04090033CITY OF CUPERTINO
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'CONTRACTQR INFORMATIO
MI
BU14DING DIVISION PERT
>d-
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BUILDING ADDRESS:
1 0699 GASCOTGNE DR
COSMOS ROOFING
PEBMfr ND.04090033
OWNER'S NAME:
PERMIT ISSUE DATE
NE:
SANITARY 0 TROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
•
BLDG ELECT PLUMB MECH
op
LICENSEDCONTRd DECLARATION
SprevisionsDELLA A(Aapmr
Job DescriFI�
under Y (commencing
1 hereby affirm that I am Ra.d under
_
with Sorra% ") of Division 3 of IN Busineuand P��Poafeadmu Code.andmy lice. I.
1 I SALE
LteUmme acme ,/-aj SearA/
REMOVE/REPLACE ROOF
License Class Lie
Data
T'S DECs c G
DECLAR TION
T & G 13
SEP V 2004
As shall kuse
1 u�1d,�d my plans shall W .d as public records
Licensed Professional
OW NER-BUILDER DECLARATION
BUILDING
I hereby .Rear that 1 exempt from the License Law far IW
heeby
1. Professions Cc
following moon. 71)7 L5,
id-, and Profession Code: Any city arra roomy
Permit s I. alar, improv, ri repair ttrtmture
Which requires •permit re c.res
h Permit t ed
poorN its issuance. also require the applicant for archpermitto files Liw(aummcm
the,
Sq. FL Floor Area
Valva[ 575
(comae litt.Jpurmanl7000)NovisionofNCCo usinesil!¢.Isw(Chep¢rY
(commencing with Section ]fan) of Division 7 the Cake) m
Any
the eget exempt on. vi
thaI he u exempt Ihertfrom and the tomo for Ne alleged exemption. Any viaution of
APN Number
Occupancy Type
Semon 7031.5 by any applicant for a permit subjects the applicant Ice a civil penalty of
art more Nen five hundred dollar (5500).
37531017.00
o 1, as owner or dm property. or ml employers with wages as their sole c sepevatfon.
aired Inspections
e nser P
Will do the work ..it Neawcmm is not intended or uttered fosaal.(S.C.7044, Business
and profession Code: The Canve. clo's LiceLaw dao oat apply In an ownof
and
q
property who builds or improves domon, end whet docs such wart himselrar through his
own employes, provided duet such improvementsue noI intended croRered fmsule. If.
however. Ne building at improvement is sold wiNin one it. of complCd-. Ne— -
builder will haw the burden of proving that he did not Wild or Improve for purpose of
salcJ.
❑ I, as owner of the proputy. am exclusively contracting with licensed convector to
construct Ima project (Sec. 7014. Business and Nofoadom Code:) The Contractors Li.
come law docs not apply to an owner of propcny who Wilds or improves dmmon, and,
who contracts for such projects with a ca runcu (s) licensed putauan, to the Convaclor's
License La -
0 1. trump, under Sec. . B a P C far this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the fallowing declarations:
I1use auk will n eCcrtif37M of Cet.nt se far Wohcra Comp cm
rort
ustus
Cock.
Section 7]00 of the Labor Code, (or the performance of the
m provided for r
i for by
mi
tusk for which this permit is issued.
wort
I have and will maintain Worker's Compensation Insurance, as required by Senion
7700 of the Lab.. Code, for IN podurmanee of the won for which this permit is issued.
My Workeen Compensation Nomence Cape, and Policy number art:
/'✓n 7 O1/iS-"
T a� Policy No.:
cr: JYk f
.
CERTIFICATE OF EXEMPTION FROM WO RS'
COMPENSATION INSURANCE
(This section need nothe complemd trine Permit is formic hundred dollar ($100)
or leu)
I certify Nm in the performance of the work for which this permit is issued, l shall not
employ any parer in my manmr a0 a5 in become si bjee110 dG WOrk d Crourchimso
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If. afar making Nu Certificate of Exemption, you should
hose me Subject m be Worker's Compensation previsions of the Labor Code. you must
raMwid, comply with such provision or this permit small W dccmcd revoked.
CONSTRUCTION LENDING AGENCY
ft (Seetinn pending a,tnq for dm performance of
irm Nat re is
I hereby Nme,the.
' dm work for Which his permit u issued (Sec. 7(19], Civ. CJ
s
Landers Namc
Lender's Add mss
I certify that 1 have read this application and sum that the move information u
correct. I agree to comply with all city and county ordinances and sure laws relating to
Wilding construction, and hereby mtbodm mprmentnives of this city to cnmr upon Ne
alcove -mentioned property for inspection purposes.
(We) agree as sew, indemnify and keep harmless the City or Cupertino against
liabilities judgments, costs and Caroni which may in any way eccnm against said City
in conuqucnce of IN, ...... C of this permit.
• APPLICANT UN STANDS AND WI C Y WITH ALL NON -POINT
Issued by: Dale
SOU g�ER TIONS.
9
Re -roofs
Type of Roof
& ,nature of Ap Ip`nnVC
MXPERIXLS DISCLOSURE Dem
ABODUS
Will mac applicant or future Wilding account stare or handle hazardous material
as defhned by the Cupertino Municipal Code. Chapter 9.12, and Ne He ft, and Safety
Code. Sent. 255324), /�
1Nu
All roofs shall be inspected prior to any roofing material being installed.
❑Ye
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devise which
emir hararm us air contaminants us defined .ahs, Bay Arca Air Quality Mana,cmcnt
all new materials for inspection.
District?
p yes
I have maJ Ne harardtws mamriau reyvimrnents under 6.45 ofNc Califon
nu HuelN6Sanlycode. Seedmts 25505.25537 mJ 255 orkmund Nrtifthe Wilding
dors not emeou y hew a4nans Nal it u my res to nWfy mac axupmt of dm
reyuiremcntsw nstWmetpdonni a enirmammrartanr.
Sign eofA cant Date
v �
All roof coverings to be Class "B" or better
O cr or auto ..cd a Dom
0 1 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37531017.00
DATE ISSUED.......: 09/08/2004
RECEIPT #.........: 26960
REFERENCE ID # ...: 04090033
SITE ADDRESS .....: 10699 GASCOIGNE DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: MIKE & JUNE SHILES
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: suem
COPY # : 1
RECEIVED FROM ....:
COSMOS ROOFING
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 ID
UNIT QUANTITY
AMOUNT PD -TO -DT
--------------------
THIS REC
NEW BAL
----------
----------
BPERMFEE
-----------------------
VALUATION 2,000.00
----------
83.16
0.00
83.16
0.00
BSEISMICRE
VALUATION 1,575.00
0.,50
----------
0.00
----------
0.50
0.00
----------
TOTAL PERMIT
----------
83.66
0.00
83.66
0.00
Z0INC,
OCU PEkTINO
r
L
CITY OF CUPERTINO
RE ROOF
PERMIT APPLICATION FORM
6 Ifo y D�3�
APN # 2) f
Date:
Building Address:
BENERGY
Owner's Name: _
Phone #:
71
z4glre
Contractor:Phone #: L S - %G% 7Z, 43
License #:
Seismic Commercial
BUILDING
Contact: Phone #: �o
Cupertino Business License #:
BUILDING
BUSLIC
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles ,-
-;2�- Other (Specify) / 7� wilier (Specify) qc—
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:
.' c /yG ue � ✓Q �c, � e Yoa 7e17
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restri ions:
Cost of Pro ct: Type of Construction: Occupancy go
Qty- '
A bl
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
CIN OF
UPEI,TINO
•
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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 Nay
Job Site Address:
Roofing Company Name: C
Iplicant's Signature: Date:(&
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
L�
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GaSeoI
R�
Community Devdopmmt
10300 Tone Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
I L)YYZYCKS NAAdb. I YLI 1- SLYi3E- 5#41 0 I FHONE # t4OX 253 - 4 4-71 1
0 I am not using any subcontractors:
Please check applicable subcontractors and
the following inforatation
y - Date -�
0
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Frnislung
Elechfcal
Excavation
Fencing
Flooring Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Pl=ibing
Roofing
Septic Tank
Sheet Metal
Sheet Rack
Tile
0
Date