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BUILDING DIVISION PERMIT
9C0NTRACTORINEORMATION,
BUILDING ADDRESS:
NGRGVE IDR
COSMOS ROOFING
PERMIT No 04080141
OWNER'S NAME:
PERMIT LSSUE DATE
ONE:
SANITARY OL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CON RACTOR'S DECLARATION
Job Descriptio 11 'Alt
1 hereby affirm Nal 1 am licensed under provisions of Chapter 9 (Commencing
P
with Section 70(1) of Division Sof On, Business and Profosssiioons Code, and my license is
in full force and cff 7954w
License Class'/ 9 ueg
REROOF W/TAR & GRAVEL
Dam M Contractor
8 2004
ARCHITECT'S DECLAI A Ig
I understand my plansshall he used six Public mcnrdi
It p
B U R L®
Licensed Profeavion.I
OWNER -BUILDER DECLARATION
a I N
I hereby affirm that 1 Om, exempt LBW for the
LiAny
dm fentim.
on C
soi Code: Any city or Bounty
following moon. (Scion 703 1.5, Business and
ve. derom
which cnnsuuca alter. improve, Or sig any ewcrem
h permit t e a
prior m s licensed issuance, also myo the the applicant for such permit to Glc B signed Catemem
Ox isnt n e. also re
Pursuant 70th) of the ConuinessadProf loons
Sq. Ft. Floor Area
Valua[on
(that commecngwiand Cade) or
of Division Coca) or
th) Busalleged
(commencingwithSectionfrnin ID0) of D osis
(cat
exe
on. Any
f r the alleged eumpdon. Any violation Of
i and the hues for
Nal he Is
3 -f�I�gr�erp p
Occupancy Type
be
Section fora permit subjects Ne applicant m a civil penalty of
io any
31.5 b any
L5
red doll
not mart Nan five hundred dollen (5300).
than five
❑ I,mO nuofiMproperty,ormyempluyceswithwagesudmirmiccompemadon.
'
Required Inspections
will do Ne work and theawctum is notimended oro@red formic (Sec. 7W, Business
and Professions Cade: The Comrmun's License Law does not apply to in owner of
propcny who builds or improves Thereon, and who does mcb work himaelf or through his
Own employees, provided that such improvements sum not intended or offered fur sok. la
however. me building or improvement is sold within one yeti of completion, the Owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed Continuum; to
construct dm project (Sec. 7014. Business and Professions Code:)no Conlrumr's Li.
ecue Law dors not apply to an owner of property who builds or improves tbtmon, and
who Contracts for such pmjcm with a contresctor(s) licensed pursuant 70 the Contri
License law.
❑ I am exempt under Sec. .B&P C far this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of dm following declarations:
1 hese and will maintain aCerd6nm of Consent self -insure for WorkctsCompcn-
sation, as provided for by Section 37M of Ne labor Code, for the performance of the
work for which this permit is issued.
1 have and will maintain Wctims's Compensation Insurance, u required by Section
t%I of the labor Code, for dm performance of Ne work for which this permit is issued.
My Worker's Cnmpamadon�2l Jmi Cartier and Policy number an:
� S%I—Dq—II2S
Camcr 5-_*— Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thi suction need notbecompleted if the Permit is free= hundred dollars ($100)
or less.)
T certify that in The performance Of Ne work for which this permit i issued. I shall not
employ any person in any manner ser u to become subject m dm Workers' Compcvmdon
Laws of Califomia. Da¢
Applicant
NOTICE TO APPLICANT: Ir. after making this Certificate Of Exemption, you should
become subject to the Workcri Compensation provisions of dm Lahr Code, you must
forthwith comply with such prowiecon or this permit shall he deemed mroked.
CONSTRUCTION LENDING AGENCY
I hereby M. that Nen I.. comorsed m lending .gamy for Um Pchfarmans of
Ne work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
lender's Address
I certify that 1 have read Nis application uW sec¢ Net Nc above ultimatum is
correct. 1 agree To comply with all city and county ordinances and state laws relating to
building construction, and hereby mdus ire reprcunutisee Of this city To enter upon Vm
shove-menduned acrtysave for imnifdant
I
to keep ho Ne City of against
(We) agree to save, indemnify and tech bay
liabilities, judgments, in an
against
Ofpcnuurnit. they in any way acervc against said City
......... ce of the Of
of Nis IL
/
granting
D W
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON -POINT
UNDERSTANDS
Issued by: Date
SOURCER Gsi TIONS.
Re -roofs
Type of Roof
/Va"
Sigh9off.of AP,I am/C.n.1.r Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or furere building OCCupanl store Or handle hamidi us material
az defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
cedcSc y. zss32(a17
❑You Apel/
All roofs shall be inspected prior to an roofing material being Installed.
P P Y Ya g
If a roof is installed without first obtaining an inspection, I agree to remove
Will The applicant or future building occupant use equipment or devices which
mit Nimmons air contaminants u dcfned by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes
1 have road the hvzNwsmau rials Tequiremenn under Chapter 6.95 of the Califon
nu Hcalm&SafctyCode, Sections 25505,25533 and 25534.[understand than!Ne huilding
/� 0
docs not currently have a mount, Nal it i my respomi1iliry m nadl'y IM eupmt of the
_
mquimmmfs hmu Iprioriniss ef.certifimteof many
Signature Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
or authon,cd ag m
Aug 17 04 07:47a
0B/16/2H04 13:321
CUPEkTINO
Cosmos Roofing 16501969-9905 p.l
5105393292 LEGALITIES Iia( FADE 01
Commumry Developmml
10300 Terse Avwae
Cupatino CA 95014
Telephone (408) 777.3228
Fax (408) 777.3333
Building Department.
JOB ADDR155:
(\
i1�+•, •�,
PERMIT # U 8 O
OWNER'S NAIvM:
!
PHONE # 4 y 4o —41
GENERAL CO CTOR:
FAX #
14 1 am not using any s bcontr4tors:/ W i I?moo
Si a Date
Please check aovlicable subcLractors and complete the followinff information:
•
x
SUBCO. TRAC'FORI
— Cabinets k Miliwor
Cement F' ling
Electrical
j
BUSINESS NAME _i
—
BUSINESS LICE
Excavation
Fencing
_
l Flooring- Chrpeting
Linoleum / Wood
Glass /.Gladng
I Heating
-- ITnsulation
[nsulati
Landscaping
- -
Lathing
Masonry
Ornamentaj Sheet Metal
' Painting / Wallpaper
Paving
Plastering
- I
Plumbing
Rooting
Septic Tank
Sheet Metal
Sheet Rock
Tile
P� o
Date
1
CITY OF
UPEkTINO
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 riot 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 theabove stated policy on re -roofing.
Homeowner's Name:
Job Site Address: < 0 -�U�
Roofing Company Name: Ji'G� /C=zr> 5i—
A plicant's Signature:
Greg teel
Building Official
�. Date: g6VO
Revised 1/30/03
Printed on Recycled Paper
t
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a
CITY OF
CUPERTINO
CITY OF CUPERTINO
REROOF 8 1�
PERMIT APPLICATION FORM
APN #
Date:/ -7 /0
l
Building Address: 4a /
Z
/l,,-"-
Owner's Name: 4,4-�
BSEISMICRE
Phone #t 4/1/4 -q7 8
Contractor:
dt.v no.✓
Phone #:
650-9769-7663
License #:
?8S 4/ 4/./
Contact: ,7 . ,
Phone #: L�
Cupertino Business Li ense #:
BUILDING
Type of Roof Covering:
Existing:
Proposed:
?. Built -Up Roof
Jam" 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: -;/—,
Residential,' Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning -Dept. if
there are any rest 'ons: LJ
Cost of Project: Type
of Co nsio Occupancy gr p
�13� ov
�-
Qty. if
ADulicabld Fee ID
Fee Deccrintinn
FPP (:rnnn
/ 1 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
$--� ,70 . S-�