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04010036EFc 02 z C CITY OF CUPERTINO CONTRACT�OR INFORMATION .q BUILDING DIVISION PERMIT I ILDING ADDRESS: COSMOS ROOFING PERMIT "b4010036OW NER'S NAME: I PERMIT ISSUE DATE ONE: SANITARY N0. CONTROL NO, 4 493- ARCHITECTICNGINCER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L� 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed undo, pmv;eiors of Chzper 9 (commencing oP with Sccbun 7M)) of Division 3 of the Business and Professions C.&,.ad an, license is in fall force and cra Cj 4� l Lm ® REROOF INGALE oS Date Das O re mr AR HE EC AT N I understand my plana s e p JAN 2 d 2004 Licensed Pmfessnmal OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from fire Contractor's License Law for the jl'�I�/1 followinrcUBusiness g om. (Section 7(31.5, and Professions Cotic: Any city nr county B U Ga which requires a permit in conarucf. al¢q improve, demolish, or repair any structure prior to its iscuonee, also requires the applicant for such permit to rile a signed s ilemenl Sq. Ft. Floor Area that he is licenud pursuant to the provisions oflhe Contractor's License Law(Chapmr9 Valuation (commencing with Section 7150) of Division 3 or the Busines and Proresvnns COU) ser that ire is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for apeonotsubjects fire applicant to a civil penalty of3'1d�B1H'�.tilt�eT00 Occupancy Type P Y YP not moon than five hundred dollars (S500). ❑ 1, as owner of the properly, or my employees with wages is their sale compensation, will do the work, and the struaec is not intended oroffered forsalc (Sec. 7064, Business Required Inspections and Professions Codc. Thc Contractor's License law does not apply In an owner of property who builds or imprawor thereon. and who doessuch workhmuelf or through his own employces. pruvidcd that such;mprovemmnts are not intended or offered for I.. It, however, the building or improvement is.mld within one you, of completion. Ne nwner- builder will have the burden of proving that he did not build as improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed commitment to construct the pmjecl (Sec. 7044. Business and Professions Cade:) The Contracmr's Li rue Law does not apply to an owner of property who Wilds or improves 0emom, and who contracts for such projects with a conmetor(s) licensed pursuant to the Contractor's License law. ❑ 1 am exempt under Sec. . B & P C for Nis reason Owner Date - WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Conificee of Consent o self-mame for Workers Compere cation, U provided for by Section 37W of the Labor Code, for Ne performance of the work for which this permit is issued. ban and will maintain Workers Compensation Insurance, s, required by Section 700 of me Labor Code, for the performance of the work for which this pctmil is Issued. My Workers peria lnsumnp¢ carrier and Policy Wr art: Came[ .7 �.z Policy No.S7I'0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Toes of. need not W completed irthe permit is fnrone hundred dollars ($100) m Icss.) 1 cenify that in the performance of the work fur which this permit is issued. 1 shall not employ any person in any manner so as to become $Objecuo the Workers' Compensation Laws of California. Das Applicant NOTICE TO APPLICANT: If, after making this CeNfies a of Exemption, you should become subject to the Worker's CompcUation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed ¢yoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency I'or the performance of the work fur which this permit is issued (Sec. 3197, Civ. C.) Under's Name Under's Address 1 cenify that 1 have read this application and arae that Ne above information is torten. 1 agree to comply with all city and county ordinances and stake laws relating to building Conswction. and hereby amortize representatives Of Nis city to enter upon the above mentioned prof<vc for inspection purposes (Wt) agree to cast, indemnify and keep harmless the City ofCupertino against r. nc n6. costs and expenses which may in any wayaccmc againslsaid City incoldes. once incomuyuenec egmntin fth' I. APPLICAN DE_ N WILL PLY )OITH ALI„�Or -POINT Issued by:s4ta4 Date SOUR L /' LT/1 Re -roofs Type of Roof Signature of AZA ApplicaRDD.O Dam HAZA. S MATERIALS DISCLOSURE HAZARDOUS Will are applicant or future building occupant store or handle ha'rartlous motorial U defined by the Cupertino Municipal do. Chapter 9.12, and the Health and Safety Code. Sc❑cdo525532(e)? All roofs shall be inspected to any roofing material being installed. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or fuwrc builth occupantucecympmodordevireawhich Or hazardous air conem;mants as def d by oke Bay Area Air Quality Management all new materials for inspection. C] Yes Ihaveread thchxaardnusmaerialsmquirementsunder Chaper695oflhe Califou �� nia HaoW &Safety Codc, ono25534.1 thmilthc building 259)5.2my p / amant,s r does not curtcndy hoe a Icnan4 Nat it is my responsibility a nudity the cu'c pant of Ne M mildly toquimmcn¢which stbemelp bra' cola rtiGcas of Occup Y. I? Signature Signature of Applicant Date 04 All roof coverings to be Class "B" or better owner ora g n - i CITY OF UPERTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 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:l�� /L4�_ Roofing Company Name: l'it9�.,.�nr� le q_ A plicant's Signature: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper Date: Wo `7 alITYOF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 6�_0� dP3_� APN # 37 S — 3 C^ v 3 Date: l � `q 0 Y Building Address: vG �S BSEISMICRE Seismic Fee Res ,� Owner's Name: Seismic Commercial Phone #: 2-59 - V545 Contractor jIG5#:'9d T — 7 G G3 _(650)'961T— License #: .?,? 5 �( Contact: y^� Phone #: Cupertino Business License #: l Type of Roof Covering: Existing: Proposed: X Built -Up Roof X 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 Descriptio zl Cw d ,O� 4— Residential 1;�r_ Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if fi there are anrestrictions: Cost of Project: Type of Construction: Occupancy group: So Qty. if Applicable Fee ID Fee Description Fee Groun 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