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04090034
CITY OF CUPERTINO 'I ORMA GONTRA BUILDING DIVISION PERMIT CT�UR INF, TIO.. N -BUILDING ADDRESS: COSMOS ROOFING PE`gMPPNO04O90034 10704 GAS DIGNE DR OWNER'S NAME: PERMIT ISSUE DATE IOGREG & DOR NE: SANITARY NO. CONTROL NO. 415 493-6-37-1 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LOp LICENSED CONTRACTOR'S DECLARATION JobDescriptiop_ w I botchy affirm that 1 am licensed under provisions of Chapter 9(commencing F i with Section 7004)) Division 3ofthe BuvreaauME67essium Code.and myliccvcia IIV�LE® in mum ff ` /�7' S �� REMOVE AND REPLACE ROOF ��Z Licim.C e 3 S Lie,# Z-0 Date 17'4'•w Contractor os i+c. T & G ARCHDECIeS DEC I.MI N I tinders d my pl he used 3-6 SEP 23 2004 o Licensed Professional OWN ILDER OECLARATIvo w 1 hereby 'f ass Net I am attempt from the Con toes License Law for the VRJ p o following mason.(Section 7031.5,Business and Professions Code:Any city or county x o which racial.a panni,W cnrwronIter,improve.demolish,m repair any shucone UILDINa 'I—w poor in i%lssuanec.also rrquir",Wapplicamfor such permit to file a signed statement �0 thin he is licensed pursue,ro the pmvisonsar he Contractor's License law(Chapt"9 Sq. Ft. Floor Area a U t O Q ce (commencing with Section 7000)of Division 3 of the Business and Professions Code)of that he u exempt incompliant and Nc Duds for da:alleged exemption.Any violation of Section 7031.5 by my applicant for it permit the applicant to a civil penalty of APN Number Occupancy Type ata,marc use eve hundred dollars($500). 37529019'. 0 0 ❑1,u owner Of the property,or my employe"with wag"u their sole compensation, will d0 thin work.and theswnule is not intended araffenA rum We(Sec.70".Business Required Inspections and Profe";ons Code:The Contractors License law da"not apply to an ow"r of fl p pmpenywho bull&or improves thereon,andwha doesauch work himaelf orthrough his own employes,provided that such impmvemensaale not intended"offered for We.If, however,Ne building or improvement is sold within ox year of completion,Ne—I- Wilder will have the burden of pmviug that he did no,build or improve for purpose of We.). ❑1,u Owner of the property,am"elusively contracting with licensed convectors to co"tinct We project(Sec.70".Baines and Nofoetiou Cade:)Tha Contfacom's Li. cause law docs not apply to an owner of property who Wilds or improses Nemon,and. who contracts for such projects;with a conwctor(s)licensed pursuant w the Contractors License Law. I am exempt under See. ,B&P C for this moon 1371M.f Date WORKER'S COMPENSATION DECLARATION 1 hereby afford under penallyorperjuryarcoftm following drslarstions:have and will maintain a Ce,0,me ofConsam m self-i"um for WmkchCompen- n,u provided for by Section 3700 of the Labor Code.for the Performance of the k for which Nis permit is issued. 1 have and will maintain Workaes Compcwdon Inwrana,u ryuimd by Section the Labor Code,for Ne performance of the work for which this permit is issued. Workeri Compensation lou sarin and Policy numberam: me.: ��a{[f✓1 Policy No.: SJ/—pOOI�1S . Y CERTIFICATE OFEKEMPI'ION FROM WORKERS' COMPENSATION INSURANW (Thu section..door W completed Rohe permit is forow handled dollars($I00) of 1"a.) I entity No,in the performance of the work for which this permit is issued.I shall nut employ any perwn in any mannefsn u b become subject to the Workeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this;CcniBcato of Eaemption,you should become$Object to the Warkees Compensation previsions of Ne Labor Code.you must .J Z forthwith comply with such provisions or this permit shall be deemed rammed. Z O CONSfRUCfION LENDING AGENCY (�. I hereby afford Nu Nem is a construction lending agency for the Performance of a> the work for which this permit u issued(Sec.3097,Civ.C.) {T] t.ender's Name 6. Lenders Address U 0 1 certify that I have road this application and such,that thc above information is u. P cams,I agree re comply with all city and county ordinances and cute laws mlatng to C.7 buildin(We)., ion.and ..hadbymNOndWc,he,leas to City Of the hive sho.omentiomed property for inspection purmses tirqa (We)giou a ave.;ndcmmfy and knep hay I.an the City of Cupertino a City at liabilitics,judgmcn¢,case and oxpenses which may in anyway attroc againx WO City f)z oomocgnenceadmgrantingaNnpermit. Date APPLICANT UND "STANDS AND P Y WITH ALL NOpWP(OyINT Issued by: SOURCE RE ONS. C /,d -G Re-roofs Signature of Applic tConv ctor / Datc AZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne appli"n,or ruwm W ilding occupant stem w NoWic hvardom material u defined by the Cupenum Mumc 1 Code. Chapter 9.12,and the Health and Safety Cada.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Nu Will the applicant or furore�btrilding occupa,use aria pment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air co ramminaUs didned by the Bay Arca Air Quality Management all new materials for inspection. Dtsmc'7 VVVV ❑yes ❑Nu 1 have mad the h,S=6 oma 51)5, rcyvimmenu under Chapter 6.95of dm Califon niaticalN&Safety Code,$cetiorr 253115,25333 and 25536.1 undcrwnd Natif Ne Wilding Jars not currently hevp a tenant.Na,i,u m "pansihility m noddy the cee.'em of Ne ` reyu;remains wso mon be met pdacu. 'atrRrc or hcatc or Occupancy. ' natureg_p li nt Date v sant DamO All rooTtave gs to be Class"B"or better the CITY OF CUPERTINO I• 2 of 2 PERMIT RECEIPT OPERATOR: quem COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 37529019.00 DATE ISSUED. . . . . . . : 09/08/2004 RECEIPT #. . . . . . . . . : 26960 REFERENCE ID # . . . : 04090034 SITE ADDRESS . . . . . : 10704 GASCOIGNE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . .. . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GREG & DOROTHY HILL ADDRESS . . . . . . : . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 8,000.00 147.96 0.00 147.96 0.00 BSEISMICRE VALUATION 8,000.00 0.80 0.00 0.80 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148.76 0.00 148.76 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CASH 232.42 TOTAL RECEIPT 232.42 • CITY OF CUPERTINO Zia- REROOF OUPERTINO PERMIT APPLICATION FORM 7 a� 003y APN# _ © Date: Building Address: Owner's Name: Phone#: vre !W g- SSS- //52 5z Contractor: n t Phone : G G qG�1 124 License #: c�h 6s /Cop in 79 S4«// Contact: // Phone#: 5 Q . fpp - 2 K/trl Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Cl Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles r--'- L] Wood Shingles G l9'Other(Specify) / 9X-6 L1-105ther(Specify) / Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: m ob Description: /"e Mcve 0 /_mc� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed withyjanning Dept. if there are any strictions: Ll Cost of Project• Type of Construction: ccupancy troo 7060. ao ,fie- /-00 Qty. if Applib)e 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 Community Development Department Building Division City of Cupertino y. 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 IUPEkTINO 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 polic on.re-roofin . Homeowner's Name `er / job Site Address: e�r� ✓� Roofing Company Nan4e: 17DD.S /'2 S 'O/ y A plicant's Signature Date:., • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper r C==UV*Develnpment 10300 Taro Me= Cupertino CA 95014 Telephone(408)777-3228 Fox(40g)777-3333 CUPER71N0 Buildin De artment JOB ADDRESS:C«-sC o/ /wo PERMrr# X' 1004 PHONE# 08 255- li �i OWNER'S NAM&: HILFAY It GF,Npu a r.CONTRACTOR: am not using any subcontractors: Date Signature Please check a livable subcontractors and complete the folio information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing Electrical Excavation �g Flooring Linoleum/ Wood �/ G Heating T. FPa:imn6.ng on ping y ental Sheet Metal g/ Wallpaper ing ng g Septic Tank Sheet Metal Sheet Rock T,ile 01 / tractor Signa Date •