completion, the owner
bullae, Will have me burden of proving Nat k did not baud or improve far purpose of
601 — ROOF TEAR OFF
sale')'
602 — ROOF PLYWOOD NAIL
❑ I. as owner of she property, am exclusively contracting with licensed contractors to
603 — ROOF BATTENS
construct the project (Sec. 7014. Business and Professions CWC:)Mae Contractor's Li-
censelawdresnotapplytoanownerofpropertywhoWildsorimprovnsthemrn,and
604 — ROOF IN—PROGRESS
who contracts for such pmjccU with a commuctrr(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. ,B& P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
1 hereby sfErm under penally of perjury ma, of die following ecelarmions:
"
I have and will maintain a Certificate of Consent to self insum for Wrrker'sCumpen-
sttion, a provided for by Section 37W of the Labor Code, for Ne performanec of the
work lin which Nis pcemil is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of Ne Labor Code, for the performance of tW work for which this permit is issued.
My orker's Cn pen^ahon lnSumncec Grand Pohe, Other am:
I •
m: PrEcy
CERTIFI ATEOF ERS
OM WORKERS'
SATIONINSURAN
COMPENSATION INSURANCE
musix ctied need not k completed if the N mil is forom hundmd dollars (SIIX)I
lr Icss)
I certify Nat in the performance of the work for which Nis permit is issued. 1 shall not
employ any Persian in any manner so as to Mcome subject to the Workers' Compensation
Laws of Cithfumia. Date
Applicant
NOTICE TO APPLICANT: It, after making this CeniGcate of Exemption. you should
hecnme Subject to the Worker's Compensation provisions of the Labor Code. You must
forthwith comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby anirm Nut there is a coanmction lending agency for the KHtnmance of
the work for which this permit is issued (Sec. 3197, Co. C)
Linda's Name
Lender's Address
I Cenlfy Nal I have read this application and sate that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
but Wing construction. and hereby authorise repreuntatives rT Nis city to enter upon the
above mentioned property for inspection purposes.
(We) indemnify
agree el save. and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way acame agai nu said City
incrnuqucncc at 00 rmU5jen1is permit.
22
APPLICANT UNDERNS. NDS AND WILL COMPLY WITH AI,LyON-POINT
Issued by: Dale
R ULA' i�✓�
Re -roofs
Slghatum of ApplicanUConuacmr Dale
HAZARDOUS MATERIALS DISCLOSURE
Type of ROOF
Will dm applicant or future building occupant store or handle hausdous material
W defined by the CuKrumo Municipal Code. Chapter 9.12, and the Ilealth and Safety
Code. Section 25532001
C] Yea
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building ocO, m use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hnrallous air comaminamis as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑secs W11 --
I haw read the Wva dous mancualsmqumemen , underChamer 6.95 ofthe Califor
did llcalN&Safety Qxk.Saunns 255115, 25533 and 2551J.1 unJcrsmnJ ufdu: Willing
Jces nal curtcn0y M1m a ¢ thm i m r ipreibility m nrd1Y the r upant of Ne
R Y twlllt' r51 n Ip filet-. Tal Crfa CCM1IIIC'aLL`r(Q'Ca pa r.
Si nature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authnri'nN agent Ll/1 Dale
L%1
CL
Building Division
10300 Toren Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
Fax: (408) 777-3333
]Building Depai6ent
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 she so that the
proper City inspection can be performed.
IWORTANT:
1. Flat roofs must have a minimum of V" 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Naame
Address:
Reroofing Company Name:
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/25101
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