04070038 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONIRACTQR�INFORMATION
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BUILDING ADDRESS: COSMOS ROOFING PERMIT N'04070038
OWNER'S NAME: PERMIT LSUE DATE
Adh PAI PEI L
ONE:
SANITARY O. 'NN OL NO.
ARCHITF.0(/ENGINEER: BUILDING PERMIT INFO
B ELECT PLUMB MECH
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LICENSED CONTRACIOR'SDECLARATION Job Description ,�d
C I hemby,affirm Nat I am licensed under,provisions of Chapter 9(commencing
b with SecGon?BfD7 of Uivision3of Ne Busi and Profes' .ayd mylicense is `Lbla O
•>>„ infdilfuoeandcfrc�n 7 I REROOF W/COMP. SHINGLES
y g? License Clue l� �jOo�
�:c Dam G
ARCH( 2rS DECLARATIOf ®�
3i 1 understand my plans dull he used as public mrnrN
3yU
3u Licensed Professional
='DS OWNER-BUILDER DECLARATION
f I hereby.(Sero that 1 am1. ncmpt Item the Comms Co Liccnu Law for the
i p O which
mason Permit
i IID I.S. t.skier. and improve.
do nos Code:Any city m county
e m_�+ which rtquire a pctmit m contused.cite,,improve.demolish,or repair any structure
FZy priormiu issuance.also rtquims lk mrtt
annlicant feraten permit to fileasigned Statement Valu tion
a that he is licensed pursuanunthe provisions ofthe ConductohLiccnulaw(chapter 9 Sq.Ft. Floor Area
'rn (commencing with Section700(bof Division 3 of the Buamostand Profeamis COO)or
that he is eximpt therefrom and On basis for On alleged caempuon.Any violation of
Section 1031.5 by."applicant for a Permit subjecu the applicant m a Civil penalty of 3 6dR2EK0tjrr0 0 Occupancy Type
not mom than five t undmd dollen(5500). v
❑I.as ewter of Ne pmycrty,mmy,.ployee with waged athcbwleoompenod...
will do the wink,and Nesuucmm is not intended oI.fCmd fonalo(SeC70aA.Businus Required Inspections
and Professions Cade:The Contei License Taw does not apply w an owner of q P
Property who Wildsmimpmvca Ncrton,and who doeaauchwork himself or Nroughts.
Own employee,Provided Oat such improvements are not intended aroRered pursue.If.
however.Ne building or improvemem is sold within ane Sear of completion.Ne awn..
Wilder will have the burden of proving that he did not Wild or improve for purpose of
sole.).
❑1.n owner of the property.am sclurively contracting with licensed contracmra to
Cons mer the pmject(Sec.7W,Business and Professions Cade:)The ComrumrY Li
cense law doe not apply in an owner of property who builds or improves daemon,and.
who conuscu for such pmjccu with a conuactor(s)licensed pursuant to On Cenua ten's
License Law.
Iamexemptunde Sec. ,Bk PCfeu Nbmeson
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby a1Rrm under penalty of perjury One Of the fallowing declarations:
I have and will maintain a Certificate of Consent mull-insure for Wortr/sCompen-
rasion,u provided for by Socuan 3100 of Ne lane,Cade,for On performatta of the
work for which Nis permft is issued.
ave and will maintain Workels Compensation I...a rtquimd by Secumr
3 Wof Ne labor Code.for Ne pardomunce or the work for which this permit is issued.
My,
O&'e amaeon lnwmue casrim and Policynu r art:
Cartfcr: Policy No.: _,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMs section need not he completed if the permit is for one hundred dollars($101)
or les.)
I anify,that in But,performance of the work for which this Permit is issuc4l shall not
employ any person in any manner so as an become subject to the Worker Compensation
Laws of California Date
Applicant
NOTICE To APPLICANT:IL after making this Cenificate of Exemption,you should
become subject in the Workei s Compensation provisions of the labor Code,you mut
�ZfaMwitb comply wish such provisions or Nipermit
s shall Cie dccmed invoked.
zCONSTRUCTION LENDING AGENCY
[r4 I hereby sniren that Vert is a construction lending for the Performance of
lYi> de work for which this)crotid is issued(Sec.)091,Civ.CJ
{L7 A Isndefs Name
�z finder's Addma
V 1 anify Nat I have read Nis aPplieuion and sum Nu the above information is
D. — Correct.I agree to comply with all city and county Ordinances and sonde lean;misting in
pU buildingcanswnion,send hereby euthome representatives of this city rocolor upon the
r W abovcmenuonW properly for bireation purposes.
Ew O. (We)agme to save,indemnify and keep harmless tiro City of Cupertino agaial
CA) liebiliuu,jail ns.cosuand ex swhiehm In any way neutron against said City
V z in eenseque "the g )conte' • D to
C A 5 ALL NO POINT Issued by:
SOU ^ �X'{y
1 I Re-roofs
signaum of Applinnl/Conumor a—i.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding aauPant am or handle hrrasdou material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.SCNen 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea ISH
Will the applicant or future building Occupant sou equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
mit ha'rta inus air contaminants as defined by Nc Bay Arca Air Qualby Management all new materials for inspection.
Diwict?
❑Yes
Ihave mad Nede aWnus materials mqulmm 255under Chapter Outifthe Califon
pis HnithRenloarveaSauoa25505,25533and255 4.1Or,understand On Occupant
tt ofOn,
does not current ave a moony Nu{,N s�5 nY msPoryJnilitY m Imufy Ne oceupend or Ne
myuimmcnu ch mon et arR rssuancc ofS Ccmfia¢ofpan SI nature ofA licant Date
do q All roof coverings to be Class "B"or better
Owner ser authoriacd agcni b..
Jul Um U9 U /: 91a Cosmos KooP1ng 16bU1BUU-tisUb p. l
87/07/"<U04 13:^4 5185383282 LEGALITIES IW PAGE 8:
,. 10300 Torre Awoue
Cupertino CA 95014
: Telephone(408)777-3228
oc Fax(08)777-3333
CUPEkTINO
Building p De artment
x JOB ADDRESSY i/O a � PERMIT k 0 0 3 D
LPOQ
OWNHR'S NAME: C/o 13� x PI]ONE#1 (o S'L� l 9- 7 4,6-,3
X GENERAL CONTRACTOR'L'p5n1 b5 (RozPP F)LAJT x a 65r�
�C I am not using any subcontractors:.1���L;� •' - �/n04 k 7
Signaivre Date
Please Check applicable subcontractors and complete the folloormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #�
Cabinets 6r Millwork _
Cement Finishing
Electrical
Excavation
Fencing
Flooring:Carpeting
Linoleum/ Wood
Glass/ Glazm
Heating
Insulation _
• Landscaping --
Lathing
j Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Pavin ��
Plastering
Plumbing
- Roofing _
Septic Tank
Sheet Metal
Sheet Rock_
Tile
zf
owner/Contrac rSignature Date
IDI28/U3
Community Development Department
Building Division
61'a3
City of Cupertino
10300 Torre Avenue
qCITY OF Telephone: (408)777-3228
UPEkTINO Fax: (408) 777-3333
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: /U 6
Roofing Company Name: 6_0_—` mr r�w r�
A p'icant's Signature: Date: y
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF v 7
CUPEkTINO PERMIT APPLICATION FORM
APN # �� zirj Date: -7/,p /o
Building Address: /
/06 Y0
Owner's Name-
c/a
ame C/ � / &a�ii!`oz
o fes+-.�... 8 7- 0 Fr•"1 T
Contractor: Phone#: JaLicense#:
650 9,/f-7(, 63
Contact: cam v Phone#: �4,n,.u _ Cupertino B us insSWe#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 19 Asphalt Shingles
-A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
I$ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Des ription- Q p
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: i Type of Construction: Occupancy group:
/o y
Qty
A icaL e Fee ID Fee Description Fee Group
BPERMFEE BldR Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•