04050121 'CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION "'
BUILDING ADDRESS: COSMOS ROOFING PERMITN(b4050121
909 BRO
OWNER'S NAME: PERMIT ISSUE DATE
ft MARIO LING 1901 OLD M
ONE: SANITARY NO, CONTROL NO.
(415) 493-6373
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION O O O O
a at I thereby affirm that I am u=mea under proviafens core3� (commencing lob Description
with SCetioo7Wi)ofDivio..3ofNe Dusincsse qfS' k mylicem 's
rt�y
in r.soclearaerrer�, 39 j'�I OOF
3 License Cla;s� 'c,n t� �e��!�����yy^�5kx�5 rlflsslI fry��
n1-0 Dam /� tJ—BDSYJfr-'-LEDD)
,l�tJa ARCHITECT' DECLARATION
y W I undcrsund my plans shell M used as public¢cards
3 Licensed Professional JUL 2-1 2004
`Oa OWNER-BUILDER DECLARATION
aM 1 hereby affirm that I em exempt from the Conoazmrs License Law for the
00 following reason.(Section 7031.5,Bovines and Pmfccsiom Cox:Any city at county �������
x m which renin.a permit to cnnsoun,altar.improve,demolish,or repair any structure
prior tit its issuance,also mquims the applicant for such Permit file a signed statement
F�O that he is licensed pursuant to the provisions of to Contractor's License Law
(Chapter 9 Sq.Ft. Floor Area Valuation
a� (commencing with Section 7000)of Division 3 of N.Business and ProfessionsCnJe)or
y that he is exempt t.mfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects thD applicant to a civil penalty of Occupancy Type
not mote than me hundred do)].(5500). el0 0 P Y YP
❑I,as owner of the propmy,or my employees wit wagesas their sale compensation.
will do the week.and the ewctum is not intended or offered for sale(Sec.7044,Busiment
and Professions Cost The Connectors License law does not apply m an owner of Required Inspections
proparty who builds in i mprovu thereon,and who dots such work himself or through his
tun employees,provided that men improvements are not intended or offered for sale,If.
howevcn the building or improvemem is sold within one year of completion,the owner.
builder will have HE,burden of proving that he did not build or improve for purpose of
.v1,).
❑1.ur of the props n,am exclusively e m among with litted mconoutra t
construct Ne project(Sec.70x4.Business and Professions Cade:)The Contractor's Li .
cense law does not apply to in owner of property who Wilds or improves thereon.and
who contracts for such projects with a contractors)licensed pursuant o the Com actor's
License law.
I am exempt under Sec. ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm mode,penalty of perjury one of the following decimations:
I have and will maintain eC.nlOcate afCDmenuo self-insure for Worker's Compcn-
cation,as provided for by Section 3700 of the labor Cade,for Ne perfmmantt of the
�wo,/Wr�k for which this permit is issued.
A have and will maintain Worker's Compensation Insurance,u required by Section
of the labor Code,for the performance of the wods for which this permit is issued.
My Worker'
ppCbon;gyp�sadmn lnsunnee earner and Policy n be a
Cartier. J• Tt's�� Polity No:T,� o4—U&J
CERTIFICATE OF EKEMPI30N MOM WORKERS
COMPENSATION INSURANCE
CILu senior coed not Imeampmed if the permit Is fnrone hundred dollars(S101)
or leu)
I certify Not in the performance of Ne work for which this permit is issued.l shall not
employ any person in any manner un as m become subject m the Workers'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.If,after making this C.niOcate of Excerption,you should
become subject ro the Worker's Compensation previsions of the Labor Code,you must
.,2, fmthwit comply with such pmvivens or Nis pttmoo, hall he deemed mvok.d.
z O CONSTRUCTION LENDING AGENCY
'ewe I hereby affirm that Nem is a Construction lending agency for the Performance of
a the work ror which Nu permit is issued(Sec.309'/.Co,C.)
1 A Lender's Name
=z Lender's Address
U O I certify that I have read this application and sure that the above infom atiun is
ly F coned I agree ED comply with all city and county ordinances and some laws mhoing N
DU building construction.and hereby authorise mpesenutisss of Nis city to eater upon the
r C above-memioned property for inspection purposes.
F (We)agate to save,indemnify and keep harmless the City of C.Nnim,against -
fA
liabilities judgment.cast and expemea which mayor any way ac cmc agmnn said City
U z incmaeqummce of ranting of iA s7�pm1°. p
'-' APPLICANT U RST `p Ly✓1�LL1C/Olhti)CQ(.Y W4'1141 ALL NON-POINT Issued by: Date
SOURCE s/4f
° Re-roofs
Signature of ApplicaDale,
HAZARDOUS
US MATE RIALS DISCLOSURE Type of Roof
Will Na applicant Or(Muni building occupant.Chsmro or handle headous lth and
az defined by time Cupertino Municipal Code.Chapter 9.13,and to Health and Safety
IjMjfDde. n All roofs shall be inspected prior to any roofing material being installed.
�Ya �Y No
wtn to apphnnt of future building ammpant aae egmipment or devices wmab If a roof is installed without first obtaining an inspection,I agree to remove
7nm,
it ha'raon air mminanis u defined by Ne,Bay Area Air Quality Management all new materials for inspection.
District? -
❑Yes �{No
I have teal the bvardous maa:rials requiremcno under Chapter 6.95 of the Califao- �J `^'� O
HcalN&Safuycodc,5tttiom 15505,25533 and 255Ja.IunJcrsond thatirNC Wilding i}aI �T -5 1,41.14 snoteurentlyhawatenantNatitu mai mmibility m ratifydo<1mmtofNe, / `luimmcnts whrt the con or colaBca (Oceupanc'S Signature of App cant Date
e OQ}« 7 'r`�� 61y All roof coverings to be Class "B" or better
nerror oriard agent--
May 18 04 09: 14a Cosmos Roofing 16501493-6372 P. 1
av Ih,2PIN 22:25 5105383262 LEGALITIE- NK5 I
' e PAGE 62
Community Development
10300 Torre Avenue
I! Cuputino CA 95014
. Telephone(408)777.3228
CUPERJTINp ' pax(406)777-331383
L
Building Department
xrJ08—AD DR S
: PERMIT#
OWNER'S x PHONE #1n5U y,e7e ryl
k GENERAL. O ACTOR: :irp1 �y>oFii�� _ FAX# (rSG- 94C�-
)t I am not usi4 s y subcontractors:
I! Signature Date
Please check a cable.subcontractors and Coln tete the followitlinformation:
SU$ NTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabin &Millwark
Cemery Finislwtg --
Eledtxi
Exceiv 'on
Fl�' .Carpeting
Lin ,le / Wood
Glass/iGlazing -----
e
He _
IM , on
Lan Mg
Latton —
Mas" ----
Or arontal Sheet Metal
Pain ' / Wallpaper - �—
Pavirl
--—
PI r g — —
Plu>xt
Ro
'c'hank
Shekt etai
Sheet k —
TUe
m ! /Contractor Signature Date
10!28/03 .
Community Development Department
Building Division
City of Cupertino
r •�� 10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
4UPEkTINO
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.
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: 9 0 9 `i�I �—
Roofing Company Name::
A plicant's Signature: rY Date:
eel ! o
® Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
fA' CITY OF CUPERTINO � ����
V y J
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 7 0 Date:
J J
Building Addre 90 9
Owner's Name: Phone #;
Contracj � Ph CSQ X16 9 -7 d (3 License#,2 &5q
Contact`: n Phone # Cupertin0Bps�z1 license#:
Gr GLvr1�—
Type of Roof Covering:
Existing: Proposed:
�C[ Built-Up Roof �K Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ 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 ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description-
?7X6
escription:
i o X G! kP . ��� c/• ,C •� Q
Residential )ff— Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anv restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE —BldgPermit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
� 37 . �