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CITY OF CUPERTINO"'
INFORMA.TIQN
BUILDING DIVISION PERMIT
kCONTRACTOR
BUILDING ADDRESS:
COSMOS ROOFING
PERMIT N004060063
2
OWNER'S NAME:
PERMIT ISSUE DATE
JANE WANG
1901 OLD M
NE:
SANITARY NO. CONTROL NO.
(415)493-6373
ARCHITECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
$ rl
1 bemby affirm Nu 1 am liceracd under provisions of Chapter 9 (commencing
ED
with SeNon 70( of Division 3 of he Business and Poressinm Code.and mylicenses i5
aC -r
5 414)
ucfmlYorce
REROOF
wande
1
Dale 39"mok Contractor
AUG 17 LUU4
ARCHITECTS DECLARATIOf
I understand my plans shall W used as public mounds
BUILDING
OWNER -BUILDER DECLARATION
Licensed Pomy
air, ucmpl from dtc Cmracmrs Licmx law for lW
I hmaso .(Brat that I
following resean. L
703 L5. Business and improve, dcoom Code: Any city s county
Improve,h ofe sigany
4450
ecomil t
Which suapcmilp rnits ucl. tlmc
a omensructum
for Con permit m file signed Su¢mcm
isissuance.mquiWe the applicant Permit t
prior m its ions Contractor's License taw (Charter 9
Sq. FL Floor Area
Valuation
d roatm of
that he is licensed pnrsuanua the provisions at the
(commencing with Section 7000) of Division 3 of (W Business and professions Code)Or
that he is eacmpm thCmfmm and the baso for the alleged exemptim. My violation of
3 AVNNiiacr 0 Q
Occupancy Type
Section 7031.5 by asryappl(ant for a pmmim subjects the applicant to a civil penalty of
not mom Nan few hundred dollars ($5)0).
❑ I,asownu of NC PropcnY•Or my cmployem with vwgesuthcir sole compenudon,
Required Inspections
p
will do thework.and thesumcture isnot intended Oroffned for falC(See 7W. Bud.
and Pmfeulom Code: The Comncmrs License law dao not apply to an owner of
q
property who Wilds or improves therron,and whodrcasuch work himselfor(hrough his
awn employ., provided that such improvements are not intended are@red fmckle. If,
however. the building., improvement is sold within on Kv of completion. Ne owner.
builder will have the burden of proving that he did am build or improve for purpose of
sale.).
1, as Owner of the properly, am exclusively contracting with licemctl mnramn to
consumer the pmjecr (Sec. 7044. Business and professions Cade:) The Contractors Li.
cense law does Out apply to m owner of progeny who builds Or improves thereon. and,
who contracts for such projects with a conuacmKs) Imen ed pursuant in the Contractors
License law.
1 am exempt under Sec. . B k P C fm Nis reason
Dwstcr Date
WORKERS COMPENSATION DECLARATION
1 hereby .(risco under pe(Wty of perjury one Of the fallowing declarations:
'
I have and will maintain a Gmdrlcme Of Consent la mlf-luure for WorkersGOmpen-
uhon, as provided for by Sttdon 37M Of the La W, Code. for "e pCRormarm Of the
work for which this permit is issued.
1 haw and will maintain Wmker's Cmnperwtion Insurance, as mquimd by Section
3 Wof Ne labor Cade, for the performance of Ne work for which Nis permit is issued.
My workers Co—m�g,e�ma I I1nsunnm caries and POhcy number art:
S S% I — 0% � 17-5
Carrier: - 1 w^ C/ Policy Na.:
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusecumr need not becompleud If"e permit is form= hundred dollars (SIOO)
car Icss.l
1 certify that in the performanec of tW work for which this Permit a issued. I shall not
mOPloy any person in any manner so as On become subject o the WOrksts COmltemadon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making thus Certificate of Exemption, You should
became subject m the W warn.. Compenkuhm provisions or BR Ichor Code. YOU mute
for"with comply with such provisions or this permit that( W domed mwked.
CONSTRUCTION LENDING AGENCY
1 hereby dist thcrc is (Sm. 30 lending agency for the perfurmantt of
ch his s ed
' the work for which Nu permit u iuuctl (Sm. J097, Civ. C.)
Under's Name
1<ndera Address
j 1 certify that 1 have read this application and sum Nat Ne know information is
correct. l agree to comply with all city and county Ordinances and some laws relating to
budding constriction, and hereby aYdlmire mpmumatim of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to tam, indemnify and scop ha micas the City of Cupanin t against
Iiobiliuesjudgm ini.comimul expenseswhichmay in anyway. verve a..instmid City
in consegmoce Of the granting Of Nis permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR ONS.
4 1 e
Re -roofs
Type of Roof
Signature or Appl ant/Conuwtnr Da
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building mCupanl store or handle haurEous material
as defmW by "c CuNoim Municipal Code, Chapter 9.12. and the Health and Safety
ode, Seedan 25532(s)7
All roofs shall be inspected prior to any roofing material being installed.
Dy. t7�
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or dcvicm which
it ha krdom air contaminants as derincd by the Bay Arta Air Quality Management
all new materials for inspection.
Disuin7
Yet QNB
I have read Ne Wardens materials mquimmcnm under Charter 6.95 of be Califon
�p /
us Heal"@Safety Cade, Sections 25505.25533 atu125534. I undcound Our if the Wilding
�
dela nal eurtndy haw a LL'nanl "al Il Y rota rUpOmihilily b nmlfY time OCCupNI O( die
—
Date
rcyuirtrygpts chic u Ec met pnorq i:5aameoracemrteate or-
In(
Signature of Applica t
�
Pm
All roof coverings to be Class "B" or better
Owner til aumml.d a
•
Y 4
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOWADDRESS:
PERMIT #
OWNER'S NAME:
PHONE # 3p l - y
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors: Pe� ,�,., � 7 G
Signatlug Date
Please check applicable subcontractors and complete the following information:
21, L.,,
Owner ontrtrac of r Sifnature
G1-71OLf
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
21, L.,,
Owner ontrtrac of r Sifnature
G1-71OLf
Date
�CITY Of
UPEI�TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 Nar
Job Site Address:
Roofing Company Name:( ey%zz� /
A phcant'1s/Signature:
\�t/r61ND��
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: L 7 o `y
f
a
•
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # � � � 33 O .
Bldg Permit Fees
Date:
Building Address: '
�f
Energy
Owner's Name:
`1
Oa,,m
Seismic Fee Res
Phone M.
307 -85 5 2
BSEISMICOM
alp
BUILDING
BPLANCHK
Contracto I Phone #:
BUILDING
License #:
650
96f-7667
785 qL//
Contact: Phone #:
Cupertino Business Li ense #:
J Y8 y
Type of Roof Covering:
Existing:
Proposed:
A Built -Up Roof
�a Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings r
❑ Provide I.C.B.O. Report #
XTo be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Description: 7 7a, v, �, , , P a-�� ice• r
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are an restrictions: LI
Cost of Project: Type of Construction: Occupancy group:
`f'/5 o . Cn
Qty. if
Annlicahle.
Fee TD
Fee Description
Fee GroUD
/ 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